R. Granger

Telephone Support Oriented by Accelerometric Measurements Enhances Adherence to Physical Activity Recommendations in Noncompliant Patients After a Cardiac Rehabilitation Program

OBJECTIVE To assess the efficacy of a strategy, based on telephone support oriented by accelerometer measurements, on the adherence to physical activity (PA) recommendations in cardiac patients not achieving PA recommendations. DESIGN Prospective and randomized study. SETTING A cardiac rehabilitation program (CRP) at a clinic. PARTICIPANTS Stable, noncompliant cardiac (coronary artery disease, heart failure, post-cardiovascular surgery) patients (weekly moderate-intensity PA <150 min) were randomly assigned to an intervention group (n=19) or a control group (n=10). INTERVENTIONS The intervention group wore an accelerometer for 8 weeks. Every 15 days, feedback and support were provided by telephone. The control group wore the accelerometer during the 8th week of the intervention only. MAIN OUTCOME MEASURES Active energy expenditure (EE) (in kilocalories) and the time spent doing light, moderate, or intense PA (minutes per week). RESULTS In the intervention group, the time spent at moderate-intensity PA increased from 95.6±80.7 to 137.2±87.5 min/wk between the 1st and 8th week (P=.002), with 36.8% of the sample achieving the target amount of moderate-intensity PA. During the 8th week, the EE averaged 543.7±144.1 kcal and 266.7±107.4 kcal in the intervention group and control group, respectively (P=.004). CONCLUSIONS Telephone support based on accelerometer recordings appeared to be an effective strategy to improve adherence to PA in noncompliant patients. This intervention could be implemented after a CRP as an inexpensive, modern, and easy-to-use strategy.

Validity of a questionnaire to assess the physical activity level in coronary artery disease patients.

The aim of the study is to compare, in coronary artery disease patients, physical activity (PA) assessed with the Dijon Physical Activity Questionnaire (DPAQ) and the true PA objectively measured using an accelerometer. Seventy patients wore an accelerometer (MyWellness Key actimeter) throughout 1 week after a cardiac rehabilitation program that included therapeutic education about regular PA. Patients completed the DPAQ at the end of the week. The mean weekly active energy expenditure was 619.9±374.6 kcal, and the mean DPAQ score was 21.3±3.1/30 points. There were low but significant correlations between total active energy expenditure and the DPAQ score (&rgr;=0.4, P=0.009). There were no correlations between peak power output and total DPAQ score. The DPAQ significantly correlates with objective measures given by the MyWellness Key actimeter. The choice between these tools relies on the clinician’s appreciation, taking into account patients’ characteristics and goals as well as the cost of the method and availability of the tool.

Comment optimiser l’alliance thérapeutique autour de l’activité physique dans les maladies cardiovasculaires ?

RésuméLa sédentarité reste un facteur de risque cardiovasculaire majeur. Les bénéfices de l’activité physique (AP) sont largement admis en prévention primaire et secondaire, et font l’objet de recommandations régulièrement remises à jour par les sociétés savantes internationales. Il persiste néanmoins quelques points de controverse, principalement concernant le type et l’intensité de l’AP. Les principales difficultés concernent les moyens de personnalisation de l’AP, dans le but de la rendre « ludique » et d’améliorer l’observance en suscitant des modifications de comportement durables. L’intégration de la promotion de l’AP dans une démarche d’éducation thérapeutique structurée peut permettre d’atteindre cet objectif. Après avoir rappelé la place centrale de l’AP dans le cadre du diagnostic éducatif (DE), nous présenterons une approche pratique du concept éducatif appliqué à l’AP dans les maladies cardiovasculaires en envisageant les outils utiles au DE ainsi qu’à la mise en place de l’intervention éducative, et enfin les éléments permettant la personnalisation des actions éducatives.AbstractSedentary lifestyle remains a major cardiovascular risk factor. The benefits of physical activity (PA) are now clearly established, for both primary and secondary prevention, and recommendations are regularly updated by international scientific societies. However, there are still some controversial points, mainly concerning the type and intensity of PA. The main difficulty with these issues concern how to customize PA, in order to make it “enjoyable” and improve compliance, by creating lasting changes in health behavior. Integrating the promotion of PA in a structured therapeutic education approach can allow achieving this goal. After recalling the central role of PA in the educational diagnosis (ED), we present a practical approach of the educational concept applied to PA in cardiovascular diseases, the tools that can be used for ED as well as for the implementation of the educational intervention, and cues to customize the therapeutic education action for the PA to the patient.

Improved Walking Claudication Distance with Transcutaneous Electrical Nerve Stimulation: An Old Treatment with a New Indication in Patients with Peripheral Artery Disease.

ObjectiveThe aim of this study was to determine whether 45 mins of transcutaneous electrical nerve stimulation before exercise could delay pain onset and increase walking distance in peripheral artery disease patients. DesignAfter a baseline assessment of the walking velocity that led to pain after 300 m, 15 peripheral artery disease patients underwent four exercise sessions in a random order. The patients had a 45-min transcutaneous electrical nerve stimulation session with different experimental conditions: 80 Hz, 10 Hz, sham (presence of electrodes without stimulation), or control with no electrodes, immediately followed by five walking bouts on a treadmill until pain occurred. The patients were allowed to rest for 10 mins between each bout and had no feedback concerning the walking distance achieved. ResultsTotal walking distance was significantly different between T10, T80, sham, and control (P < 0.0003). No difference was observed between T10 and T80, but T10 was different from sham and control. Sham, T10, and T80 were all different from control (P < 0.001). There was no difference between each condition for heart rate and blood pressure. ConclusionsTranscutaneous electrical nerve stimulation immediately before walking can delay pain onset and increase walking distance in patients with class II peripheral artery disease, with transcutaneous electrical nerve stimulation of 10 Hz being the most effective.

Whole-Body Strength Training Using a Huber Motion Lab in Coronary Heart Disease Patients: Safety, Tolerance, Fuel Selection, and Energy Expenditure Aspects and Optimization

Objective The aim of this study was to investigate safety, tolerance, relative exercise intensity, and muscle substrate oxidation during sessions performed on a Huber Motion Lab in coronary heart disease patients. Design After an assessment of V˙o2 peak, 20 coronary heart disease patients participated in two different exercises performed in random order at 40% and 70% (W40 and W70) of the maximal isometric voluntary contraction. Results No significant arrhythmia or abnormal blood pressure responses occurred during either session, and no muscle soreness was reported within 48 hrs posttest. The authors found a difference between W40 and W70 sessions for mean (standard deviation) ventilation (25.1% [8%] and 32.1% [9%] of maximal ventilation, respectively; P = 0.04) and a small difference for mean (standard deviation) heart rate (73 [7] and 79 [8] beats/min, respectively; P < 0.01). When compared with the W40, the W70 was associated with higher active energy expenditure (2.4 [0.6] and 3.1 [0.9] Kcal/min, respectively; P < 0.0001) and a similar mean (standard deviation) oxygen uptake (5.5 [1] and 6.6 [1] ml/min per kilogram, respectively; P = 0.07). The qualitative percentages of carbohydrates and lipids oxidized were 71% and 29%, respectively, at W40 and 91% and 9%, respectively, at W70. Conclusions Both protocols, which consisted of repeating 6-sec phases of contractions with 10 secs of passive recovery on the Huber Motion Lab, seemed to be well tolerated, safe, and feasible in this group of coronary heart disease patients.