ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The Sickness Impact Profile (SIP) was used to evaluate the perceived health status of individuals with heart disease at four health care systems in the Philadelphia /South Jersey area. Using a quasi-experimental design with an interview/questionnaire and follow-up with mailed questionnaires, participants were categorized by ethnicity, gender, and whether or not they entered a cardiac rehabilitation program. Of the 97 individuals who completed both a pretest and posttest evaluation, 46 entered a cardiac rehabilitation program, while 51 received routine care. Jews and Italian-Americans in cardiac rehabilitation showed an improvement in their perceived health status over those individuals who received routine care. While Black men exhibited some improvement, Black women actually deteriorated in perceived health status. Overall, men improved marginally more than women in the cardiac rehabilitation program, with the biggest differences occurring in the control group.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The effects of a rehabilitation course in a rehabilitation center were compared to those in a community-based rehabilitation program after first acute myocardial infarction. Four hundred fifty-six patients under 65 years of age were randomized at discharge from hospital either to a hospital outpatient clinic group combined with a community-based rehabilitation program (O group, n = 228), or to a residential rehabilitation program (R group, n= 228). The coronary mortality during the 6-year follow-up was 24.1% in the O group, compared to 19.7% in the R group (NS). The nonfatal reinfarction rate was 11.8% in the O group and 13.6 % in the R group (NS). The changes in serum total cholesterol and triglycerides were more favorable only during the first 3 months in R group compared to O group. At follow-up there were no differences between the groups in physical working capacity or return to work. Thus, the community-based rehabilitation program combined with regular outpatient check-ups was comparable with residential rehabilitation with regard to mortality and morbidity, although there was a tendency towards lower lifestyle-related risk factor levels in patients receiving residential rehabilitation.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Patient with chronic obstructive pulmonary disease (COPD) commonly report, greater brethless ness and functional limitation for activities invoicing the arms rather than the legs. Exercise reconditioning for these patients has generally emphasized lower extremity training. The authors developed a simple and safe upper extremity exercise training program for patients with COPD that is included routinely in their pulmonary rehabilitation program. The training program was evaluated in an observational study of 80 consecutive patients enrolled in the pulmonary rehabilitation program. Patients started with light weights, gradually increased the training level for 8-weeks, and kept records of daily training. During supervised sessions, patients also performed isokinetic arm cycle exercise and rated symptoms of perceived breathlessness and fatigue. For 72 patients who performed upper extremity training during the pulmonary rehabilitation program and kept adequate training records, the training level (range, 1 to 15) doubled from 6.15 \pm 2.46 (mean \pm SD) at baseline to 12.30 \pm 4.36 (P < 0.0001). The work load for the isokinetic arm cycle endurance exercise increased from 313 \pm 104 to 398 \pm 132 kg-m/min (P < 0.0001). Ratings of perceived breathlessness (range, 1 to 10)were significantly reduced from 3.3 \pm 1.4 to 2.8 \pm 1.7, (P < 0.05), and symptoms of fatigue were reduced from 3.5 \pm 1.3 to 2.8 \pm 1.5, (P < 0.001). The authors believe that-upper extremity conditioning has important potential benefits in the rehabilitation of patients with COPD and warrants additional attention and investigation.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Apacemaker is an implantable device designed primarily to compensate for an abnormally low heart rate or an inadequate heart rate response to exercise. The capabilities of such devices range from simple ventricular back-up pacing at a fixed rate, to sophisticated devices that pace the atrium and the ventricle sequentially and also vary their rates automatically to match the physiologic needs of the patient. To be truly physiologic, a pacemaker should maintain atrioventricular synchrony as well as increase heart rate with exercise. However, heart rate is a much more important factor in increasing cardiac output during exercise than atrioven-tricular synchrony. When a patient's own sinus node can no longer vary its rate as necessary in response to metabolic demand, pacemakers can act as a substitute, using alternative sensors such as body activity or minute ventilation. The choice of an appropriate pacemaker for a patient depends on a number of factors, including the indication for pacing, the status of the atrium, the presence of underlying heart disease or arrhythmias, and the exercise tolerance of the patient. Exercise programs for patients with implanted pacemakers should be based primarily on the patients' underlying medical condition. Patients with pacemakers who cannot increase their heart rates with exercise and who exhibit exercise intolerance, may occasionally need upgrading of their pacemakers to a more physiologic, rate-responsive model. Patients with rate-responsive pacemakers already implanted can achieve a nearly normal heart rate response to exercise with proper programming.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

