David Verrill

Resistive exercise training in cardiac rehabilitation : An update

Resistive exercise training has become very popular for patients of cardiopulmonary rehabilitation programmes (CRPs). For decades, CRPs focused almost exclusively on improving cardiorespiratory endurance and most programmes ignored muscular fitness development. Moreover, resistance training was thought to be potentially hazardous for the cardiac patient due to the risk of cardiovascular complications from adverse haemodynamic responses. We now know that resistive exercise testing and training is very safe for properly screened patients, even at relatively high workloads. Improvement in muscular strength facilitates return to daily vocational and avocational activities and is important for the CRP participant to regain lost strength and resume work soon after a cardiac event. Circuit weight training (CWT) is helpful in this respect and has been shown to increase muscular strength, cardiovascular endurance, body composition, bone density and mineral content, self-confidence, and self-efficacy in various populations. This article presents an update on current research in cardiac patients and also presents guidelines for implementing a properly supervised cardiac resistive exercise programme.

Quality of life measures and gender comparisons in North Carolina Cardiac Rehabilitation Programs.

BACKGROUND Quality of life (QOL) is an important health-related outcome measure in patients with cardiovascular disease. The North Carolina Cardiopulmonary Rehabilitation Association (NCCRA) is a coalition of 72 state-certified, multidisciplinary cardiac rehabilitation (CR) programs. In 1997, the NCCRA Executive Board and Research Committee agreed to collect ongoing data to assess QOL changes following CR participation using the Ferrans & Powers QOL Index Cardiac Version III. The purpose of this study was to determine if changes were present in QOL scores after 12 weeks of CR in men and women from multiple outpatient centers. METHODS Data were analyzed from 420 patients from 19 Phase II early outpatient CR programs who completed the QOL index survey within the first week of program entry and upon discharge. The four QOL index domains measured were health/function, psychological/spiritual status, socioeconomic status, and family interaction. Overall QOL was tabulated as the aggregate score from the four domains. Each domain, as well as overall QOL, was compared pre- and post-CR participation with a repeated measures analysis of variance. RESULTS Across programs, statistically significant improvements in QOL indices were observed following 12 weeks of CR in each of the four domains and on the overall score in all patients. Men reported greater CR entry and discharge scores than women on the health/function, family interaction, and overall scores. Women showed a greater positive change in scores than men on the socioeconomic, family interaction, and overall scores. CONCLUSIONS Patients who participated in Phase II multidisciplinary North Carolina CR programs and completed the protocol improved QOL parameters. While men had higher physical function and overall QOL scores both pre- and post-CR, women showed greater improvements in overall scores, as well as in family and socioeconomic parameters. These findings suggest that North Carolina CR patients experience a positive change in QOL following short-term participation in CR. Further study with a larger number of patients benchmarked with programs from other regions with comparisons to patients who do not participate in formalized CR programs is indicated from this investigation.

Complications of ergometer exercise in children

SummaryTo determine the frequency of significant complications of exercise testing in children, we reviewed 1,730 studies performed over a 9-year period, 1973 to 1982. The protocol used a graded, continuous test to maximal effort on a cycle ergometer. The overall incidence of complications was 1.79%, similar to the 1.7% previously reported by Freed [4]. No deaths occurred. Complications were classified into 4 groups with their frequency of occurrence as follows: chest pain (0.69%), dizziness or syncope (0.29%), decreased blood pressure (0.35%), hazardous arrhythmias (0.46%). These data confirm that exercise testing in children has low morbidity and mortality. We believe that the safety of stress testing should encourage physicians to expand its use in the assessment of functional ability.

Resistive Exercise Training in Cardiac Patients

SummaryResistive exercise training has recently gained popularity in cardiopulmonary rehabilitation programmes. Improvement in muscular strength is important to facilitate return to daily vocational and recreational activities after a cardiac event. Resistive exercise has been shown to be haemodynamically safe for selected individuals with cardiovascular impairment, even at relatively high workloads. This form of training may enhance muscular strength and endurance, body composition, blood lipid and lipoprotein levels, and cardiovascular endurance, although further research is needed in cardiac populations. Patients should be clinically screened and perform a symptom-limited maximal graded exercise test prior to resistive training. Patients who have characteristics associated with an increased risk of cardiac event during exercise should avoid heavy resistive training.Free weights, cuff and hand weights, isotonic/isokinetic machines, elastics, and other resistive modalities may be used for exercise of major muscle groups in cardiopulmonary rehabilitation. Resistive training workloads may be determined by gradual acclimatisation or 1 repetition maximum testing. Heart rate, blood pressure, rate-pressure product and rating of perceived exertion should be determined during lifting movements. Circuit weight-training has been recommended and has been reported to improve strength, lean body mass, self-efficacy, and may decrease risk factors for coronary artery disease. Nonsustained isometric or combined dynamic/isometric exercises have also been recommended for cardiac patients since many vocations involve lifting/pushing movements or frequent isometric muscle contraction.There appears to be considerable benefit and minimal risk of resistive exercise training for patients with cardiovascular impairment. This mode of exercise may allow patients to perform daily strength tasks safely, more efficiently, and with greater self-confidence.

