T. Guiraud

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.

A Single Bout of High-Intensity Interval Exercise Does Not Increase Endothelial or Platelet Microparticles in Stable, Physically Fit Men With Coronary Heart Disease

BACKGROUND High-intensity interval exercise (HIIE) is gaining in popularity in fitness centres, even among coronary heart disease (CHD) patients. However, whether HIIE can have deleterious acute effects on the vasculature in CHD has not been studied. We hypothesized that when compared with moderate-intensity continuous exercise (MICE), a single bout of HIIE could lead to vascular damage and increasing numbers of circulating endothelial and platelet microparticles (EMPs, PMPs) in stable, physically fit CHD patients. METHODS Nineteen male CHD patients (aged 62 ± 11 years) underwent, in random order, a single session of HIIE corresponding to 15-second intervals at 100% of peak power output and 15-second passive recovery intervals, and an isocaloric MICE session. EMPs (CD31+ and/or CD62E+ and CD42b-); PMPs (CD42b+); nitrates and nitrites; prostacycline; and troponin T, cardiac form (cTnT), were measured 10 minutes before exercise and 20 minutes, 24 hours, and 72 hours after both exercise sessions. RESULTS EMPs, PMPs, nitrates and nitrites, prostacycline, and cTnT remained unchanged after both HIIE and MICE exercise sessions. Initial EMP concentration correlated inversely with EMP concentration 20 minutes post exercise, irrespective of exercise modality (r = 0.78, P < 0.0001). CONCLUSIONS A single HIIE session with very short exercise and passive recovery periods appears safe and does not induce changes to markers of endothelial function. Future studies are required to determine the safety of a long-term HIIE training program.

Exercise training-induced modification in autonomic nervous system: An update for cardiac patients

Patients with cardiovascular disease show autonomic dysfunction, including sympathetic activation and vagal withdrawal, which leads to fatal events. This review aims to place sympathovagal balance as an essential element to be considered in management for cardiovascular disease patients who benefit from a cardiac rehabilitation program. Many studies showed that exercise training, as non-pharmacologic treatment, plays an important role in enhancing sympathovagal balance and could normalize levels of markers of sympathetic flow measured by microneurography, heart rate variability or plasma catecholamine levels. This alteration positively affects prognosis with cardiovascular disease. In general, cardiac rehabilitation programs include moderate-intensity and continuous aerobic exercise. Other forms of activities such as high-intensity interval training, breathing exercises, relaxation and transcutaneous electrical stimulation can improve sympathovagal balance and should be implemented in cardiac rehabilitation programs. Currently, the exercise training programs in cardiac rehabilitation are individualized to optimize health outcomes. The sports science concept of the heart rate variability (HRV)-vagal index used to manage exercise sessions (for a goal of performance) could be implemented in cardiac rehabilitation to improve cardiovascular fitness and autonomic nervous system function.

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.

Vitamin D deficiency related to physical capacity during cardiac rehabilitation

BACKGROUND Vitamin D deficiency is a frequent pathology associated with cardiovascular diseases and physical performance. OBJECTIVE To study the link between 25-hydroxyvitamin D (25OHD) level and physical performance and gain in physical performance after cardiovascular rehabilitation (CVR) with vitamin D deficiency. METHODS 25OHD level was assessed in a retrospective cohort of patients admitted for CVR. Data were collected on physical fitness [6-min walk test distance (6MWD) in percentage of predicted, maximal power (Pmax)]. The threshold of vitamin D deficiency was 20ng/ml chosen according to the literature. RESULTS Among the 131 patients included, as compared with those with nondeficiency (n=83; 63%), patients with vitamin D deficiency (n=48, 37%) had lower initial 6MWD (82±18 vs 89±12% predicted, P=0.009) and Pmax (100±58 vs 120±39W, P=0.006). After CVR, this difference was maintained. The improvement in 6MWD and Pmax was significantly lower with deficiency than nondeficiency, for an increase of 11±8% versus 14±9% predicted (P=0.048) and 10±30 versus 32±30W (P=0.00001), respectively. CONCLUSION Vitamin D deficiency may be associated with impaired physical fitness before CVR and a smaller gain in physical fitness with CVR, probably related to the action of vitamin D on the muscle.