Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Taylor, Jenna L.; Bonikowske, Amanda R.; Olson, Thomas P.

doi:10.3389/fcvm.2021.734278

Cited by 59 publications

(57 citation statements)

References 158 publications

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“…This may lead to lack of adequate progression and compromise patient outcomes. Clinical guidelines do suggest the use of subjective indicators of intensity, but these should be used as adjunctive measures to help guide exercise [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Exercise Prescription and Progression Practices among US Cardiac Rehabilitation Clinics

Krieger

McCann

Bluhm

et al. 2022

Clinics and Practice

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Background: Little is known about exercise prescription practices in cardiac rehabilitation (CR). Therefore, the purpose of this study was to understand how initial exercise is prescribed and how exercise intensity is progressed among cardiac patients enrolled in United States CR programs. Methods: A 22-question survey was sent out to US CR clinics. Results: Ninety-three clinics responded to the survey. RPE was the most commonly reported exercise intensity indicator used for prescribing exercise, followed by resting HR + 20–30 bpm. Exercise progression practices were also based on patient sustained RPE values. Conclusions. Exercise prescription practice has become reliant on subjective indicators of exercise intensity. This may limit patient outcomes, such as improvement in functional measures.

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Section: Discussionmentioning

confidence: 99%

Exercise Prescription and Progression Practices among US Cardiac Rehabilitation Clinics

Krieger

McCann

Bluhm

et al. 2022

Clinics and Practice

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“…[ 7 ] Cardiac rehabilitation will prevent cardiac incidents to a considerable degree in the first place, decrease recurrence, and enable the survivors to lead a relatively safe, independent, and productive life. [ 8 9 ] The feasibility of cardiac rehabilitation has been studied in India; however, rehabilitation programs are yet to be established. [ 10 ] Cardiac rehabilitation includes preventive strategies before any major catastrophe in addition to techniques and coping strategies after any cardiovascular event, such as myocardial infarction and cerebrovascular incidents.…”

Section: Agingmentioning

confidence: 99%

The need for physical medicine and rehabilitation as an integral component in the medical education curriculum in India

Sheikh

Sahu

Vasudeva

et al. 2022

Journal of Family Medicine and Primary Care

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Enhanced quality of health care and increased life expectancy come with issues about the quality of life. This challenge is especially relevant to physical medicine and rehabilitation (PM and R)—a specialty focused on enhancing the quality of life. With the increasing burden of chronic diseases and disabling conditions, requirement for PM and R specialists will increase. This narrative review discusses the changing demographics, the disability trends, and the unmet needs both at present and anticipated in future. We also discussed problems faced by the present training system in PM and R, identified the lacunae, and attempted to provide suggestions to fill those.

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“…Con respecto a los pacientes con antecedentes de ECV, la rehabilitación cardíaca basada en el ejercicio está reconocida internacionalmente como una recomendación de práctica clínica de clase 1 para pacientes con ECV e insuficiencia cardíaca con fracción de eyección reducida, para reducir la mortalidad por todas las causas y cardiovascular 76 . La aptitud cardiorrespiratoria es un fuerte predictor de mortalidad también en pacientes con enfermedad coronaria e insuficiencia cardíaca 97 95 .…”

Section: Intensidad De La Actividad Física Y Riesgo De Enfermedad Car...unclassified

“…Por lo tanto, el ejercicio vigoroso, que mejora en la aptitud cardiorrespiratoria de forma más eficaz es interesante también en la rehabilitación cardiaca 100 . Según varios estudios de cohortes y ensayos clínicos, el ejercicio a intervalos de alta intensidad mejora significativamente la capacidad cardiorespiratoria (captación máxima de oxígeno) en comparación con el ejercicio moderado continuo en pacientes que han sufrido un infarto de miocardio (IAM) y parece ser seguro 76 . Lo mismo ocurre con el entrenamiento continuo de alta intensidad 101 .…”

Section: Intensidad De La Actividad Física Y Riesgo De Enfermedad Car...unclassified

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La intensidad de la actividad física y su papel en la prevención cardiovascular en la cohorte SUN

Hidalgo¹

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Introduction Emerging evidence suggests that vigorous physical activity may be associated with greater cardioprotective and metabolic benefits than moderate physical activity, but this topic requires further study. Furthermore, no longitudinal study has investigated the combined effect of the Mediterranean diet and the intensity of physical activity on mortality and cardiovascular disease.. Objective This study aims to evaluate the long-term relationship betweenthe intensity of physical activity and the risk of developing metabolic syndrome and cardiovascular disease in a prospective cohort study. We also intend to assess the individual and combined effects of adherence to the Mediterranean diet and intensity of physical activity on all-cause mortality and cardiovascular disease. Methods and design The Seguimiento Universidad de Navarra (SUN) Project comprises Spanish university graduates. When evaluating the incidence of metabolic syndrome or cardiovascular disease, we excluded participants with any component of metabolic syndrome or cardiovascular disease prior to study entry. We estimated the mean intensity of leisuretime physical activity using a validated questionnaire. An 8-item score was also constructed to assess an active lifestyle. Adherence to the Mediterranean diet was obtained from a validated 136-item food frequency questionnaire and we used two validated dietary scores. The association between intensity of leisure-time physical activity and metabolic syndrome or cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular causes) was evaluated with logistic regression models or Cox proportional hazards models respectively, adjusting for total energy expenditure and other confounding factors. In addition, multivariable Cox regression models were used to study the individual and combined effect of adherence to the Mediterranean diet, intensity of physical activity, and an active lifestyle on all-cause mortality and cardiovascular disease. 4 Results Among 10,145 participants without any criteria for metabolic syndrome, 412 new cases of metabolic syndrome were observed. Vigorous physical activity was associated with a 37% relatively lower risk (Adjusted OR=0.63, 95% CI=0.44, 0.89) compared with light activity, independent of the total energy expenditure and with a linear trend. During 172,299 person-years of follow-up, we recorded 127 cases of cardiovascular disease. Vigorous physical activity was associated with a 69% relatively lower risk (Adjusted HR=0.31, 95% CI=0.12, 0.79) compared with inactivity, independent of the total energy expenditure and with a linear trend. During a median follow-up of 10.3 years, we recorded 305 deaths. Participants with an active lifestyle and greater adherence to the Mediterranean diet had lower mortality (adjusted HR=0.39, 95% CI=0.21, 0.72), and when intensity was added to this combination, its power protective was even greater (adjusted HR=0.33, 95% CI=0.15, 0.71). Likewise, when analyzing joint exposure to the Mediterranean diet and an active lifestyle or intensity of physical activity, the greatest benefit was related to greater adherence to the Mediterranean diet and a more active lifestyle or vigorous physical activity, respectively. In any case, although there is a synergy, a multiplicative interaction between the Mediterranean diet and the intensity of physical activity was not found. Conclusions In the SUN cohort, given the same level of energy expenditure, respondents who engage in vigorous leisure-time physical activity have a lower risk of developing metabolic syndrome and cardiovascular disease. In the SUN cohort, the combined effect of Mediterranean diet adherence and physical activity intensity had synergistic effects on mortality and cardiovascular disease risk reduction.

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Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Cited by 59 publications

References 158 publications

Exercise Prescription and Progression Practices among US Cardiac Rehabilitation Clinics

Exercise Prescription and Progression Practices among US Cardiac Rehabilitation Clinics

The need for physical medicine and rehabilitation as an integral component in the medical education curriculum in India

La intensidad de la actividad física y su papel en la prevención cardiovascular en la cohorte SUN

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