ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Cardiac rehabilitation is commonly prescribed after myocardial infarction (MI) to coordinate exercise training and secondary preventive services. Cost-effectiveness analysis allows the quantitative comparison of the relative economic worth of cardiac rehabilitation in relation to other common interventions.Methods.The cost-effectiveness of cardiac rehabilitation, in dollars per year of life saved ($/YLS), was calculated by combining published results of randomized trials of cardiac rehabilitation on mortality rates, epidemiologic studies of long-term survival in the overall postinfarction population, and studies of patient charges for rehabilitation services and averted medical expenses for hospitalizations after rehabilitation.Results.Cardiac rehabilitation participants experienced an incremental life expectancy of 0.202 years during a 15-year period. In 1988, the average cost of rehabilitation and exercise testing was $1,485, partially offset by averted cardiac rehospitalizations of $850 per patient. A cost-effectiveness value of 2,130 $/YLS was determined for the late 1980s, projected to a value of 4,950 $/YLS for 1995. A sensitivity analysis supports the study results.Conclusions.Compared with other post-MI treatment interventions, cardiac rehabilitation is more cost-effective than thrombolytic therapy, coronary bypass surgery, and cholesterol lowering drugs, though less cost-effective than smoking cessation programs. Cardiac rehabilitation should stand alongside these therapies as standard of care in the post-MI setting.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.In addition to the respiratory limitation in patients with chronic obstructive pulmonary disease (COPD), skeletal muscle abnormalities may occur and contribute to the exercise intolerance. This study assessed the ability of the skeletal muscle of patients with COPD to adapt to individualized exercise training at the gas exchange threshold (GET).Methods.Fourteen patients (8 in a training group and 6 controls) performed the following exercise tests before and after a 3-week training period: an incremental exercise test, maximal voluntary contraction of the quadriceps, and three endurance tests consisting of dynamic contractions of the quadriceps until exhaustion. These endurance tests, characterized by three different power outputs, were used to determine muscle limit times and critical power.Results.The results showed that training increased exercise tolerance (+ 11% for symptom limited peak oxygen consumption [VO2sl], P < 0.05), maximum voluntary contraction (+ 8%, P < 0.05), limit times (from + 45% to + 161%, P < 0.05) and critical power (+ 39%, P < 0.05).Conclusions.These findings indicate greater muscle strength and endurance after training in COPD patients and suggest better muscular recruitment and improved oxidative capacity in the exercising muscles. The sharp differences in the magnitude of VO2sl and limit times suggest that the kinetics of peripheral and central changes in response to training are different. In conclusion, peripheral muscle performance can be increased rapidly in response to an individualized training program at the GET in COPD patients.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Cardiovascular benefits of resistance training in cardiac patients have been suggested but not studied in a randomized, controlled trial of circuit weight training (CWT) without an aerobic exercise component. The purpose of the current study was to examine the effects of 10 weeks of CWT on muscular strength, peak oxygen consumption (peak V˙O2), and myocardial oxygen demand (mV˙O2) in men after coronary artery bypass surgery.Methods.Twenty-six, post-coronary bypass male subjects (mean 19 months after bypass), aged 60 ± 8.5 years, were randomly allocated to 10 weeks of CWT at 40 to 60% of maximum voluntary contraction (n = 12) or to a control group (n = 14). Muscular strength was assessed using a modified one repetition maximum technique. Peak V˙O2was recorded during symptomlimited treadmill exercise. Rate pressure product, as an indirect measure of mV˙O2, was measured during isometric, isodynamic, and dynamic exercise.Results.No ischemic symptoms nor electrocardiographic changes were recorded during testing or training. Strength increased by 18% (P < 0.005) in five out of seven exercises in the training group, but was unchanged in the control group. Training did not improve peak V˙O2. Rate pressure product during isometric and isodynamic exercise decreased from pre- to posttesting (P < 0.05) but was equivalent to that seen in the control group.Conclusions.Moderate intensity CWT is safe and can improve strength in selected low-risk patients after coronary artery bypass surgery. However, it does not significantly increase peak V˙O2nor reduce mV˙O2during isometric, isodynamic, and dynamic exercise.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Preliminary results of lung volume reduction surgery (LVRS) for patients with severe emphysema are promising, although many issues regarding the selection process for LVRS are still unaddressed. For example, it is unclear which patients should be referred for pulmonary rehabilitation, lung transplantation, or LVRS, and whether health-care providers are optimizing conservative treatment options before referral for surgical intervention. The purpose of this analysis is to describe preliminary results of the evaluation process for LVRS implemented as part of an integrated, programmatic approach to the evaluation, treatment, and rehabilitation of patients with advanced emphysema.Methods.The records of 105 consecutive patients with chronic obstructive pulmonary disease (COPD) referred for consideration for LVRS at the University of California San Diego Medical Center were reviewed. Results of prospective data collection pertaining to patient demographics, baseline dyspnea scores, and history of prior treatment, including pulmonary rehabilitation, were extracted. Patient disposition after the evaluation was noted.Results.One hundred five patients (mean age 65 years, range 40 to 84 years) completed evaluation. Fifty-eight had never before participated in pulmonary rehabilitation, and 47 of these patients were eventually referred to a rehabilitation program. Fourteen patients were referred for consideration of lung transplantation, 25 were considered eligible for LVRS, 13 were still undergoing rehabilitation and surgical eligibility had not yet been determined, and 53 were ineligible for LVRS because patients had other illnesses (n = 34), did not meet radiological or physiologic criteria (n = 5), were considered too ill (n = 5), or were too healthy (n = 9) after rehabilitation to warrant surgical intervention.Conclusions.Lung volume reduction surgery is a surgical option to be considered within the framework of an integrated medical evaluation program that includes pulmonary rehabilitation. Pulmonary rehabilitation remains an often underused therapeutic alternative in patients with severe COPD. It has become the central component of our comprehensive management program for patients with severe dyspnea and deteriorating quality of life.