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This detailed reference provides practical strategies and a scientific foundation for designing and implementing cardiac rehabilitation services to relieve the symptoms of cardiovascular disease patients through exercise training and risk reduction and secondary prevention, improve quality of life, and decrease mortality. Emphasizes multidisciplinary care that includes exercise training, behavioral interventions, and education and counseling regarding lifestyle changes and other aspects of secondary prevention! Written by world-renowned physicians, nurses, exercise physiologists, psychologists, dietitians, educators, and counselors in the field, Cardiac Rehabilitation presents evidence-based medicine as the cornerstone of clinical cardiology practice discusses interventions that limit the physiological and psychological effects of cardiac illness offers guidelines that enable elderly patients to maintain self-sufficiency and functional independence describes means of social and workplace reintegration evaluates policies for maintaining high-quality care, efficacy, and safety in an atmosphere of diminishing resources explains the role of managed care in moving rehabilitative care into the home, workplace, and other nontraditional sites assesses new interactive technologies that aid in tracking patient data gives pragmatic recommendations for the delivery of cardiac rehabilitative care in the next millenium and more! Advocating integrated, high-quality, consistent cardiac rehabilitation services for the well-being of patients recovering from a variety of cardiovascular problems and procedures, Cardiac Rehabilitation is ideally suited for cardiologists, cardiovascular surgeons, primary care physicians, cardiac rehabilitation professionals, cardiac care nurses, dietitians, physical and occupational therapists, exercise physiologists, psychologists, behavioral counselors, hospital managers, health plan designers, and upper-level undergraduate, graduate, and medical school students in these disciplines.
Patients with heart failure (HF) suffer from symptoms such as dyspnea, fatigue and reduced quality of life, which affect their physical function and often lead to immobilization and poor survival prognosis. Exercise training in cardiac rehabilitation should be offered to every patient with HF and can be performed both in a hospital-setting and with a home training programme. Exercise, in patients with HF, improves physical function and functional capacity as well as health-related quality of life (HRQoL) and reduces the need for hospital care. There are several barriers against participating in exercise based cardiac rehabilitation despite information about its benefits. The patient may anticipate not being able to exercise, that the exercise would be too hard, lives far away or has not been referred. Aim: The aim of this thesis was to evaluate the effects of exercise in heart failure patients, of a one-year training programme, with hospital-based training followed by a home-based setting or only home-based, with special emphasis on peripheral muscle training (PMT). Furthermore, to study frequently used methods for evaluation of the effects, i.e the 6-minute walk test and instruments for estimating health-related quality of life. Methods and findings: In study I, PMT was evaluated and the PMT programme in a hospital-setting (with equipment) and subsequent homebased training (with elastic bands) was compared with solely home-based training, over 1 year. At follow-up every third month, duplicated six minute walk test (6MWT) and two HRQoL questionnaires were used. The walking distance increased significantly after three months in both groups and was maintained thereafter. Also HRQoL increased but at different time points. In study II, PMT was compared with interval training on an ergometer bike/free walking. Both groups started under supervision of a physiotherapist in a hospital-setting, for three months and thereafter at home for nine months. The same measurements were used as in study I. Neither walking distance nor HRQoL changed over the study period. However, this may be regarded as a positive effect in the light of the known progressive nature of heart failure. In study III, the 6MWTs from study I and II were used to evaluate the necessity of performing duplicated 6MWTs in follow-ups clinically and for research purposes. We found that it is sufficient to perform one 6MWT. In study IV, both 6MWT and HRQoL forms from study I and II were used to investigate the relationship between walking distance and perceived HRQoL in HF patients. Patients with shorter walking distance, than the group median, experienced poorer general HRQoL but not HRQoL related to HF, than the higher performing half of the study group. There were no longitudinal trends in these relationships. Conclusion: PMT can be used as an exercise modality in patients with HF, both in hospital and at home, and may be evaluated with a single 6MWT. Shorter walking distance was related to a lower general HRQoL as judged by the patients but there was no significant relation between short walking distance and the HF-related HRQoL. Individualizing the training programme and methods, and offering the choice of exercise modality and the possibility of exercising at home, might be a way to increase adherence in cardiac rehabilitation. Patienter med hjärtsvikt besväras av andfåddhet och trötthet vilket påverkar deras fysiska funktion och ofta leder till immobilisering, nedsatt livskvalitet och dålig prognos. Träning inom hjärtrehabilitering