摘要:

Purpose.This randomized controlled study assessed whether adding a program of high-intensity strength training (80% of maximum) to an outpatient cardiac rehabilitation program would be a safe and effective means of improving muscle strength and body composition.Methods.Thirty-eight cardiac patient volunteers (29 men and 9 women) were randomized to either high-intensity strength training or flexibility training added concurrently to a 12-week outpatient cardiac rehabilitation aerobic exercise program. Muscle strength, local muscle endurance, joint flexibility, maximum treadmill tolerance time, and body composition were measured before and after completion of the training.Results.The strength-trained patients (n = 18) had greater increases in mean strength (90 ± 19% versus 9 ± 4%, P < 0.0001) and local muscle endurance (20 versus 6 times, P < 0.0001), and decreases in mean perceived exertion for lifting the initial one repetition maximum load (11 ± 1 versus 15 ± 1, P < 0.001) when compared with flexibility-trained patients (n = 16). The strength group lost more body fat (2.8 ± 2.0 versus 1.3 ± 2.0 kg, P < 0.01), tended to gain more lean tissue (1.5 ± 2.3 versus 0.5 ± 1.2 kg, P < 0.10), and had greater improvements in treadmill time (2.3 ± 1.3 versus 1.2 ± 1.0 minute, P < 0.02) than did the flexibility group. Improvements in joint flexibility were similar for each group. None of the subjects had evidence of cardiac ischemia or arrhythmia during the training sessions.Conclusions.Medically supervised high-intensity strength training is well tolerated when added to the aerobic training of cardiac rehabilitation programs and allows patients to aggressively gain the strength and endurance they will need to complete daily living tasks at lower perceived efforts. Strength training also reduces cardiac risk factors by improving body composition and maximum treadmill exercise time.

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

摘要:

