Meg Gulanick

Resistance Exercise in Individuals With and Without Cardiovascular Disease: 2007 Update A Scientific Statement From the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism

Prescribed and supervised resistance training (RT) enhances muscular strength and endurance, functional capacity and independence, and quality of life while reducing disability in persons with and without cardiovascular disease. These benefits have made RT an accepted component of programs for health and fitness. The American Heart Association recommendations describing the rationale for participation in and considerations for prescribing RT were published in 2000. This update provides current information regarding the (1) health benefits of RT, (2) impact of RT on the cardiovascular system structure and function, (3) role of RT in modifying cardiovascular disease risk factors, (4) benefits in selected populations, (5) process of medical evaluation for participation in RT, and (6) prescriptive methods. The purpose of this update is to provide clinicians with recommendations to facilitate the use of this valuable modality.

Physical Activity and Exercise Recommendations for Stroke Survivors An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council

Annually, 700 000 people in the United States suffer a stroke, or ≈1 person every 45 seconds, and nearly one third of these strokes are recurrent.1 More than half of men and women under the age of 65 years who have a stroke die within 8 years.1 Although the stroke death rate fell 12% from 1990 to 2000, the actual number of stroke deaths increased by 9.9%. This represents a leveling off of prior declines.2 Moreover, the incidence of stroke is likely to continue to escalate because of an expanding population of elderly Americans; a growing epidemic of diabetes, obesity, and physical inactivity among the general population; and a greater prevalence of heart failure patients.3 When considered independently from other cardiovascular diseases, stroke continues to be the third leading cause of death in the United States. Improved short-term survival after a stroke has resulted in a population of an estimated 4 700 000 stroke survivors in the United States.1 The majority of recurrent events in stroke survivors are recurrent strokes, at least for the first several years.4 Moreover, individuals presenting with stroke frequently have significant atherosclerotic lesions throughout their vascular system and are at heightened risk for, or have, associated comorbid cardiovascular disease.5,6 Accordingly, recurrent stroke and cardiac disease are the leading causes of mortality in stroke survivors. Both coronary artery disease (CAD) and ischemic stroke share links to many of the same predisposing, potentially modifiable risk factors (hypertension, abnormal blood lipids and lipoproteins, cigarette smoking, physical inactivity, obesity, and diabetes mellitus), which highlights the prominent role lifestyle plays in the origin of stroke and cardiovascular disease.5,7,8 Modification of multiple risk factors through a combination of comprehensive lifestyle interventions and appropriate pharmacological therapy is now recognized as the cornerstone of initiatives aimed …

The Relationships Among Self-Esteem, Stress, Coping, Eating Behavior, and Depressive Mood in Adolescents

The prevalence of adolescent overweight is significant, almost 25% in some minorities, and often is associated with depressive symptoms. Psychological and psychosocial factors as well as poor coping skills have been correlated with unhealthy eating and obesity. The purpose of this study was to examine relationships among self-esteem, stress, social support, and coping; and to test a model of their effects on eating behavior and depressive mood in a sample of 102 high school students (87% minority). Results indicate that (a) stress and low self-esteem were related to avoidant coping and depressive mood, and that (b) low self-esteem and avoidant coping were related to unhealthy eating behavior. Results suggest that teaching adolescents skills to reduce stress, build self-esteem, and use more positive approaches to coping may prevent unhealthy eating and subsequent obesity, and lower risk of depressive symptoms.

Risk factors for type 2 diabetes mellitus.

