HIGH PREVALENCE OF METABOLIC SYNDROME IN CARDIAC REHABILITATION PATIENTS
Patrick Savage; Philip Ades; Fletcher Allen; Health Care-University of Vermont
Rationale:
Individuals with metabolic syndrome (MS) are at increased risk of cardiovascular disease and second coronary events. NCEP III guidelines defines MS as more than 3 of the following abnormalities: waist circumference (WC) > 102 cm in men and 88 cm in women; serum triglycerides (HITRIG) level > 150 mg/dL; high-density lipoprotein cholesterol (LOHDL-C) < 40 and 50 mg/dL in men and women, respectively; blood pressure (HTN) > 130/85 mm Hg; or serum glucose (DM) levels > 110 mg/dL.
Objective:
To measure the prevalence of MS in a cardiac rehabilitation (CR) population.
Methods:
We analyzed data on 908 men and 307 women that entered CR from 1996 to 2001. Patients on medication for hypertensive or a resting blood pressure > 130/85 were classified as HTN. Patients had WC measured at entry into CR and a fasting lipid profile was measured > 4 weeks after the cardiac event. We counted patients on medication to lower triglycerides or had a measure of > 150 mg/dL as HITRIG.
Results:
The prevalence of MS in the total CR population was 51%. More women (61%) than men (48%) (P < .0001) had MS. Men younger than the age of 65 had a greater prevalence of MS than men older than 65 (51% vs 42%) (P < .02). There was no difference between younger (62%) and older women (59%) (P = NS). For men, LOHDL-C (65%) was the most prevalent abnormality followed by HTN (64%), HITRIG (53%), high WC (50%) and DM (23%). In women, HTN (73%) was most common followed by LOHDL-C (70%), high WC (67%), HITRIG (64%), and DM (25%). These results underestimated the prevalence of DM and MS as we did not have glucose measures and required use of hypoglycemic medications to diagnose diabetes.
Conclusion:
These results document that MS is highly prevalent and CR programs need to develop specific interventions to assist participants in treating and preventing MS.
QUALITY-OF-LIFE MEASURES IMPROVE AND THEN PLATEAU WITH LONG-TERM PARTICIPATION IN NORTH CAROLINA CARDIAC REHABILITATION
C. Barton, W. Beasley, Davidson College Psychology Department, Davidson, NC; M. Lippard, D. Verrill, NorthEast Medical Health and Fitness Institute, Concord, NC
Rationale:
There have been conflicting reports in the literature regarding the long-term effects of cardiac rehabilitation (CR) on quality-of-life parameters.
Objective:
Scores from the Ferrans and Powers Quality of Life Index Cardiac Version III (QOLI) improve following short-term participation in CR. This investigation looked at the effects of long-term supervised CR participation on quality-of-life trends in North Carolina patients.
Methods:
For this study, 2677 patients aged 40 to 89 years from 23 hospital outpatient and free-standing CR programs were given QOLI surveys following standardized instructions prior to and immediately following 12 weeks (n = 2580), 24 weeks (n = 88), and 52 weeks (n = 9) of supervised CR participation. Overall QOLI scores were compared pre- and post-CR participation with repeated measures analysis of variance. Mean overall score differences at each time period were assessed by post hoc t tests.
Results:
Mean overall QOLI scores at 12 weeks (24.3 +/- 4.0) were 6% greater than scores at CR entry (22.9 +/- 4.3;P < .001). Mean overall QOLI scores at 24 weeks (24.5 +/- 3.9) were no different than scores at 12 weeks (24.7 +/- 3.9;P = .632), but 5% greater than entry scores (23.4 +/- 3.7;P = .003). Mean overall QOLI scores improved after 12 weeks but not at either 24 weeks or 52 weeks in 9 patients who completed all surveys.
