Failure to Improve Cardiopulmonary Fitness in Cardiac Rehabilitation

Savage, Patrick D.; Antkowiak, MaryEllen; Ades, Philip A.

doi:10.1097/hcr.0b013e3181b4c8bd

Cited by 52 publications

(71 citation statements)

References 42 publications

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“…In previous reports of CABG patients, age was not correlated with change in peak VO 2 11 . In the current study, the valve patients were significantly older than individuals in the CABG group.…”

Section: Discussionmentioning

confidence: 59%

“…For individuals with coronary heart disease, it has been previously shown that a diagnosis of T2DM is associated with lesser improvements in peak VO 2 11, 23 . Similarly, our results indicate that T2DM and HbA1c are negatively associated with changes in aerobic fitness for individuals rehabilitating from valve-related surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The exercise training program has been described elsewhere 11 and is similar to that performed at most rehabilitation programs around the United States 12 . Subjects performed CR exercise at an intensity of 70 to 85% of their peak heart rate (65 to 75% of peakVO 2 ) and/or a Borg Scale rating of perceived exertion (RPE) of between “light” and “somewhat hard” (12 to 14 on a scale of 6 to 20) 13 .…”

Section: Methodsmentioning

confidence: 99%

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Cardiac Rehabilitation After Heart Valve Surgery

Savage

Rengo

Menzies

et al. 2015

Journal of Cardiopulmonary Rehabilitation and Prevention

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Background Coronary artery bypass graft (CABG) surgery patients participating in cardiac rehabilitation (CR) experience improvements in aerobic fitness but there has been little study of outcomes for heart valve (HV) surgical patients. The primary aims of this study are to evaluate baseline peak aerobic capacity for HV patients participating in CR and to compare outcomes between HV and CABG patients. Methods Five hundred and seventy six consecutive patients who underwent HV (N=125), valve plus coronary artery bypass surgery (HV+CABG, N=57), or CABG (N=394) (all with classic sternotomy) and enrolled in CR were prospectively studied. Changes in outcome measures were assessed for individuals that completed CR (N=313). Results Valve patients were significantly older and had a greater percent of females than the CABG only group. Combining HV and HV+CABG groups, valvular disorders included: 134 mitral, 39 aortic and 8 combined abnormalities (mitral and aortic). For the entire cohort, the mean number of CR exercise sessions attended was 23.6±11.7. Peak VO2 increased 19.5% from 17.4±4.4 to 20.8±5.5 mLO2*kg−1*min−1(p<0.0001). Improvements in peak VO2 with CR exercise training were similar between the 3 groups of patients. Within the group of patients who had HV surgery, percent change in peak VO2 was similar between the 3 types of valvular abnormalities (i.e. Mitral [19.2%], Aortic [24.4%], and Mitral + Aortic [21.9%]) (p=0.27). Conclusions Heart valve surgery patients gain similar improvements in aerobic fitness from participating in CR exercise training as individuals that have CABG. The observed improvements in aerobic fitness are similar regardless of the type of valve abnormality or whether coronary artery bypass was performed concurrently.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Cardiac Rehabilitation After Heart Valve Surgery

Savage

Rengo

Menzies

et al. 2015

Journal of Cardiopulmonary Rehabilitation and Prevention

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“…101,102 Although this might suggest that patients with coexistent heart and lung disease would be particularly benefited by exercise rehabilitation, some data suggest that the presence and burden of comorbid conditions are predictive of ineffectiveness of exercise rehabilitation interventions. 99,103 Given the frequency of coexistent heart and lung disease and the implications this has for functional prognosis, there is remarkably little reported specifically about exercise responses in patients with mixed disease. 104 There is clearly a need to better define the interactive effects of coexistent heart and lung diseases on functional capacity and the most effective approaches to these patients in the rehabilitation setting.…”

Section: Arena and Sietsema Cpx In Clinical Practicementioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Clinical Evaluation of Patients With Heart and Lung Disease