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose.The American College of Sports Medicine recently published new guidelines to classify individuals at increased risk for coronary heart disease (CHD) before starting a vigorous (>60% maximum oxygen consumption) exercise program. We compared the prognostic value of the new guidelines to the earlier guidelines.Methods.Subjects included men and women over 30 years of age, free from known CHD according to the Lipid Research Clinic Follow-up Cohort. Endpoints included an abnormal exercise test result (± 1 mm ST, anginal chest pain, or exercise hypotension) and future death of CHD ascertained during an average 12.2 years of follow-up. Data analysis included 2 × 2 contingency tables to compare the test characteristics of the old and new guidelines.Results.Among 4,074 subjects, 219 (5.4%) had abnormal exercise test results and 65 (1.6%) eventually died of CHD. The new guidelines classified 75.7% of individuals as high risk versus 58.7% using the old guidelines. Comparing the new guidelines with the old, test sensitivity was significantly (P = 0.007) higher for patients with an abnormal exercise test result (87% versus 77%) than for patients who died of CHD (100% versus 99%). Test specificity of the new guidelines was significantly (P < 0.001) lower than the old guidelines for individuals with abnormal exercise test results (25% versus 42%) and those who died of CHD (25% versus 42%). The new guidelines also showed significantly lower overall diagnostic accuracy and positive likelihood ratios compared with the old guidelines for both patients with abnormal exercise test results and those who died of CHD. The positive predictive value for the new and old guidelines for both patients with abnormal exercise test results and those who died of CHD were similar.Conclusions.Although the new guidelines are more sensitive in the abnormal exercise test result endpoint, they are less specific and overall less accurate than the old guidelines given the low prevalence of CHD in this asymptomatic population. The current guidelines should be modified to better target high-risk adults.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Purpose.Recent exercise guidelines recommend a generalized rating of perceived exertion (RPE) range of 12 to 16 (15-point Borg scale) as the perceptual range associated with a physiological training effect. However, whether an individual who selects an RPE within the generalized range during an graded exercise test or exercise training, is actually within the correlated physiological range (50 to 85% maximum oxygen consumption [VO2max]) has not been studied in large samples of apparently healthy individuals or cardiac patients. The purpose of the present study was to assess the validity of the generalized RPE recommendations in a large heterogeneous group of apparently healthy subjects and cardiac patients.Methods.Subjects included apparently healthy adults (N = 463) and cardiac patients (N = 217) who presented for a sign-symptom limited maximal graded exercise test (SSLMGXT). Ratings of perceived exertion associated with relative exercise intensities of 60 and 80% of maximal heart rate reserve (MHRR) and peak exercise were selected for analyses.Results.Significant interindividual variability in RPE was observed at both relative exercise intensities (6 to 20 RPE range at 60% MHRR; 8 to 20 RPE range at 80% MHRR) for both populations. Thirty-nine percent of healthy subjects and 32% of cardiac patients reported an RPE outside an 11 to 14 range at 60% of MHRR, whereas 32% of healthy subjects and 52% of cardiac patients reported an RPE outside of a 14 to 17 range at 80% of MHRR. Peak RPE was higher for the apparently healthy subjects compared with the cardiac patients (18.8 ± 1.2 versus 16.5 ± 1.8; P < 0.01).Conclusions.These results challenge the applicability of the generalized RPE recommendations described in recent exercise guidelines under typical clinical exercise testing conditions. The basis for the generalized RPE recommendations warrant further investigation. Those who desire to use RPE as a marker of relative exercise intensity during SSLMGXT should take into consideration the large interindividual variability in these measures.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Acupressure is a therapy in which gentle pressure is applied with fingers at specific acupoints on the body. It is reported to relieve pain and have other beneficial effects. This study was designed to ascertain the value of self-administered acupressure as an adjunct to a pulmonary rehabilitation program (PRP) for relief of dyspnea and other symptoms in patients with chronic obstructive pulmonary disease (COPD).Methods.A single-blind pretest-posttest, cross-over design was used. Thirty-one new patients beginning a 12-week PRP at two private hospitals were randomly assigned to one of two groups. Patients in group 1 were taught acupressure and practiced it daily at home for 6 weeks, then sham acupressure for the following 6 weeks. In group 2, the order of acupressure and sham acupressure was reversed. During weeks 1, 6, and 12, patient dyspnea, other symptoms associated with COPD, activity tolerance, lung function, and functional exercise capacity were assessed.Results.Real acupressure was more effective than sham acupressure for reducing dyspnea as measured by a visual analog scale (P = .009, one-tailed), and was minimally effective for relieving decathexis (P = .044, one-tailed). Sham acupressure seemed to be more effective than real acupressure for reducing peripheral sensory symptoms (P = .002, two-tailed), but the presence of these symptoms may also be an indication that the acupressure is affecting the body.Conclusions.Acupressure seems to be useful to patients with COPD as an adjunct to a PRP in reducing dyspnea. Some persons who are not initially familiar with traditional Chinese medicine can learn and will accept self-administered acupressure as part of their self-care.

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1997

数据来源: OVID