No description available.

No description available.

The typical cardiac surgery patient is increasing in age and level of frailty. Frailty can be defined as an increased vulnerability to stressors due to decreased physiological reserve. Previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) programming on surgical outcomes. However, the link between pre-operative frailty and post-operative CR completion is unclear. The purpose of this study was to determine if pre-operative frailty status impacts CR completion post-operatively. A total of 114 cardiac surgery patients with an average age of 71 years were included in the analysis. CR completers were significantly less frail than CR non-completers at baseline based on the Clinical Frailty Scale (CFS; p=0.01), Modified Fried Criteria (MFC; p=0.0005), Short Physical Performance Battery (SPPB; p=0.007) and the Functional Frailty Index (FFI; p=<0.0001). The change in frailty status from baseline to 1-year post-operatively was not statistically different between CR completers and non-completers; CFS (p=0.90), MFC (p=0.70), SPPB (p=0.06) and FFI (p=0.07). However, the MFC frailty domains of cognitive impairment (p=0.0005) and low physical activity (p=0.04), in addition to the FFI physical domain of frailty (p=0.009), did significantly improve among CR completers when compared to non-completers. CR attendance measured by swipe card access did not correlate with frailty modifications. Collectively, these data suggest that participants deemed to be frail at the pre-operative time point attend and complete CR less frequently than non-frail participants. Furthermore, CR completion does not appear to modify frailty status overall; although, some frailty domains appear to be more sensitive to change than others. / February 2017

Studies have indicated that weight gain, and being overweight, are risk factors for the development of cardiovascular disease. Weight management is particularly intense in cardiac rehabilitation (CR) settings where the majority of participants are medically defined as overweight or obese and often have co-morbid risk factors. CR programs in Canada focus primarily on cardiovascular fitness, but have extended their program interventions to address cardiac risk factor modification, including diet management and weight loss. Health-related research has indicated that on average, CR participants show weight neutrality (no change from baseline weight) upon CR program completion. Prior to this study there was no substantive qualitative data exploring why this occurs. This doctoral study was a concurrent analysis of a larger funded qualitative study that explored the everyday practices of people with heart disease and type 2 diabetes who were participating in one of three large urban CR programs. A total of 33 participants were enrolled in the study (17 men and 16 women). Data was collected through the use of in-depth interviews, an activity journal, and field notes. Data analysis used sociologist Chris Shillings’ work related to body projects and corporeal realism in order to explore themes related to body size, diet management, and weight loss. Study results pointed to the importance of recognizing the role of social practice in health behaviour change, and the role of social discourses in determining how healthy bodies should look and act. Participants described how their social worlds shaped their eating practices, and relayed accounts of attempting to integrate their CR prescription into their daily routines. These findings suggest that a more nuanced approach to CR programming that takes into account the medical and social influences at work on CR participants while they attempt to modify health behaviours, may further inform the development of future CR weight loss and diet programming.

Studies have indicated that weight gain, and being overweight, are risk factors for the development of cardiovascular disease. Weight management is particularly intense in cardiac rehabilitation (CR) settings where the majority of participants are medically defined as overweight or obese and often have co-morbid risk factors. CR programs in Canada focus primarily on cardiovascular fitness, but have extended their program interventions to address cardiac risk factor modification, including diet management and weight loss. Health-related research has indicated that on average, CR participants show weight neutrality (no change from baseline weight) upon CR program completion. Prior to this study there was no substantive qualitative data exploring why this occurs. This doctoral study was a concurrent analysis of a larger funded qualitative study that explored the everyday practices of people with heart disease and type 2 diabetes who were participating in one of three large urban CR programs. A total of 33 participants were enrolled in the study (17 men and 16 women). Data was collected through the use of in-depth interviews, an activity journal, and field notes. Data analysis used sociologist Chris Shillings’ work related to body projects and corporeal realism in order to explore themes related to body size, diet management, and weight loss. Study results pointed to the importance of recognizing the role of social practice in health behaviour change, and the role of social discourses in determining how healthy bodies should look and act. Participants described how their social worlds shaped their eating practices, and relayed accounts of attempting to integrate their CR prescription into their daily routines. These findings suggest that a more nuanced approach to CR programming that takes into account the medical and social influences at work on CR participants while they attempt to modify health behaviours, may further inform the development of future CR weight loss and diet programming.

