In individuals with heart failure (HF), low daily activity is associated with a poorer prognosis. The purpose of this pilot study was to investigate the effects of two home-based interventions on the primary HF-related outcome of daily activity and secondary outcomes of exercise tolerance, HF-related health status, and lower extremity functional strength in 16 patients with HF and implanted Medtronic implantable cardioverter defibrillator and cardiac resynchronization devices using a single-blind, randomized controlled pilot trial. Interventions were either daily activity feedback and encouragement or health coaching and home-based exercise. There were no significant differences in primary or secondary outcomes either between or within groups. Three subjects in each treatment group improved in two or more secondary outcomes, and only one improved in daily activity. Although the present pilot study incorporated both exercise and psychosocial components in the intervention, there was no effect on daily activity, perhaps because readiness for behavioral change was not accounted for either in group stratification/allocation or inclusion criteria.
PURPOSE The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) clinical trial was designed to test whether intervening on depression or low perceived social support reduces mortality and reinfarction in patients with acute myocardial infarction (MI). This report analyzes the effect of the intervention on quality of life (QOL), which was an important secondary outcome. METHODS ENRICHD was a randomized controlled clinical trial comparing a psychosocial intervention based on cognitive behavioral therapy to usual medical care in 2,481 patients from 8 clinical centers. Patients with acute MI were included if they met criteria for depression, low perceived social support, or both. QOL was assessed at the 6-month clinic visit in the first 1,296 patients. QOL measures included the Medical Outcomes Study Short Form summary measures of physical functioning (SF12-PCS) and mental functioning (SF12-MCS), a Life Satisfaction Scale (LSS), and a measure of overall QOL based on the ladder of life (LOL) technique. RESULTS There were significant treatment differences on the SF12-MCS (difference 2.2, 95% confidence interval [CI] 1.2-3.2), the LSS (difference 1.0, 95% CI 0.5-1.5), and the LOL (difference 0.3, 95% CI 0.1-0.6), but not on the SF12-PCS (difference 0.8; 95% CI = -0.5-2.0). Effect sizes for the intervention on QOL outcomes were modest. CONCLUSIONS Psychosocial interventions of limited duration confer modest QOL benefits in post-MI patients who are depressed or have low perceived social support. Interventions of longer duration or greater intensity may be required to produce more substantial improvements in QOL in these patients.
PURPOSE Guidelines suggest that individualized ramp protocols with treadmill times targeted between 8 and 12 minutes are most suitable to estimate exercise capacity. However, previous methods to determine individualized ramp rates and comparisons between ramp and standardized protocols have been limited to clinically referred populations. METHODS Forty-three healthy volunteers [median (interquartile range), age 36 (30-41) years; 10 women] performed an individualized ramp and a Bruce treadmill exercise protocol in random order. The Veterans Specific Activity Questionnaire [VSAQ, resulting in metabolic equivalents (METs)VSAQ] combined with a modified variant of the VSAQ nomogram (resulting in METs(NOMOGRAM)) was used to individualize the ramp protocol. Exercise capacity estimated from speed and grade of the treadmill (METs(ESTIMATED)) and that derived from directly measured peak oxygen uptake (VO2) [METs(MEASURED)] were compared with the pretest estimates of exercise capacity. RESULTS Median values for METs(VSAQ), METs(NOMOGRAM), METs(ESTIMATED), and METs(MEASURED) for the ramp protocol were 12.0 (10-12), 15.0 (14-16.5), 16.7 (15.9-17.8), and 15.2 (13.5-16.7), respectively. For the ramp protocol, all 43 participants achieved a treadmill time between 8 and 12 minutes, whereas with the Bruce protocol only 6 (14%) participants fell within this range (P < .0001). Peak VO2 [ramp: 53.1 (47.4-58.3) versus Bruce: 53.5 (48.7-58.3) mL/kg/min; P = .008] was slightly lower using the ramp protocol. CONCLUSIONS The modified variant of the VSAQ nomogram is a useful tool to estimate an individual's exercise capacity and to select a treadmill ramp protocol to yield the recommended exercise duration for moderately to highly fit, healthy individuals. The individualized ramp and the Bruce protocols are similar with regard to directly measured peak VO2 achieved.
Saladyga, Michele RN; Lawrence, Susan MS, CPHQ, CMAC; Phillips, T. MD; Swierczynski, M. RN Author Information
PULMONARY REHABILITATION: CACR Abstracts: Canadian Association of Cardiac Rehabilitation Association Canadienne de Réadaptation Cardiaque: 16th Annual Meeting and Symposium October 20-22, 2006 Vancouver, British Columbia
Martin, Rene PhD, RN; Young Shin, Ju MSN, RN; Lounsbury, Patricia MEd, RN; Young Lim, Ji PhD; Spertus, John A. MD, MPH Author Information
AACPVR Abstracts: 10: 30 am-12: 00 pm Scientific Free Communication Session D-1: Pulmonary Rehabilitation/Primary Prevention
Guazzi, Marco MD, PhD; Gripari, Paola MD1; Tumminello, Gabriele MD1; Arena, Ross PhD, PT2 Author Information
PULMONARY REHABILITATION: CACR Abstracts: Canadian Association of Cardiac Rehabilitation Association Canadienne de Réadaptation Cardiaque: 16th Annual Meeting and Symposium October 20-22, 2006 Vancouver, British Columbia
Montilla, Heather BA, RRT; Junk, Leah RRT; Lowry, Linda RRT; Hess, Sidnie RRT; Shumway, Judith RRT; Farrell, Susan BS, RRT; Baker, Jill BS RRT; Emerick, Ann RRT; Colvin, Tomasha RRT; Connors, Gerilynn BS, RRT; Malinowski, Thomas P. BS, RRT; Lamberti, James P. MD Author Information
Marsh, Lisa A. MS, ATC1; Armstrong, J Brandon MS1; Marley, William P. PhD1 Author Information
PULMONARY REHABILITATION: CACR Abstracts: Canadian Association of Cardiac Rehabilitation Association Canadienne de Réadaptation Cardiaque: 16th Annual Meeting and Symposium October 20-22, 2006 Vancouver, British Columbia
AACPVR Abstracts: 10: 30 am-12: 00 pm Scientific Free Communication Session A-1: New Investigator Award Session
PULMONARY REHABILITATION: Literature Update: Selected Abstracts From Recent Publications in Exercise Physiology, Cardiopulmonary Prevention, and Rehabilitation