bör erbjudas alla patienter med hjärtsvikt och kan utföras såväl på sjukhus som hemma med hemträningsprogram. Träning vid hjärtsvikt förbättrar fysisk funktion och funktionell kapacitet, hälsorelaterad livskvalitet, och minskar behovet av vård på sjukhus. Det finns många barriärer till att delta i hjärtrehabilitering trots information om vinster, t ex att patienten tror sig inte klara av att träna, bor långt ifrån, har inte fått remiss för att nämna några. Syfte: Syftet med avhandlingen var att utvärdera effekterna av ett träningsprogram för patienter med hjärtsvikt under 1 år, träning på sjukhus följt av hemträning eller enbart hemträning. Ett specifikt syfte var att utvärdera perifer muskelträning (PMT) som en möjlig, lämplig träningsmetod för hjärtsviktspatienter. Vidare var syftet att utvärdera effekten av sex minuters gångtest och hälsorelaterad livskvalitet. Metod och resultat: I studie I utvärderades PMT och jämförde träning på sjukhus (med redskap) med efterföljande hemträning (med elastiska band) med enbart hemträning under 1 år. Vid utvärdering var tredje månad användes dubbla sex minuters gångtest och frågeformulär om livskvalitet. Gångsträckan ökade signifikant efter träning och höll i sig hela träningsperioden i båda grupperna. Även livskvaliteten ökade men vid olika tidpunkter. I studie II, jämfördes PMT med intervallträning på ergometercykel/promenader. Båda grupperna tränade under ledning av fysioterapeut i tre månader och därefter hemma upp till 1 år. Samma utvärdering som i studie I. Gångsträcka och livskvaliteten ändrade sig inte under studietiden. Det kan dock ses som en positiv effekt eftersom hjärtsviktspatienter vanligen försämras över tid. I studie III, användes gångtesten från studie I och II för att utvärdera om det är nödvändighet att utföra dubbla sex minuters gångtest vid utvärdering. Ingen kliniskt betydelsefull skillnad sågs mellan gångtest ett och två. I studie IV, användes både gångtest och livskvalitetsformulär, från studie I och II, för att undersöka samband mellan gångsträcka och upplevd livskvalitet och om detta samband ändrades med tiden. Patienter med kortare gångsträcka upplevde sämre allmän hälsorelaterad livskvalitet men inte livskvalitet relaterad till hjärtsvikten, någon kliniskt signifikant förändring över tid kunde inte påvisas. Konklusion: Perifer muskelträning kan användas som en säker träningsform för patienter med hjärtsvikt, både på sjukhus och som hemträning och kan utvärderas med endast ett sex minuters gångtest. Patienter med kortare gångsträcka upplever sämre allmän livskvalitet vilket förefaller relativt oberoende av de olika testtidpunkterna.
This edition addresses the cost effectiveness of interventions that educate and motivate patients to assume personal responsibility for long-term disease prevention.
Guidelines for Cardiac Rehabilitation Programs, Sixth Edition With Web Resource, presents the combined expertise of more than 50 leaders in the field of cardiac rehabilitation (CR), reimbursement, and public policy to empower professionals to successfully implement new CR programs or improve existing ones. Developed by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), this guidebook offers procedures for providing patients with low-cost, high-quality programming that moves them toward a lifelong commitment to disease management and secondary prevention. Cardiovascular disease (CVD) is the principal cause of death worldwide. It is projected that by 2035, more than 130 million adults in the United States will have CVD. The challenge to CR professionals is to select, develop, and deliver appropriate rehabilitative and secondary prevention services to each patient tailored to their individual needs. Guidelines for Cardiac Rehabilitation Programs, Sixth Edition, is the definitive resource for developing inpatient and outpatient cardiac rehabilitation programs. The sixth edition of Guidelines for Cardiac Rehabilitation Programs equips professionals with current scientific and evidence-based models for designing and updating rehabilitation programs. Pedagogical aides such as chapter objectives, bottom line sections, summaries, and sidebars present technical information in an easy-to-follow format. Key features of the sixth edition include the following: A new chapter on physical activity and exercise that helps readers understand how to develop and implement exercise programs to CVD patients A new chapter on cardiac disease populations that offers readers a deeper understanding of CVD populations, including those with heart valve replacement or repair surgery, left ventricular assist devices, heart transplant, dysrhythmias, and/or peripheral artery disease Case studies and discussion questions that challenge readers to consider how concepts from the text apply to real-life scenarios An expanded web resource that includes ready-to-use forms, charts, checklists, and logs that are practical for daily use, as well as additional case studies and review questions Keeping up with change is a professional necessity and keeping up with the science is a professional responsibility. Guidelines for Cardiac Rehabilitation Programs, Sixth Edition, covers the entire scope of practice for CR programs and professionals, providing evidence-based information on promoting positive lifestyle behavior patterns, reducing risk factors for disease progression, and lessening the impact of CVD on quality of life, morbidity, and mortality. Note: The web resource is included with all new print books and some ebooks. For ebook formats that don’t provide access, the web resource is available separately.