Measuring behavioral outcomes in cardiopulmonary rehabilitation: AN AACVPR STATEMENT.

Outcome measurement in cardiopulmonary rehabilitation is required for optimal assessment of program quality, effectiveness of treatments, and evaluation of patient progress. Recent position statements from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology, American Heart Association, American Thoracic Society, and American College of Chest Physicians have provided state-of-the-art information on the importance of assessing performance and outcome measures for optimal program effectiveness. Such measures are also required for AACVPR program certification. To meet current standards of practice, the AACVPR developed an Outcomes Matrix that includes 4 domains: Health, Clinical, Behavioral, and Service. Although the Clinical and Health domains have been most commonly used in outcome reporting (eg, 6-minute walk test, quality-of-life survey scores), behavioral measures have received less attention, primarily because they have been perceived as being more difficult to measure and quantify over time. This statement describes 5 common behavioral outcome measures: smoking cessation, medication use, supplemental oxygen use, exercise habits, and nutritional behaviors. Sample questions and calculations for each of these behavioral measures are also provided. By using these measures at program entry and completion, cardiac and pulmonary rehabilitation practitioners can effectively track and document behavioral changes over time for physicians, third-party insurance providers, or hospital administrators and thus demonstrate the effectiveness of exercise and educational interventions on patient overall health and well-being.

Validity and reliability of the North Carolina 6-minute cycle test.

PURPOSE The purposes of this investigation were to determine (1) if the 6-minute cycle (6MC) test is a valid and reliable measure of physical performance in cardiac patients and (2) if physiologic responses to the 6-minute walk (6MW) and 6MC tests differ in men and women. METHODS Subjects were 101 phase II cardiac rehabilitation patients aged 40 to 79 years. Each subject performed a maximal graded exercise test (MGXT), a 6MW test, and three 6MC tests on separate days. RESULTS Pearson product moment correlation r values ranged from 0.78 to 0.89 (P = .001) when the three 6MC tests were compared with one another, indicating good test/retest reliability. The 6MC tests were all significantly and positively correlated to 6MW distance (P < .01), with r values ranging from 0.55 to 0.59. Each 6MC test was also correlated with maximal graded exercise test total time (P < .01), with r values ranging from 0.51 to 0.63, and with estimated maximal metabolic equivalents (P < .01), with r values ranging from 0.44 to 0.60. Although heart rate, systolic blood pressure, rate-pressure product, and rating of perceived exertion values for men were greater during the 6MC test than during the 6MW test (P < .001), no differences were seen in these parameters between tests in women (P = .166 to.260), with the exception of a greater exercise rating of perceived exertion seen during the 6MC test(P = .009). CONCLUSION The North Carolina 6MC test seems to provide a valid and reliable measure of functional abilities in phase II cardiac rehabilitation participants. Men generally present with greater heart rate, systolic blood pressure, and rate-pressure product values during this test than do the women when compared with a standard 6MW test.

Patient and program outcome assessment in pulmonary rehabilitation: an AACVPR statement.

Quantifying and analyzing pulmonary rehabilitation (PR) results in the form of an outcome assessment are a means of evaluating patient performance and program effectiveness. Implementation of a structured outcome assessment is feasible and parallels many aspects of the traditional rehabilitation evaluation. This statement outlines key components to PR outcome evaluation in the context of the American Association of Cardiovascular and Pulmonary Rehabilitation PR Outcome Matrix and includes a discussion of some of the popular tools used to collect measurement data.

CEPA 2015 Clinical Exercise Physiology Practice Survey

In 2015, the Clinical Exercise Physiology Association conducted a clinical exercise physiology practice survey. The survey was completed by 1,271 individuals who reported working as a clinical exercise physiologist in the United States without having a concomitant degree or certification in another allied health field (e.g., dietetics).