Background.The authors examined the importance of the frequency of aerobic exercise training in multidisciplinary rehabilitation in improving health-related quality of life in the short run in patients with documented coronary artery disease.Methods.Patients (114 males and 16 females; age range, 32-70 years) were randomized into either a high-frequency or a low-frequency exercise training program (10 versus 2 sessions per week, respectively) as part of a 6-week multidisciplinary cardiac rehabilitation program. The General Health Questionnaire and the RAND-36 were used to assess changes in psychological distress and subjective health status.Results.After 6 weeks, high-frequency patients reported significantly more positive, change in "psychological distress" (P < 0.05), "mental health" (P = 0.05), and "health change" (P < 0.01), than low-frequency patients. Apart from changes in mean scores, individual effect sizes indicated that a significantly greater percentage of high-frequency patients experienced substantial improvements in "psychological distress" (P < 0.01), "physical functioning" (P < 0.05), and "health change" (P < 0.05), compared with low-frequency patients. In addition, deterioration of quality of life was observed in a considerable number of high-frequency patients (ranging from 1.7% to 25.8% on the various measures).Conclusions.The frequency of aerobic exercise has a positive, independent effect on psychological outcomes after cardiac rehabilitation. However, this benefit after high-frequency rehabilitation appears to be limited to a subgroup of patients. Further investigation is required to identify these patients. Results provide input into recent controversies regarding the role of exercise training in cardiac rehabilitation.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Purpose.Goal setting is an established strategy in health behavior change programs although its usefulness remains uncertain. The authors investigate the validity of attainment of a patient-identified goal as an outcome measure in cardiac rehabilitation after myocardial infarction.Methods.On entry into a randomized controlled trial of cardiac rehabilitation after an acute myocardial infarction, patients identified one activity that, if and when attained, would reflect their perception of a successful recovery. Patients reported whether they had attained their goal and the time of goal attainment. This was then related to trial outcomes that included generic and specific health-related quality of life and percent predicted exercise tolerance.Results.Goals identified by 180 of the 201 (89.6%) patients, were attained by 51.5% at 8 weeks and by 86.5% at 12 months. At the end of the 8-week intervention, there was a substantial trend for fewer rehabilitation than usual care patients to have attained their identified goal (P < 0.06), although rehabilitation patients demonstrated greater improvement in specific health-related quality of life and exercise tolerance than usual care patients (P < 0.05). Among patients who identified a recreational physical activity goal (26.7%), significantly fewer (P < 0.007) rehabilitation than usual care patients had attained their goal at the end of the intervention with no differences in improvement in outcomes.Conclusions.Although improvement in outcomes was greater in rehabilitation patients than usual care patients at 8 weeks, goal attainment, particularly for the recreational physical activity goal, was greater among usual care patients. The validity of self-identified activity goal attainment as a measure of the efficacy of cardiac rehabilitation is unclear and might give misleading results.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Purpose.This study examined functional status abnormalities in pulmonary rehabilitation patients, its responsiveness to pulmonary rehabilitation intervention, and its relationship to patient characteristics and traditional measures of disease severity.Methods.One hundred sixty-four men and women age 69 years (SD ± 8), who participated in 1 of 10 pulmonary rehabilitation programs in Connecticut, were studied pre- and postrehabilitation with the following outcome measures: (1) the 6-minute walk distance, (2) the Pulmonary Functional Status Scale (PFSS), and (3) in a subset of 60 subjects, health-related quality of life was measured using the Chronic Respiratory Disease Questionnaire (CRDQ). Patient characteristics were compared to baseline values of these measures using Spearman correlations and Wilcoxon Rank Sum tests, whereas pre- to post-changes in outcome measures were evaluated using Wilcoxon signed-ranks tests. Effect size, respresenting a standardized measure of change, was calculated for the PFSS.Results.The mean FEV1was 0.95 ± 0.50 liters (38 ± 18% predicted). Rehabilitation resulted in significant increases in the 6-minute walk distance (24%, P < 0.001, the total PFSS scores [13%, P < 0.001, effect size 1.0]) and the total CRDQ (18% P < 0.001). The prerehabilitation function subscore and total PFSS score correlated strongly with the 6-minute walk distance (r = 0.76, 0.73; P < 0.001) and to a lesser degree with the FEV1(r = 0.31, 0.33; P < 0.001). Males scored higher baseline scores in several PFSS subscales, the total PFSS score, and the 6-minute walk distance; females showed more improvement in some of the PFSS scores.Conclusion.The 6-minute walk distance, the PFSS, and CRDQ all improved significantly with rehabilitation. Functional status, as measured by the PFSS is very strongly correlated with the 6-minute walk. Gender differences in the timed walk distance and functional status highlight the need to study this variable more thoroughly.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Purpose.The authors determined (1) whether peripheral arterial occlusive disease (PAOD) patients who smoke have a reduction in either the duration or intensity of daily physical activities compared with nonsmoking patients, and (2) whether group differences in the pattern of physical activity persisted after controlling for potential confounding variables.Methods.A total of 170 smokers and 201 nonsmokers who had quit smoking for at least 1 year prior to investigation were studied. Physical activity patterns were measured using the Minnesota Leisure Time Physical Activity (LTPA) questionnaire. Patients also were characterized on potential covariates such as demographics, comorbid conditions, cardiovascular risk factors, ambulatory measures, peripheral hemodynamics, and anthropometric measures.Results.The smokers were 37% less physically active than the nonsmokers (87 ± 90 versus 139 ± 121 kcal/day; P = 0.027). The reduced total LTPA in the smokers was due to a 28% shorter duration of performing activities (26 ± 17 versus 36 ± 22 min/day; P = 0.031), and a 13% lower mean intensity of the activities (3.3 ± 1.0 versus 3.8 ± 0.8 kcal/min; P = 0.038). The distance score on the Walking Impairment Questionnaire and the hip circumference were significant covariates of the LTPA measures. After adjusting for these covariates, the total LTPA remained 29% lower in the smokers (P = 0.039), the mean daily duration of LTPA remained 20% lower (P = 0.043), but the mean intensity of LTPA was no longer different between the groups.Conclusion.Compared with their nonsmoking counterparts, claudicants who smoke have a reduced total LTPA because they engage in activities of similar intensity for a shorter duration of time.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Strength training (ST) may be beneficial for preservation of lean tissue, increasing bone mineral content, decreasing falls, and enhancing quality of life. Strength training is becoming an appropriate mode of exercise for cardiac rehabilitation (CR) patients. One method for determining optimal exercise intensity for safe and effective ST requires one repetition maximum (1RM) testing. Clinicians may be reluctant to perform 1RM testing in CR patients because of potential muscle soreness/injury and adverse hemodynamic responses in deconditioned patients. The purpose of this investigation was to perform 1RM testing in CR patients and determine muscle soreness/injury rate.Methods.Seventy-four CR patients stratified by risk (low n = 30, intermediate n = 21, high n = 23) and sex (males = 55, females = 19) participated. Subject's ages ranged from 39 to 76 years and time from procedure ranged from 19 days to 2 years. No patient had ever undergone 1RM testing. The method of Kraemer and Fry was used to assess 1RM. High-risk patients' heart rates/rhythms and blood pressures were monitored. Patients were evaluated for occurrence of muscle soreness/injury immediately after 1RM testing and on days 2 and 7 using a soreness scale developed by Shaw et al. Muscle soreness/injury was considered significant if a patient reported altering or stopping physical activities.Results.No injury or significant muscle soreness occurred as a result of 1RM testing. No abnormal heart rate/rhythm or blood pressure responses occurred in high-risk patients.Conclusions.Results indicate that with proper technique, 1RM testing may be performed in CR patients without injury or significant muscle soreness.

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