AACVPR Cardiac Rehabilitation Resource Manual is the companion text to Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. It complements and expands on the guidelines book by providing additional background material on key topics, and it presents new material concerning cardiac rehabilitation and secondary prevention. AACVPR Cardiac Rehabilitation Resource Manual combines reference-based data with practical information from the field. It applies current position statements, recommendations, and scientific knowledge from medical and scientific literature to aid in designing and developing safe, effective, and comprehensive cardiac rehabilitation programs. Useful for practitioners as well as students and instructors who are learning and teaching key concepts, AACVPR Cardiac Rehabilitation Resource Manual provides strong background support to topics addressed in the guidelines, such as risk factors for coronary heart disease, secondary prevention, psychosocial issues, and patients with special considerations. In addition, each chapter opens with a cross-reference box so that readers know where to reference the topic in the guidelines book. In addition to supporting information for the guidelines, the manual contains new information to help round out cardio programs. Topics include the atherosclerotic disease process, cardiovascular and exercise physiology, exercise prescription, and the electrocardiogram. AACVPR Cardiac Rehabilitation Resource Manual is divided into three parts. Part I examines the development and prevention of coronary artery disease, including reduction of risk factors, psychosocial issues and strategies, and contemporary procedures for revascularization. Part II delineates the role of exercise in heart disease, including the exercise and coronary artery disease connection, cardiovascular and exercise physiology, and exercise prescription. Part III focuses on special considerations, including heart disease as it relates to women and to the elderly and considerations for people with diabetes, chronic heart failure, and heart transplants. AACVPR Cardiac Rehabilitation Resource Manual contains pertinent, detailed information on the topics involved in contemporary cardiac rehabilitation and secondary prevention of coronary artery disease. Teamed with Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, the book provides professionals and students with the full range of guidelines and background materials needed for teaching and understanding the key issues in cardiac rehabilitation and secondary prevention.
The aim of this textbook is to give guidance in prevention, lifestyle counselling and rehabilitation for cardiologists, other physicians and many different categories of health professionals in cardiac rehabilitation teams.
In recent years, research has demonstrated that exercise programs can benefit patients with chronic obstructive pulmonary disease (COPD) and patients with congestive heart failure (CHF). Yet many physicians do not refer such patients to any kind of exercise or rehabilitation program. Advances in Cardiopulmonary Rehabilitation examines the history of how pulmonary and cardiac diseases have been treated and shows how that history tends to constrain contemporary thinking in spite of significant advances in treatment. -Why do only a small percentage of eligible patients enroll in cardiopulmonary rehab programs? -What percentage of patients can be helped, and in what ways? -What are the most cost-efficient allocations of scarce financial resources for cardiac and pulmonary patients? The contributors to this book address these questions and provide answers that are challenging and often quite surprising. The First Québec International Symposium on Cardiopulmonary Rehabilitation was held in Québec City in May 1999, bringing together experts from around the world to discuss every aspect of cardiopulmonary rehabilitation. Editors Jean Jobin, PhD, François Maltais, MD, Pierre LeBlanc, MD, and Clermont Simard, PhD, selected the most groundbreaking papers presented at the conference and expanded on several of them for this reference. The book offers review articles and some original research. The editors' comprehensive introduction and conclusion provide an invaluable synthesis and overview of current understanding and future directions for cardiopulmonary rehabilitation. Whether you are a clinician, a researcher, an educator, or an administrator, Advances in Cardiopulmonary Rehabilitation will give you -an understanding of how trends in cardiopulmonary rehabilitation during the past century affect current practices, -hard data that will help you determine the best practices in cardiopulmonary rehabilitation, -data that will enhance your ability to treat patients you may have assumed were untreatable, and -a clear overview of recent research in cardiopulmonary rehabilitation. Part I explains not only what has happened in the past, but how past and current practices may influence the future. Part II offers thorough scientific reviews of pharmacological treatment for CHF and COPD. Part III, offers the clearest discussion available--accompanied by extensive data--of how to decide who should be referred and who should not. Part IV discusses peripheral muscle limitations and dysfunction. Part V addresses risks and benefits for different kinds of patients, home exercise programs for COPD patients, interactions between exercise and left ventricular remodeling, and effects of temperature extremes on people with cardiovascular disease. Part VI explains how cardiopulmonary illness, as well as various rehab approaches, affect a patient's psychosocial health, and examines economic evaluations of rehab programs. Part VII deals with factors that affect quality of life and how to measure outcomes of treatment in terms of quality of life. Finally, part VIII looks to the future--what is likely to happen in the areas of technology, pharmacology, psychosocial factors, and self-help care. This well-researched volume (more than 2,200 bibliographical references) is essential for anyone who deals with cardiac or pulmonary patients. This is the only single volume that probes the scientific, clinical, economic, and even psychosocial frontiers of cardiac and pulmonary rehabilitation.