Genetic, environmental, and metabolic risk factors are interrelated and contribute to the development of type 2 diabetes mellitus. A strong family history of diabetes mellitus, age, obesity, and physical inactivity identify those individuals at highest risk. Minority populations are also at higher risk, not only because of family history and genetics, but also because of adaptation to American environmental influences of poor dietary and exercise habits. Women with a history of gestational diabetes as well as their children are at greater risk for progressing to type 2 diabetes mellitus. Insulin resistance increases a persons risk for developing impaired glucose tolerance and type 2 diabetes. Individuals who have insulin resistance share many of the same risk factors as those with type 2 diabetes. These include hyperinsulinemia, atherogenic dyslipidemia, glucose intolerance, hypertension, prothrombic state, hyperuricemia, and polycystic ovary syndrome. Current interventions for the prevention and retardation of type 2 diabetes mellitus are those targeted towards modifying environmental risk factors such as reducing obesity and promoting physical activity. Awareness of risk factors for developing type 2 diabetes will promote screening, early detection, and treatment in high-risk populations with the goal of decreasing both microvascular and macrovascular complications.

THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND PERIMENOPAUSE

Our purpose in conducting this study was to examine the relationship between physical activity and symptoms associated with perimenopause. A group of 214 perimenopausal women aged 40-55 years (mean = 47 years) completed the Womens Health Assessment Scale (assesses symptoms associated with perimenopause: vasomotor, psychosomatic, menstrual, and sexual symptoms) and the physical activity questionnaire. These women were categorized into three groups based on their levels of physical activity: inactive, relatively active, and active. Analyses of covariance (ANCOVA) revealed significant differences between groups in frequency and distress of overall symptoms associated with perimenopause (F = 8.86, p = .00, F = 6.25, p = .00, respectively). Further analyses indicated that relatively active and active women had significantly fewer and less distressful psychosomatic symptoms (F = 8.05, p = .00, F = 5.80, p = .00, respectively), such as irritability, forgetfulness, and headache as well as fewer and less distressful sexual symptoms (F = 3.42, p = .03, F = 3.73, p = .03, respectively), such as vaginal dryness and decreased sexual desire than inactive women. No significant differences were found among groups on vasomotor and menstrual symptoms. In conclusion, physical activity may be an important alternative/adjunct to hormone therapy particularly for psychosomatic and sexual symptom management at perimenopause.

Perimenopause and the Quality of Life

The purposes of this study are to describe the frequency and distress of symptoms associated with perimenopause, to examine the changes in the quality of life (QOL) related to perimenopause, and to examine the relationships between symptoms associated with perimenopause and the QOL. A cross-sectional, correlational design was employed. Two hundred fourteen perimenopausal women completed the Women’s Health Assessment Scale (WHAS) and the Quality of Life Scale. It was found that vasomotor symptoms were not central to the list of symptoms associated with perimenopause. More women reported psychosomatic complaints as opposed to vasomotor complaints. Compared to the premenopausal period, women during perimenopause experienced slightly, yet significantly decreased, levels of QOL. Multiple regression analysis demonstrated that the psychosomatic symptom category was the sole predictor of the QOL during perimenopause. In summary, psychosomatic symptoms occur most frequently and are most distressful for perimenopausal women in this study. It may be important to manage psychosomatic symptoms to improve the QOL for perimenopausal women.

Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs A Scientific Statement From the American Heart Association/American Association for Cardiovascular and Pulmonary Rehabilitation

