摘要:

Background.Developing adequate levels of muscular strength in the cardiac rehabilitation (CR) patient helps return the patient to an active lifestyle. This study evaluated the effects and safety of an 8-week high-intensity strength training (ST) program combined with a traditional aerobic-based CR program on the muscular strength of a diverse phase II CR population.Methods.Sixty-one phase II CR patients (age = 60.5 ± 10.6 years) stratified by risk (high risk:n= 18, ejection fraction = 23.6 ± 7.8%; intermediate risk:n= 19, ejection fraction = 40.0 ± 4.6%; low risk:n= 24, ejection fraction = 58.0 ± 7.7%) and gender (males = 46, females = 15) participated. One repetition maximum (1RM) testing was performed on the horizontal squat, shoulder press, leg extension, lat pulldown, and biceps curl. Patients performed two sets of each exercise 2 days per week at an intensity that started at 60% 1RM and progressed to 80% 1RM by week 4. Weeks 4 to 8 intensity was adjusted individually to maintain 8RM per set. Blood pressure and heart rate/rhythm responses to 1RM testing were monitored in high-risk patients. Muscle soreness and injury were monitored for all patients immediately after 1RM testing and on days 2 and 7.Results.All patient groups made significant gains (P< 0.05) in muscle strength (mean increase: lower body = 15.3%, upper body = 16.7%). No injury or significant muscle soreness occurred due to 1RM testing. No abnormal heart rate/rhythm or blood pressure responses occurred in high-risk patients.Conclusions.Diverse phase II CR patients can improve their strength significantly with a combination of high-intensity strength and aerobic training.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Optimal strategies to maintain short-term benefits of an initial rehabilitation program (RP) are not known. To assess the long-term effects of exercise maintenance (EM) after an initial outpatient RP, the authors conducted a prospective study.Patients and Methods.Fifty-eight patients with moderate to moderately severe chronic obstructive pulmonary disease who completed an initial 7-week outpatient RP were included. They were allocated into four groups according to the conditions of EM they self-selected: 15 patients received a structured EM session supervised by a physiotherapist twice a week (group A); 14 patients received a structured EM session supervised by a physiotherapist once a week (group B); 15 patients continued self EM daily at home (group C); and 14 patients did not continue EM (group D). Patients were evaluated before, immediately after, and 18 months after the initial outpatient RP. Measurements included exercise testing on a cycle ergometer and a visual analog scale to evaluate chronic dyspnea.Results.After RP, all patients exhibited improvements in maximal workload (P< 0.05) and in dyspnea (P< 0.05). Improvements in maximal workload were maintained at 18 months in patients in groups A, B, and C but these only reached significance in groups B and C (P< 0.05). On the other hand, maximal workload returned to baseline values in group D (P= 0.01) at 18 months.Conclusions.Our results indicate definite benefits of EM after an initial outpatient RP compared with no EM. Daily EM at home appears to be as efficient as structured EM sessions supervised by a physiotherapist, once or twice a week, in moderate to moderately severe chronic obstructive pulmonary disease.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives.The authors examined clinical outcomes in 71 male and female patients with coronary atherosclerosis who enrolled in a 2-year, independent-living, lifestyle modification program. The findings in 43 patients who completed the program were compared with those in 28 patients who dropped out of the program.Background.Clinical studies suggest that lifestyle modification of risk factors for coronary atherosclerosis reduces subsequent cardiac events but there are very few reports of the effect of these programs in patients living independently.Methods.Patients with diagnosed coronary atherosclerosis were managed for a 2-year period in a structured multidisciplinary program by a team that included two cardiologists, a nurse, a dietitian, an exercise physiologist, and a clinical psychologist. The overall aim of the program was to normalize or control all major reversible cardiovascular risk factors. Patients were required to participate in several weekly sessions for exercise, meditation/stress reduction training, dietary education and counseling, and participatory dinners. There was a strong emphasis on patient's self care, inclusion of support members, and regular monitoring of and feedback to patients.Results.Data comparing baseline and 2-year outcomes showed a significant reduction in body weight, dietary intake of total/saturated fat and cholesterol, serum low- and high-density lipoprotein concentration, and an increase in exercise capacity. In the compliant group, the incidence of cardiac events was 2.3% over 2 years.Conclusion.Multidisciplinary lifestyle modification programs addressing cardiovascular risk factors are known to have a significant impact upon cardiac risk factors in patients with coronary atherosclerosis. Data show that these changes can be accomplished in independent-living patients in a program offered through a routine cardiology service. However, compliance is an important issue in these self-regulated programs.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Exercise training is recommended before lung volume reduction surgery (LVRS) in patients with emphysema. Unfortunately, many of these patients are referred from remote areas where there is no available rehabilitation program. The authors evaluated the feasibility and efficacy of a minimally supervised home-based exercise training program.Methods.Twenty-three emphysematous patients (age 61 ± 6, forced expiratory volume in 1 second = 29 ± 7% predicted [mean ± SD]) were recruited from our LVRS program. Measurements of pulmonary function, maximal and submaximal exercise capacity, 6-minute walking distance (6-MWD), muscle strength, and quality of life with the Chronic Respiratory Questionnaire were obtained before and after training. Home-based exercise training program included muscle exercises and aerobic training, and started with detailed teaching while the follow-up was ensured through weekly phone calls and a diary filled by each patient.Results.Significant increases in 6-MWD (P< 0.001), quality of life (P< 0.005), peak work rate (P< 0.05), peak oxygen consumption (P< 0.05), endurance time (P< 0.005), and muscle strength were observed in the home-based exercise training program.Conclusions.Home-based exercise training for patients in preparation for LVRS was feasible, and induced significant improvement in exercise tolerance and quality of life.