This report shows how social work services have been developed and used in an urban cardiac rehabilitation program from 1984 to 1989. A patient profile is offered, followed by a rationale for the need for social work in a multi-disciplinary rehabilitation program. An elaboration of the clinical responsibilities of social work is provided, along with a description of the salient features of the psychosocial assessment upon which social work treatment is based. This report also elaborates common themes seen by the author in 5 years of cardiac rehabilitation social work practice. Three case reports are provided to emphasize the nature of direct interventions. Important points are made regarding the need for more research into psychosocial variables as causal factors in heart disease, and the need for a model that attempts to integrate the traditional medical hypotheses such as diet and smoking wiih risk factors in the psychosocial domain.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine if the rate of increase in work on a graded exercise test (GXT) influenced oxygen uptake response in patients with depressed left ventricular function, oxygen uptake (VO2) Was directly measured in nine patients with congestive heart failure (CUT) and ten age-and sex-matched control subjects during a high-incremental and a low-incremental treadmill protocol. The VO2response of the patients with CHF was not significantly different between the high- and the low-incremental treadmill protocols; both were significantly lower compared to that of the normal controls. Although plasma renin activity (PRA) was significantly higher in the CHF group at rest and at every level of work during both protocols, the change in PRA with each level of work was similar for both protocols and for both groups. Lactate levels were also similar for the high- and the low-incremental protocols the both groups. These results indicate that a larger incremental GXT protocol does not influence the VO2 response of patients with CHF. In addition, using estimated values based on a normal population to predict the VO2response of patients with CHF is likely to overestimate oxygen consumption.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

McConnell and Clark (1987) and Foster et al. (1984) have developed equations for predicting functional capacity (VO2peak) from maximal treadmill performance. McConnell investigated the effects of handrail support (HHR). while Foster did not allow HRS. On the basis of the known reduction in the aerobic demands of walking by HRS, a right shift in the treadmill time (TT)/VO2peakcarve would be expected when HRS is allowed. Instead, the McConnell equation intersects the Foster equation and predicts higher VO2peakat test durations of less than 7 minutes on the Bruce protocol (a left shift). To resolve this inconsistency, we studied 41 patients during treadmill exercise both with and without HRS. VO2peak(31.0 \pm 12.0 vs 31.9 \pm 11.4 ml/min/kg) and peak heart rate (157 \pm 34 vs 158 \pm 31 beats/min) were not different, although TT was significantly longer with HRS (9.9 \pm 4.1 vs 8.0 \pm 2.9 min). Both submaximal VO2and heart rate were significantly reduced at matched work loads by HRS. The McConnell equation predicted VO2peakaccurately (mean error = 0.2 \pm 5.1 ml/ min/kg) during HRS exercise. The Foster equation tended systematically to underestimate VO2peakduring non-HRS exercise (mean error = −4.0 \pm 3.4 ml/min/kg). The mean absolute error in predicting VO2peakwas similar for the McConnell (4.2 \pm 2.8 ml/min/kg) and Foster (4.4 \pm 3.4 ml/min/kg) equations. Curve-fitting analysis and reanalysis of the original data form the Foster equation suggested that the unexpected relationship of the McConnell and the Foster equations was due to small sampling errors, and suggested that the limits of accuracy of predicting VO2peakmay have been achieved by the existing equations.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Graduates of a Phase II cardiac rehabilitation (CR) program in a large midwestern American city were surveyed regarding demographic variables, health-related habits, and status on several risk factors for coronary heart disease (CHD). Fifty-one percent of the 231 graduates solicited were available for contact and participated. On the average, graduates of this apparently typical program showed relatively good risk factor status on body mass index (BMI), cigaretle smoking, blood pressure, reported stress, and exercise, Graduates showed a median serum cholesterol value of 219 mg/dl, which should be treated according to recently revised recommendations. Those participants showing poorer status on each risk factor appeared to be at likely added risk, and additional management efforts seemed adinmbie. Robust correlations were found between mild exercise and reduced stress (r = −0.26, P = .002), between mild exercise and reduced serum cholesterol (r = −0.28, P = .012), and between stress and higher serum cholesterol (r = 0.30, P = .007). Partial correlations controlling for more mundane explanations of these relationships left them substantial and significant; therefore, efforts to induce more mild exercise in less active participants and to reduce stress in those reporting more stress seem well advised.

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1991

数据来源: OVID