Exercise in cardiac rehabilitation.

Bethell, Hugh

doi:10.1136/bjsm.33.2.79

Cited by 22 publications

(19 citation statements)

References 119 publications

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“…Low levels of patient participation and completion (14–43% after MI) have been reported in Australia, France, the United Kingdom, and New Zealand with high levels of dropout after enrollment [ 13 – 17 ]. Lack of completion reduces the benefits of CR, such as improvements in CVD risk factors [ 18 ]. Patient-oriented, medical, and healthcare system factors associated with suboptimal participation include availability, affordability and accessibility of a program, as well as work/domestic commitments and psychological barriers [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Text4Heart II – improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial

Maddison

Stewart

Doughty

et al. 2018

Trials

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BackgroundCardiac rehabilitation (CR) is an essential component of contemporary management for patients with coronary heart disease, including following an acute coronary syndrome (ACS). CR typically involves education and support to assist people following an ACS to make lifestyle changes and prevent subsequent events. Despite its benefits, uptake and participation in tradition CR programs is low. The use of mobile technologies (mHealth) offers the potential to improve reach, access, and delivery of CR support. We aim to determine the effectiveness and cost-effectiveness of a text-messaging intervention (Text4Heart II) to improve adherence to medication and lifestyle change in addition to usual care in people following an ACS. A second aim is to use the RE-AIM framework to inform the potential implementation of Text4Heart II within health services in New Zealand.MethodsText4Heart II is a two-arm, parallel, superiority randomized controlled trial conducted in two large metropolitan hospitals in Auckland, New Zealand. Three hundred and thirty participants will be randomized to either a 24-week theory- and evidence-based personalized text message program to support self-management in addition to usual CR, or usual CR alone (control). Outcomes are assessed at 6 and 12 months. The primary outcome is the proportion of participants adhering to medication at 6 months as measured by dispensed records. Secondary outcomes include medication adherence at 12 months, the proportion of participants adhering to self-reported healthy behaviors (physical activity, fruit and vegetable consumption, moderating alcohol intake and smoking status) measured using a composite health behavior score, self-reported medication adherence, cardiovascular risk factors (lipids, blood pressure), readmissions and related hospital events at 6 and 12 months. A cost-effectiveness analysis will also be conducted. Using the RE-AIM framework, we will determine uptake and sustainability of the intervention.DiscussionThe Text4Heart II trial will determine the effectiveness of a text-messaging intervention to improve adherence to medication and lifestyle behaviors at both 6 and 12 months. Using the RE-AIM framework this trial will provide much needed data and insight into the potential implementation of Text4Heart II. This trial addresses many limitations/criticisms of previous mHealth trials; it builds on our Text4Heart pilot trial, it is adequately powered, has sufficient duration to elicit behavior change, and the follow-up assessments (6 and 12 months) are long enough to determine the sustained effect of the intervention.Trial registrationAustralian New Zealand Clinical Trials Registry, ID: ACTRN12616000422426. Registered retrospectively on 1 April 2016. Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2468-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Text4Heart II – improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial

Maddison

Stewart

Doughty

et al. 2018

Trials

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“…Sustaining habitual physical activity participation is necessary following cardiac rehabilitation completion to maintain the associated health benefits. However, findings indicate that many patients do not maintain physical activity participation following programme completion [ 9 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation

2015

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Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence.

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“…The participation rate for the CR program has increased recently; however, the rate is still low despite evidence that participation in a CR program confers clinically significant benefits for patients diagnosed with cardiovascular disease [ 16 ]. One of the main reasons for low attendance is that especially the patients with low LVEF and poor cardiopulmonary function do not actively participate because of misconceptions such as CR is not safe and is relatively contraindicated; therefore, not beneficial [ 17 ]. However, findings of recent studies support the claim that patients with poor cardiopulmonary function and reduced LVEF are no longer a contraindication to CR nowadays and attending a CR program more actively has a positive effect on long-term mortality [ 18 19 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Cardiac Rehabilitation Exercise Training on Cardiopulmonary Function in Ischemic Cardiomyopathy With Reduced Left Ventricular Ejection Fraction

2016

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ObjectiveTo observe the effect and safety of cardiac rehabilitation (CR) exercise in ischemic cardiomyopathy and to compare the results between patients with preserved left ventricular ejection fraction (LVEF) and reduced LVEF.MethodsPatients with ischemic cardiomyopathy with LVEF <50% were included as subjects. The patients were classified into the preserved LVEF (pLVEF; LVEF 41%–49%) group and the reduced LVEF (rLVEF; LVEF ≤40%) group. Patients underwent hourly aerobic exercise training sessions with an intensity of 60%–85% of heart rate reserve, three times a week for 6 weeks. Graded exercise test and transthoracic echocardiogram were performed in all study patients before and after completion of the CR exercise program.ResultsAfter completion of the CR exercise program, both groups (pLVEF, n=30; rLVEF, n=18) showed significant increases in LVEF and VO2max. In the pLVEF group, LVEF and VO2max increased from 45.1%±4.8% to 52.5%±9.6% (p<0.001) and from 24.1±6.3 to 28.1±8.8 mL/kg/min (p=0.002), respectively. In the rLVEF group, LVEF and VO2max increased from 29.7%±7.7% to 37.6%±10.3% (p<0.001) and from 17.6±4.7 to 21.2±5.1 mL/kg/min (p<0.001), respectively. Both groups completed their exercise program safely.ConclusionIn both groups, patients with ischemic cardiomyopathy who completed a 6-week supervised CR exercise program demonstrated remarkable improvements in cardiopulmonary function. This result implies that neither of the two groups showed higher efficacy in comparison to each other, but we can conclude that CR exercise in the rLVEF group was as effective and safe as that in the pLVEF group.

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Exercise in cardiac rehabilitation.

Cited by 22 publications

References 119 publications

Text4Heart II – improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial

Text4Heart II – improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial

Using Visual Methods to Understand Physical Activity Maintenance following Cardiac Rehabilitation

The Effect of Cardiac Rehabilitation Exercise Training on Cardiopulmonary Function in Ischemic Cardiomyopathy With Reduced Left Ventricular Ejection Fraction

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