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Although clinicians often rely on patients' retrospective reporting of dyspnea, it is not known if dyspnea scores recalled after exercise are equivalent to dyspnea scores during exercise. The objective of this study was to determine whether patients could accurately recall after exercise the maximum ratings of the intensity of dyspnea and the anxiety associated with it that they experienced during exercise.Methods.Forty-nine patients with chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second 0.92 ± 0.23 L) participating in a randomized clinical trial of the impact of coached versus monitored exercise training on dyspnea rated dyspnea intensity (shortness of breath [SOB]) and dyspnea related anxiety (DA) on a visual analog scale every 2 minutes during treadmill exercise. After each of 12 training sessions each subject was asked to rate the worst level of the two sensations that they recalled having experienced during exercise.Results.For the groups as a whole, actual maximum scores for SOB and DA during exercise were highly correlated with recalled maximum values after exercise (r ⩾ 0.85,P< 0.0001) and the average differences were small (0-10.9 mm on a 200-mm scale). However, individual variation was substantial, limiting predictability for individual ratings.Conclusions.After exercise, patients with COPD as a group can accurately recall the worst SOB and DA that they experienced during exercise. This finding supports the further study and use of retrospective symptom ratings as a method for dyspnea assessment during exercise training in pulmonary rehabilitation.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Purpose.In the current era of efficient use of personnel and cost containment, the use of non-physicians in selected roles previously occupied exclusively by physicians has become increasingly prevalent. Traditionally, physicians have directly supervised graded exercise testing of patients with chronic heart failure. The purpose of this prospective pilot investigation was to determine the safety and results of non-physician supervised exercise testing of these high-risk patients.Methods.Two hundred eighty-nine consecutive outpatients (211 men, 78 women) with left ventricular ejection fractions of ≤35% were referred for cardiopulmonary exercise testing. Symptom-limited treadmill graded exercise tests were supervised by paramedical personnel with a physician immediately available, but not present in the lab.Results.Nonsustained ventricular tachycardia was present during exercise in approximately 20% of patients. Test-limiting hypotension was documented in 5% of subjects. Only one serious event occurred during the 289 exercise tests, an episode of ventricular fibrillation with a successful resuscitation outcome. Peak exercise respiratory exchange ratio averaged 1.10 ± 0.14, consistent with a near-maximal patient effort. Peak oxygen uptake was 18 ± 5 ml/kg/min.Conclusions.Supervision of cardiopulmonary graded exercise testing in properly screened patients with severe systolic left ventricular dysfunction by experienced non-physicians appears to be reasonably safe and the results are suitable for clinical decision making. Such a practice is an attractive cost-containment strategy and deserves further investigation.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Purpose.The authors determined the frequency and effectiveness of pharmacologic lipid lowering, guided by the recommendations of the National Cholesterol Education Program (NCEP) before and after institution of a systematic lipid assessment performed at the time of the cardiac rehabilitation entry evaluation.Methods.The systematic lipid evaluation included a full lipid profile and a dietary evaluation at which time an active approach to pharmacologic lipid therapy was taken. Therapy was guided by the NCEP guidelines, with the collaboration of the referring physician. The frequency of lipid therapy change (starting or changing therapy) from the baseline evaluation to a 3-month follow-up visit was the primary study outcome variable. The control group consisted of 51 patients with coronary heart disease (CHD) seen in 1995 at cardiac rehabilitation, who agreed to have their serum lipids measured in a double-blinded fashion. There was no systematic lipid lowering intervention. The intervention group consisted of 187 patients with CHD who participated in cardiac rehabilitation in 1996 to 1997.Results.At baseline, a similar percentage of patients in each group were on lipid lowering therapy: 38% (19/51) in controls versus 35% (65/187) in intervention patients. Among patients with a baseline low-density lipoprotein (LDL) cholesterol of ≥ 130 mg/dL, therapy was modified in 18% (4/22) of control patients compared with 52% (35/68) of intervention patients (P< 0.05). Among patients with a baseline LDL cholesterol of ≥ 160, therapy was altered in 22% (2/9) control patients compared with 72% (18/25) intervention patients (P< 0.01). In both risk strata of ≥ 130 mg/dL and ≥ 160 mg/dL, LDL cholesterol measures were lowered to a greater degree in the intervention group.Conclusions.The performance of a systematic lipid review at the time of cardiac rehabilitation entry, with an active stance toward pharmacologic therapy, results in a threefold increase in pharmacologic modifications and lower LDL cholesterol values for cardiac rehabilitation participants.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID