Presenter: Praveen N Pakeerappa, MBBS, PGY-3 Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY

Transcription

1 Outcomes in Phase II Cardiac Rehabilitation: A Retrospective Analysis Comparing Participants with CABG to Participants with Non-Surgical Interventions Praveen N Pakeerappa, Beth Cundiff, Robert Nickerson, Alison Bailey. Department of Physical Medicine and Rehabilitation, Department of Cardiology, University of Kentucky, Lexington Presenter: Praveen N Pakeerappa, MBBS, PGY-3 Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY

2 INTRODUCTION Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality in the United States (13) A sedentary lifestyle is one among the chief modifiable risk factors in the development of CAD Physical activity not only aids in the prevention of CAD, but can also help mitigate further damage even after CAD is present (2,3)

3 BENEFITS OF PHYSICAL ACTIVITY Benefits of Physical Activity on Risk Factors Lowers LDL and triglycerides levels. Increases HDL levels. Systolic and diastolic resting blood pressures are reduced (greater reduction is seen in hypertensive patients). Improved blood glucose tolerance. Weight reduction. Increased rates of smoking cessation.

4 Adults who are unable or unwilling to meet these specific recommendations can still benefit from any amount of exercise, no matter how small. Studies have documented that improvements in hypertension, glucose intolerance, insulin resistance, dyslipidemia and inflammatory markers were made with continued physical activity, even during weight regain. (5,6,7)

5 INTRODUCTION The benefits of physical activity on cardiovascular health in adults has long been established The American Heart Association (AHA) and the American College of Sports Medicine (ACSM) both recommend that adults engage in moderateintensity exercise training for >30 min/day on >3-5 days/week, or vigorous intensity cardiorespiratory exercise training for >20 min/day (5)

6 BACKGROUND DEFINITION: The term cardiac rehabilitation refers to coordinated, multifaceted interventions designed to optimize a cardiac patient s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality (12)

7 CARDIAC REHABILITATION Phase I: Begins while inpatient after cardiac event Phase II: Outpatient phase of the program Phase III: Maintenance

8 COMPONENTS OF CARDIAC REHAB PROGRAM Exercise training Improve physical activity Improve functional endurance Medication management Medication compliance Medications /safety counseling Recognize adverse effects Lifestyle modification Smoking cessation counseling Nutrition and dietary counseling Stress management Psychosocial improvement Referral and follow up Follow-up scheduled physician visits Continuity of physical activity Continue community and social activities

9 PHASE II CARDIAC REHABILITATION Schematic exercise training and different modalities Initial stretching Warm up Stretching Treadmill Arm ergometer Bicycle ergometer Seated elliptical Weights/resistance exercises Cool down

10 HYPOTHESIS Patients with CAD with no prior surgical intervention will benefit more than post CABG patients from an outpatient Cardiac Rehab Program

11 RETROSPECTIVE ANALYSIS OF EXERCISE PROGRAM The patients exercise data from the outpatient cardiac rehabilitation will be retrospectively analyzed and compared with those from CABG and CAD patients Patients in the CAD group include patients with STEMI, NSTEMI, PCI, and Stable Angina We will look into the data of the patients in CR who were consistent in their rehab program and had a minimum of 18 or more sessions We plan to obtain results from a total of n= 50 patients in each group Calculate the mean age of CABG patients and CAD patients The average attendance of sessions for each group

12 PRE AND POST EXERCISE RESULTS PRE AND POST EXERCISE DATA The pre and post-6 minute walk test in the CABG group vs. CAD group The pre and post exercise tolerance in minutes in CABG group vs. CAD group The average metabolic equivalent (METS) in each group will be compared in initial session and terminal session in each modality of exercise The pre and post questionnaire of Ferrans and Powers score to assess the psychosocial and overall wellness of individual

13 Means test Paired t test STATISTICAL ANALYSIS

14 FUTURE GOALS CONCLUSION Currently there are studies that show documented improvements in hypertension, insulin resistance, dyslipidemia and inflammatory markers, with continued physical activity in patients with CAD 6, 7, 8 However our study is primarily focused on quantifying the exercise data comparing CABG and CAD groups. FUTURE PLAN IRB approval Data collection

15 QUESTIONS

16 REFERENCES 1. Quantity and quality for exercise for developing and maintaining Cardiorespiratiory, Musculoskeletal and Neuromotor Fitness in apparently Healthy Adults. 2. Lee IM, Rexrode KM, Cook NR, Manson JE, Buring JE. Physical activity and coronary heart disease in women: is no pain, no gain passe? JAMA. 2001;285(11): US Department of Health and Human Services Physical Activity Guidelines for Americans [Internet]. Washington (DC): ODPHP Publication No. U [cited 2010 Oct 10]. 4. American College of Sports Medicine. ACSM s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia (PA):Lippincott Williams & Wilkins; p Durstine JL, Grandjean PW, Davis PG, Ferguson MA, Alderson NL, DuBose KD. Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. Sports Med. 2001;31(15): Durstine JL, Grandjean PW, Cox CA, Thompson PD. Lipids, lipoproteins, and exercise. J Cardiopulm Rehabil. 2002;22(6): Johnson JL, Slentz CA, Houmard JA, et al. Exercise training amount and intensity effects on metabolic syndrome (from studies of a targeted risk reduction intervention through defined exercise). Am J Cardiol. 007;100(12): Simpson ME, Serdula M, Galuska DA, et al. Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, Am J Prev Med. 2003;25(2): Larry F. Hamm, Bonnie K. Sanderson, Philip A. Ades, et al. Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update. Journal of Cardiopulmonary Rehabilitation and Prevention 2011;31: Liu-Ambrose T, Khan KM, Eng JJ, Lord SR, McKay HA. Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities. Gerontology. 2004;50(6): Liu-Ambrose T, Donaldson MG, Ahamed Y, et al. Otago home based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Am Geriatr Soc. 2008;56(10): Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized trials. Am J Med. 2004; 116: Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, Gibbons RJ, Grundy SM, Hiratzka LF, Jones DW, Lloyd-Jones DM, Minissian M, Mosca L, Peterson ED, Sacco RL, Spertus J, Stein JH, Taubert KA. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011: published online before print November 3, 2011, /CIR.0b013e318235eb4d.