2011

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Exercise tests are commonly used in clinical practice for both functional and diagnostic assessments. Many exercise tests are designed to produce a single measurement relevant to a specific clinical setting such as a timed walking distance as a measure of functional capacity in rehabilitation candidates or the presence of ECG changes consistent with myocardial ischemia in patients with chest pain. Cardiopulmonary exercise testing (CPX) measures a broader range of variables related to cardiorespiratory function, including expiratory ventilation (VE) and pulmonary gas exchange (oxygen uptake [VO 2 ] and carbon dioxide output [VCO 2 ]), along with the ECG and blood pressure, with the goal of quantitatively linking metabolic, cardiovascular, and pulmonary responses to exercise. [1][2][3] With increased availability of instruments for the facile measurement of exercise gas exchange, experience with CPX has expanded from clinical research applications to a broad range of clinical practice settings. 4 Interpretation of CPX for clinical purposes includes comparison of data from individual patients with those from healthy and disease populations. Substantial data are available characterizing exercise responses of patients with certain common heart and lung diseases, providing a basis for using CPX to compare individual patients' impairment relative to others from the same populations. Diagnostic applications of CPX, eg, for evaluating unexplained dyspnea or exercise intolerance, also rely on a comparison of patients' data with those of patients with known diagnoses. In clinical practice, in contrast to much of the research related to specific disorders, patients frequently have multiple medical problems, confounding the assessment of impairment or the attribution of symptoms to one or another condition. Although there are few systematic analyses of the effects of coexistent conditions on exercise responses, an advantage of CPX compared with other forms of testing is the potential for gaining insight into these interactions. This review highlights CPX findings in selected clinical populations and the implication of these observations to the clinical evaluation of patients with heart and/or lung diseases. Rationale and TerminologyTo contract, skeletal muscle uses energy in the form of adenosine triphosphate, generated from oxidative metabolism of substrate, involving the consumption of O 2 and production of CO 2 . Exchange of these gases in the muscle requires equivalent rates of exchange with the environment. Transport of gases between muscle and environment is mediated by the integrated function of multiple organ systems, any of which could become limiting to exercise if sufficiently impaired. The dependence of gas transport on large excursions in output of the heart and lungs makes disease of these organs particularly common causes of exercise intolerance.The standard expression of capacity for endurance, or aerobic, exercise is the maximumVO 2 , reflecting the highest attainable rate of transport and use of oxygen. Pe...

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“…The study authored by Savage et al, which included 385 patients in CR program, showed that 81 (21%) patients failed to improve peak VO 2 after termination of the program. 13 Similarly, patients with peak VO 2 bellow 10ml/kg/min had a poor prognosis, and those above 18ml/kg/min had a good prognosis.…”

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confidence: 99%

Effect of very short-term inpatient cardiac rehabilitation programs in acute myocardial infarction patients treated with primary percutaneous coronary intervention

Spiroski¹,

Anđić²,

Burazor³

et al. 2017

Srce i krvni sudovi

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Background: Exercise-based rehabilitation is an important part of treatment patients following acute myocardial infarction (MI). However, data are scarce on the efffects of very short-term exercise programs in patients with acute MI treated with primary percutaneous coronary intervention (pPCI). The aim of the study was to evaluate the effects of very short-term exercise training on cardiopulmonary exercise testing (CPET) parameters in patients suffering acute MI treated with pPCI. Methods: We studied 40 consecutive patients with MI treated with pPCI reffered for rehabilitation to our institution. The study population consisted of 39 men and 1 women (age 50,60±8,40 years, left ventricular ejection fraction 53,05±6,74 %), who participated in 3-week clinical cardiac rehabilitation program. The program consisted of cycling for 7 times/week, and daily walking for 45 min at intensity of 70-80% of the individual maximal heart rate. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10w/min. The CPET also performed after cardiac rehabilitation programs. Results: After 3 weeks of exercise-based cardiac rehabilitation program improved exercise tolerance as compared to baseline (peak workload 111,50±15,07 vs 129,00±12,77 watts, respectively, p<0,001), as well as peak respiratory exchage ratio (1,02±0,10 vs 1,08 ± 0,13, respectively, p<0,05). Peak systolic blood pressure, heart rate, peak and after 1 minute of rest were also improved. Most importantly, peak VO2 (18,17±3,30 vs 20,64±3,27 ml/kg/min, respectively, p<0,001), peak VCO2 (1,65±0,28 vs 1,96±0,25 ml/kg/min, respectively, p<0,001), peak ventilation (48,61±10,70 vs 57,27±9,85 L/min, respectively, p<0,001) and peak oxygen pulse (14,16±2,62 vs 60.18±14.19 ml/ beat, respectively, p<0,05) were also improved. No major adverse cardiac events were noted during the rehabilitation program. Conclusion: Very short-term exercise training in patients with acute MI treated with pPCI is safe and improves functional capacity, as well as test duration, work load and heart rate response. cardiac pulmonary exercise testing, exercise training, cardiac rehabilitation, myocardial infarction AbstractKey Words

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Failure to Improve Cardiopulmonary Fitness in Cardiac Rehabilitation

Cited by 52 publications

References 42 publications

Cardiac Rehabilitation After Heart Valve Surgery

Cardiac Rehabilitation After Heart Valve Surgery

Cardiopulmonary Exercise Testing in the Clinical Evaluation of Patients With Heart and Lung Disease

Effect of very short-term inpatient cardiac rehabilitation programs in acute myocardial infarction patients treated with primary percutaneous coronary intervention

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