Conclusions:
Overall quality of life, when assessed by the QOLI, improved significantly in men and women across programs after 12 weeks of CR participation. No further improvements in QOL scores were evident in a smaller subset of patients who completed surveys at 24 weeks and 52 weeks. Improvements in quality of life may peak during early CR and remain elevated, without a further increase or decrease with up to 1 year of CR participation. Further analysis of quality of life measures on a greater number of patients over longer time periods will shed greater light on this issue.
INDIVIDUALIZED EXERCISE INSTRUCTION AND THE USE OF INTERNET
Susan A. Keller, George Washington University
Rationale:
Cardiac rehabilitation programs are ideal settings to offer individualized exercise instruction with subsequent e-mail follow-up to increase physical activity among individuals.
Objectives:
Study objectives were: (1) to determine whether two 60-minute individualized exercise sessions were effective in increasing a sedentary person's level of physical activity, and (2) to test whether reporting exercise behavior via e-mail to an exercise coordinator (experimental group), who provided cues to action to ensure regular exercise, was more effective in increasing physical activity than independently tracking exercise with a pen-and-paper log (control group).
Methods:
A randomized intervention study was conducted to test the effects of individualized exercise instruction and follow-up on sedentary individuals. Subjects participated in two exercise sessions within a 3-day period; thereafter subjects were randomized into the control or experimental group. Exercise behavior (measured in minutes and days exercised per week) was tracked for a 6-week period.
Results:
The level of physical activity in previously sedentary individuals increased for both groups. The mean minutes exercised for the experimental group (754;P = .047) was greater than the control group (352), as were the mean days exercised (20.20 vs 11.40;P = .06). For weeks 4 to 6, the mean minutes exercised for the experimental group (413;P = .012) was greater than the control group (96.4), as were the mean days exercised (10.6 vs 3.4;P = .019). The percent change score was greater in the experimental group than the control group for both the SF-36 and the HPLP survey.
Conclusion:
Two individualized exercise sessions were effective in increasing levels of physical activity in sedentary individuals. Guided exercise follow-up, as provided in the form of an e-mail, significantly increased physical activity in previously sedentary individuals.
EFFECT OF EDUCATIONAL STATUS ON CLINICAL OUTCOMES IN PARTICIPANTS IN A CONTEMPORARY PHASE 2 CARDIAC REHABILITATION PROGRAM
Michele Doughty, MD; Laurence Sperling, MD; Kathy Lee Bishop Lindsay, MS, PT; Richard Salmon, DDS; Brenda Mitchell, PhD; Barry Franklin, PhD; Neil Gordon, MD Emory University and INTERxVENT Coordinating Center
Patient education, counseling, and behavioral interventions are important elements of cardiac rehabilitation (CR). INTERxVENT CR is designed to help facilitate these elements during phase 2 CR and includes the use of written and audio materials together with brief one-on-one counseling. In this multicenter study, we investigated the clinical effectiveness of phase 2 CR programs that utilize INTERxVENT CR in participants with (group A, n = 539) and without (group B, n = 264) 1 or more years of college education. Cardiovascular disease (CVD) risk factors were evaluated at baseline and after an average of approximately 90 days of participation in the phase 2 CR program at 12 centers in the United States. On exit from the phase 2 CR program, clinically relevant improvements (P < .05, unless otherwise indicated) in multiple CVD risk factors were observed for participants in both groups who had abnormal baseline risk factor values (based on national clinical guidelines), as follows: total cholesterol (group A -40 mg/dL, group B -42 mg/dL); LDL cholesterol (group A -25 mg/dL, group B -32 mg/dL); HDL cholesterol (group A 4 mg/dL, group B 4 mg/dL); triglycerides (group A -85 mg/dL, group B -16 mg/dL, P = NS); fasting glucose (group A -52 mg/dL, P = NS; group B -32 mg/dL); systolic/diastolic BP (group A -23/-20 mm Hg, group B -17/-16 mm Hg) and weight (group A -2 lbs, group B -2 lbs). With the exception of serum triglycerides and systolic BP (which decreased to a greater degree in group A versus group B, P < .05), no other statistically significant differences were observed for group A compared with group B. These data demonstrate that patients with and patients without 1 or more years of previous college education derive clinically relevant improvements in multiple CVD risk factors during participation in a phase 2 CR program that utilizes INTERxVENT CR.
