On-site programmatic attendance to cardiac rehabilitation and the healthy-adherer effect

Alter, David A.; Zagorski, Brandon; Marzolini, Susan; Forhan, Mary; Oh, Paul

doi:10.1177/2047487314544084

Cited by 23 publications

(17 citation statements)

References 32 publications

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“…3). In cardiovascular patients, it is clear that attending a higher proportion of cardiovascular rehabilitation sessions confers greater longterm benefit than attending fewer sessions [43][44][45]. Our findings were consistent with those of previous studies in cardiovascular patients.…”

Section: Discussionsupporting

confidence: 83%

“…On the other hand, some other studies regarding prevention, e.g., in the general sedentary population, [40] patients with cancer, [41,42] and cardiovascular disease patients, [43][44][45] used the proportion of exerciserelated program attendance as a predictor of outcome. In the present study, the median proportion of attendance at the management program was 75%, which was within the range reported in other studies [41,42,45] (Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

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Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

Yamamoto

Matsuzawa

Abe

et al. 2018

Kidney Blood Press Res

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Background/Aims: Several clinical practice guidelines recommend regular assessment of physical activity and physical function as part of routine care in hemodialysis patients. However, there is no clear evidence to support these recommendations. We investigated whether the proportion of attendance at a regular program for management of physical activity and physical function can predict all-cause mortality and cardiovascular events in hemodialysis patients. Methods: This retrospective cohort study consisted of 266 hemodialysis patients participating in the management program at least once. Participants were tracked for 3 years after their first attendance at the management program to determine their attendance proportion. The main study outcomes included all-cause mortality and a composite of fatal and nonfatal cardiovascular events. Results: Median patient age was 64.5 (interquartile range, 56.8 – 72.0) years, 45% were women, and the median time on hemodialysis was 35.5 (interquartile range, 12.0 – 114.3) months at baseline. Sixty-five patients died over a median follow-up of 79 months. The incidence of cardiovascular events was 60 over a median follow-up of 68 months. Even after adjusting for any of the prognostic models, participants who attended ≤ 75% of sessions (n = 140) had higher risks of mortality (hazard ratio (HR), 1.79; 95% confidence interval (CI): 1.00 – 3.36; P = 0.049) and cardiovascular events (HR, 1.84; 95% CI: 1.07 – 3.48; P = 0.03) than those attending > 75% of sessions (n = 126). Conclusion: Hemodialysis patients in whom physical activity and physical function could be assessed more regularly had better prognosis than those with only intermittent assessment.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

Yamamoto

Matsuzawa

Abe

et al. 2018

Kidney Blood Press Res

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“…Consequently, good exercise adherence could be considered a marker for adherence to other positive health behaviours which may also decrease the risk of mortality and clinical events. This has been previously observed by others, with increased attendance at on-site cardiac rehabilitation sessions related not only to reductions in all-cause mortality, re-admissions and major events, but also to greater improvements in clinical risk profile and secondary prevention behaviours such as medication and dietary adherence [128, 129]. Additionally, some ‘clustering’ of good lifestyle behaviours (diet, exercise, smoking cessation) was observed in survivors of MI, where increased adherence led to a decrease in mortality, myocardial infarction and stroke [130].…”

Section: Discussionsupporting

confidence: 57%

The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression

2017

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BackgroundWhile the clinical benefits of exercise-based cardiac rehabilitation are well established, there is extensive variation in the interventions used within these trials. It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes. This study aims to systematically examine the relationship between individual components of the exercise intervention in cardiac rehabilitation (such as intensity and frequency) and clinical outcomes for people with coronary heart disease.MethodsIn this systematic review, eligible trials were identified via searches of databases (PubMed, Allied and Complementary Medicine, EMBASE, PEDro, Science Citation Index Expanded, CINAHL, The Cochrane Library, SPORTDiscus) from citation tracking and hand-searching. Studies were included if they were randomised trials of a structured exercise intervention (versus usual care) for participants with coronary heart disease and reported at least one of cardiovascular mortality, total mortality, myocardial infarction or revascularisation outcomes. Each included trial was assessed using the Cochrane Risk of Bias Tool. Authors were also contacted for missing intervention details or data. Random effects meta-analysis was performed to calculate a summary risk ratio (RR) with 95% confidence interval (CI) for the effect of exercise on outcomes. Random effects meta-regression and subgroup analyses were conducted to examine the association between pre-specified co-variates (exercise components or trial characteristics) and each clinical outcome.ResultsSixty-nine trials were included, evaluating 72 interventions which differed markedly in terms of exercise components. Exercise-based cardiac rehabilitation was effective in reducing cardiovascular mortality (RR 0.74, 95% CI 0.65 to 0.86), total mortality (RR 0.90, 95% CI 0.83 to 0.99) and myocardial infarction (RR 0.80, 95% CI 0.70 to 0.92). This effect generally demonstrated no significant differences across subgroups of patients who received various types of usual care, more or less than 150 min of exercise per week and of differing cardiac aetiologies. There was however some heterogeneity observed in the efficacy of cardiac rehabilitation in reducing total mortality based on the presence of lipid lowering therapy (I 2 = 48%, p = 0.15 for subgroup treatment interaction effect). No single exercise component was identified through meta-regression as a significant predictor of mortality outcomes, although reductions in both total (RR 0.81, p = 0.042) and cardiovascular mortality (RR 0.72, p = 0.045) were observed in trials which reported high levels of participant exercise adherence, versus those which reported lower levels. A dose-response relationship was found between an increasing exercise session time and increasing risk of myocardial infarction (RR 1.01, p = 0.011) and the highest intensity of exercise prescribed and an increasing risk of percutaneous coronary intervention (RR 1.05, p = 0.047).ConclusionsE...

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“…10-12 Comorbidities, such as diabetes, peripheral vascular disease, obesity, and chronic obstructive pulmonary disease, appear to also predict fewer sessions completed. 13-16,8 Effects of smoking have been reviewed, with current smoking being a powerful predictor of fewer sessions completed. 17 Lower-socioecomonic status (SES), measured by income, education, or having subsidized insurance (e.g.…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

Gaalema

Savage

Rengo

et al. 2017

Journal of Cardiopulmonary Rehabilitation and Prevention

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Purpose Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality following a major cardiac event. Although a dose response relationship between number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study we examined associations between number ofsessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES). Methods Multiple LogisticRegression and Classification and Regression Tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and number of sessions completed in a prospectively collected CR clinical database (N=1658). Results Current smoking, lower-SES, non-surgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (i.e., risk profiles) predict number of sessions completed. Those with the highest-risk profile for non-adherence (less than 65 years old, current smoker, lower-SES) completed on average 9 sessions while those with the lowest-risk profile (greater than 72 years old, not current smoker, higher-SES, surgical diagnosis) completed on average 27 sessions. Conclusions Younger individuals, as well as those who report smoking, economic challenges, or have a non-surgical diagnosis, may require additional support to maintain CR session attendance.

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On-site programmatic attendance to cardiac rehabilitation and the healthy-adherer effect

Abstract: Associations between on-site attendance at cardiac rehabilitation and outcomes may represent a healthy-adherer effect. Future research must evaluate the clinical utility of on-site attendance as a behavioral health-adherence metric for cardiac rehabilitation monitoring and surveillance.

Cited by 23 publications

References 32 publications

Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

Utility of Regular Management of Physical Activity and Physical Function in Hemodialysis Patients

The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence

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