No description available.

No description available.

Purpose: There is a growing evidence based for the benefits of exercise as part of cardiac rehabilitation (CR), yet uptake in heart failure (HF) patients is low, with as few as of 1 % of patients referred for CR. Many factors contribute to this situation; however the mode of exercise, which is often carried out in a standing position, is likely to be a significant deterrent in moderate to severe HF patients who are breathless at rest. Chair-based exercise (CBE) could be an alternative method for enabling moderate to severe HF patients to participate in exercise training, but such exercise is less well researched in the literature. Our study was therefore aimed at developing appropriate exercises and an exercise prescription protocol, and evaluating the utility for patients during CBE programme. in addition, the thesis also aimed to evaluate the reliability of assessment and outcomes during CBE and to establish the extent of any relationship between baseline characteristics and those derived from exercise testing and clinical measures. Methods: Two studies have been conducted. The fIrSt study was a feasibility study, involving twenty cardiac patients and the second study was the main CBE study, involving thirty HF patients. Conventional cardiac patients were recru ited from a coronary support group and HF patients were recruited from an NHS HF service and HF patient support group. The main CBE study data was used for the development of e BE, reliability, assessment and exercise prescription. Both studies involved sub-maximal and steady state testing for ann and leg. The feasibi lity study, in contrast to the eBE study, involved testing while sitting and standing, while the eBE study included additional testing such as a BNP test, 6MWT, and need to answer a Total Activity Measure 2 (TAM 2) questionnaire. The CBE study participants were also asked to wear an accelerometer for a week to determine the extent of the validity ofthe eBE in a new physical activity questionnaire. Results: The findings showed that the eBE programme gave a good range of intensity for HF patients. The study found that the level of intensity was as suggested by the guidelines. The measurement exercise variables during eBE testing and BNP testing was highly reliable, using intra-class correlation coefficient (ICC), limits of agreement (LOA) and standard error of measurement (SEM). The physical questionnaire showed less reliable and less valid results for the HF patient population. In add ition to these findings, 6MWT turned out to be most powerful tool for predicting eBE levels, while NYHA and BNP tests could be used as alternative methods if the patients are not able to perform fitness testing. Conclusion: The eBE programme is safe and offers a range of intensity levels and is suitable to the abi lity range of most patients with HF.

No description available.

Adopting a phenomenologically inflected approach, which recognizes the role of the body in the constitution of experience, this thesis examines the experience of heart disease and the process of ‘narrativization’ of the illness experience. The body, as the locus of intentionality, is given in experience, yet at the same time it is constructed as an object of medicine. The body of experience, it is argued, exists in tension with the textual body of medical science. This thesis traces a brief history of the medicalisation of the body, from the anatomy theatres of early modern Europe, to the clinical encounter in its various forms; from the doctor-patient relationship to the nurse-patient interaction in the cardiac rehabilitation clinics of today. It is argued that ‘illness narratives’ represent more than a lay response to objectifying medical discourses and practices. Such narratives are in fact constitutive of experience and, as such, are exemplifying practices. It is also argued that the body is possessed of a memory and, to illustrate this further, I present research conducted among people who have experience of heart disease, surgery, and cardiac rehabilitation. This ‘memory of the body’ is that which, to some extent, is lost in the dehumanising spaces of medical science, but I assert that it is by way of the body’s remembered capacities that selfhood is re-established. An issue that drives this thesis is the question of whether remaking the body, during the difficult process of recovery and cardiac rehabilitation, entails a remaking of the self. Illness, as a medicalised phenomenon, disrupts the biographical trajectory of the sick person, severing affective ties to family, friends and community. It effectively dislocates the experience of the embodied person. This thesis is concerned principally with the means by which the person relocates himself or herself.

Aims: The primary aim of this randomised-controlled trial was to evaluate the effect of an exercise consultation (experimental condition) compared with standard exercise information (control condition) on maintenance of physical activity six and 12 months following completion of a phase III hospital-based exercise programme. Secondary aims included assessing the effect of an exercise consultation compared with exercise information on physiological and psychological variables at six and 12 months. Conclusions: This study demonstrated that the exercise consultation was more effective than exercise information in maintaining self-reported physical activity for 12 months after completion of a phase III exercise programme. However, the change in CSA accelerometer readings over the 12-month study period did not parallel the significant decrease in self-reported physical activity observed in the control group. The exercise consultation was not effective in maintaining exercise capacity for 12 months after completion of phase III. Significant decreases in peak VO2 from baseline to 12 months were observed in both groups. In contrast, an improvement in the VO2 at the lactate threshold, which is an index of submaximal endurance capacity, was recorded in the experimental group compared to the control group from baseline to follow-up. Finally, the exercise consultation had no significant effect on processes of exercise behaviour change, lipid profile and psychological function. These variables were normal at baseline and were maintained over the study period in both groups. The results of this study demonstrate that the exercise consultation may be an effective intervention for maintaining physical activity after completion of phase III hospital-based exercise programmes. The exercise consultation is a minimal intervention that could be delivered by physiotherapists to patients at the end of phase III or by British Association of Cardiac Rehabilitation (BACR) trained exercise instructors to patients in phase IV.