Outpatient cardiac rehabilitation/secondary prevention programs are characterized by comprehensive services, including medical evaluation, prescribed exercise, and cardiovascular disease risk factor modification through evidence-based pharmacological management of risk factors and behavioral interventions. This multifactorial process is designed to limit the adverse physiological and psychological effects of cardiac illness, to reduce the risk of sudden death or reinfarction, to control cardiac symptoms, to stabilize or reverse the atherosclerotic process, and to enhance the patient’s psychosocial and vocational status.1 Provision of these services is physician directed and implemented by a team of healthcare professionals that may include nurses, exercise physiologists, dietitians, health educators, behavioral medicine specialists, and other healthcare professionals.2 Appropriate patient/physician interaction during cardiac rehabilitation is important from a clinical and a regulatory perspective. In practice, the cardiac rehabilitation team interacts with a patient multiple times per week, providing an opportunity to facilitate management of blood pressure and lipids, glycemic control, smoking cessation, medication compliance, and adherence to lifestyle modification. Although long-term management of these issues is the responsibility of the primary care physician and/or cardiologist, cardiac rehabilitation provides an opportunity for concentrated risk factor modification during a critical period for the patient with coronary heart disease. By working closely with referring physicians, the cardiac rehabilitation team can assist the patient in reaching target goals more efficiently. The medical director is ultimately responsible for ensuring that systems are in place to facilitate this process and that appropriate communication with referring physicians is maintained. This document will serve as a guide for the medical director of an outpatient cardiac rehabilitation/secondary prevention program to link the clinical aspects of physician involvement to the provision of services by program staff while maintaining compliance with regulatory requirements. It is not meant to replicate the excellent reviews, practical guidelines, and scientific statements published elsewhere3–7 …

Does knowledge of coronary artery calcium affect cardiovascular risk perception, likelihood of taking action, and health-promoting behavior change?

Background:Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the “teachable moment” to enhance motivation for change. Objective:The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease. Methods:This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets. Results:Participants’ mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101–400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P < .001). McNemar &khgr;2 analysis indicated that risk reduction medication use increased in all groups, with a significant increase in statin (P < .001) and aspirin (P < .001) intake. Predictors of behavior change were perceived barriers (&bgr; = −.41; P < .001) and quality of life (&bgr; = .44; P < .001). Conclusions:Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses can better assist patients to modify behaviors during teachable moments.

Coronary risk factors: influences on the lipid profile.

Risk factors for cardiovascular disease have been defined by various groups and experts for decades. Unfortunately, the lack of consensus among these groups and the periodic changes in risk factor listings have led to confusion among health care professionals. Because so many risk factors inter-relate, it is difficult to isolate the effect of a specific risk factor on the lipid profile. In an effort to eliminate some of the confusion, this article describes the known effects of physical inactivity, obesity, cigarette smoking, age, hypertension, and diabetes mellitus on lipids and lipoproteins. A summary of the known results is displayed in a table. Because of the complexity of the atherosclerotic disease process and the multifactorial influences on lipid metabolism, this remains an exciting and challenging area for research.

Upper-body progressive resistance training improves strength and household physical activity performance in women attending cardiac rehabilitation.

PURPOSE The purpose of this study was to examine the impact of moderate-intensity, progressive, upper-body resistance training (RT) on muscle strength and perceived performance of household physical activities (HPA) among women in cardiac rehabilitation. METHODS The 10-week, pretest-posttest, experiment randomized women to either usual care (UC) aerobic exercise or RT. Muscle strength for 5 upper-body RT exercises (chest press, shoulder press, biceps curl, lateral row, and triceps extension) was measured using the 1-Repetition Maximum Assessment. The RT group progressively increased weight lifted using 40%, 50%, and 60% of obtained 1-Repetition Maximum Assessment at 3-week intervals. Perceived performance of HPA was measured with the Kimble Household Activities Scale. RESULTS The RT group (n = 16, mean age 64 ± 11) significantly increased muscle strength in all 5 exercises in comparison with the UC group (n = 14, mean age 65 ± 10) (chest press, 18% vs 11%; shoulder press, 24% vs 14%; biceps curl, 21% vs 12%; lateral row, 32% vs 9%; and triceps extension, 28% vs 20%, respectively). By study end, Household Activities Scale scores significantly increased (F = 13.878, P = .001) in the RT group (8.75 ± 3.19 vs 11.25 ± 2.14), whereas scores in the UC group decreased (8.60 ± 3.11 vs 6.86 ± 4.13). CONCLUSION Progressive upper-body RT in women shows promise as an effective tool to increase muscle strength and improve the ability to perform HPA after a cardiac event. Beginning RT early after a cardiac event in a monitored cardiac rehabilitation environment can maximize the strengthening benefit.