EFFECT OF A PHASE 2 CARDIAC REHABILITATION PROGRAM ON SERUM LIPIDS AND LIPOPROTEINS IN PATIENTS WITH VERSUS WITHOUT KNOWN PERIPHERAL ARTERIAL DISEASE
Tim Maynard, MSS; Laurence Sperling, MD; Barry Franklin, PhD; Linda Hall, PhD; Richard Salmon, DDS; Neil Gordon, MD; Providence Hospital and INTERxVENT Coordinating Center
The cornerstone of treatment for peripheral arterial disease (PAD) is intensive cardiovascular disease (CVD) risk factor modification. In this multicenter study, we compared the effect of a contemporary phase 2 cardiac rehabilitation (CR) program on fasting serum lipids and lipoproteins in patients with (n = 45) and without (n = 326) a documented history of PAD. Serum lipids and lipoproteins were evaluated at baseline and after an average of approximately 90 days of participation in a contemporary phase 2 CR program at 12 centers in the United States. On exit from the phase 2 CR program, clinically relevant improvements in fasting serum lipids and lipoproteins were observed for participants with and without PAD who had abnormal baseline risk factor values (based on national clinical guidelines), as follows (P < .05): total cholesterol (PAD -24 mg/dl, no PAD -44 mg/dL); LDL cholesterol (PAD -16 mg/dL, no PAD -32 mg/dL); HDL cholesterol (PAD 7 mg/dL, no PAD 5 mg/dL); and triglycerides (PAD -44 mg/dL, no PAD -43 mg/dL). Reductions in total cholesterol and LDL cholesterol were greater (P < .05) in participants without PAD as compared to participants with PAD. Although additional research is warranted, these observations suggest that while patients with and without PAD substantially improve their lipid profiles during participation in a phase 2 CR program, the magnitude of improvement may be greater for participants without PAD.
GENDER DIFFERENCES IN GENERIC HEALTH-RELATED QUALITY OF LIFE FOLLOWING PULMONARY REHABILITATION
Donna Lunsford, RRT; Andrew Harver, PhD; Carolinas Medical Center-Pineville
Rationale:
General health status is an important outcome of comprehensive pulmonary rehabilitation (PR) programs for evaluating program effectiveness, and for determining individual patient responses. In this project, we compared improvements in SF-36 scores between men and women who completed PR.
Methods:
37 men and 54 women (mean age 64 years) who complained of dyspnea on exertion completed PR including exercise training, education, and psychosocial interventions. Patients completed, on average, 16 of 17 scheduled rehabilitation sessions. At the start of PR, mean FEV1 and FVC percent predicted values of participants were 43 +/- 20 and 60 +/- 19, respectively. Before and following the program patients completed the MOS 36-item Short-Form Health Survey (SF-36).
Results:
For all patients, reliable improvements (p < .01) in health status were observed for all SF-36 subscale scores (physical functioning, physical limitations, bodily pain, social functioning, mental health, emotional limitations, vitality, and general health perceptions) following PR. Separate comparisons for male and female patients showed that reliable improvements in health status were evident for all SF-36 subscale scores in women but that the improvements in general health perceptions following PR observed in men were not statistically significant (t [29] = 1.19, P = 0.24). Additionally, overall improvements in physical functioning scores following PR were significantly greater in women than in men (t [73] = -2.16, P < .05).
Summary and Conclusion:
General health status improved reliably as a function of comprehensive PR. On the other hand, women reported greater improvements in physical activity following PR compared to men. In addition, perceived levels of general health went unchanged, on average, in men following PR. We conclude that increases in physical activity levels contribute to important improvements in overall perceived health status.