Cardiac rehabilitation (CR) is recommended for those living with heart disease, however adherence is suboptimal. The home program (HP) model of care is as clinically effective as traditional programs (TP), however little information exists about the HP&rsquo;s effect on adherence. The objectives of this thesis were to 1) compare adherence of patients in a HP and TP model of CR. 2) To characterize self-regulatory self-efficacy (SR-SE) in a CR HP and 3) to explore the reasons for non-completion of a HP. Study 1 showed adherence to be similar between the TP and HP. Study 2 showed that SR-SE was high throughout the HP for completers, but dropped in those who did not complete the program. The HP is a good alternative for those unable to attend a TP; however those with low SR-SE may require further interventions to help them complete their program.

Cardiac rehabilitation (CR) is recommended for those living with heart disease, however adherence is suboptimal. The home program (HP) model of care is as clinically effective as traditional programs (TP), however little information exists about the HP&rsquo;s effect on adherence. The objectives of this thesis were to 1) compare adherence of patients in a HP and TP model of CR. 2) To characterize self-regulatory self-efficacy (SR-SE) in a CR HP and 3) to explore the reasons for non-completion of a HP. Study 1 showed adherence to be similar between the TP and HP. Study 2 showed that SR-SE was high throughout the HP for completers, but dropped in those who did not complete the program. The HP is a good alternative for those unable to attend a TP; however those with low SR-SE may require further interventions to help them complete their program.

No description available.

Background: Exercise-based cardiac rehabilitation (CR) is considered routine practice for patients following an acute cardiac event or surgical intervention. Although there is a seemingly strong evidence base supporting it for patients with chronic heart failure (CHF), provision in the UK remains poor for this patient group. In addition, data for CHF patients reported in key CR reviews and meta-analyses are not a true representation of the UKs CHF population. The transferability of current evidence into actual practice settings in the UK therefore remains incongruous. Rationale and aims: Study outcomes have typically included an increase in VO2 peak/ VO2 max, a decrease in natriuretic peptides, improved left ventricular function and improved health related quality of life (QoL). Access to facilities and equipment, such as cardiopulmonary exercise testing equipment is limited in the UK for the majority of CR services thus an alternative means of assessment and exercise prescription is required. The recommended alternative for testing CHF patients is the six-minute walk test (6MWT); this requires a given space and a full practice test, the latter which adds to valuable clinical and staff time available. Methods: The first set of studies of this thesis therefore investigated two adapted assessment procedures for use with CHF patients: i. the use of a shorter practice walk test of two minutes vs six minutes prior to a 6MWT and ii. the use of the space saving Chester step test with an adapted lower step height protocol to accommodate the anticipated lower fitness in CHF (4-inch vs 6-inch). Having determined a more practical and efficient means of assessing exercise capacity in CHF patients, this thesis then used the 6MWT to evaluate the efficacy of a typically recommended 12-week programme (for the UK) of exercise-based rehabilitation. It was the aim of this PhD to also combine the use of the Chester step test with cardiopulmonary measures as a corresponding physiological outcome in a sub-sample of participants; however due to resource problems, only validation of the low-step protocol was possible. In the main intervention study, the efficacy of a 12-week course of supervised moderate intensity exercise in CHF patients (ejection fraction <44%, NYHA class II to III) was then evaluated. For purposes of evaluating safety and recovery of any acute myocardial stress induced by exercise in CHF, a sub-group study was performed to evaluate the influence of an acute exercise session on two-day post-exercise levels of circulating NT-proBNP. Results: In this current suite of studies, participants were more representative of the UK CHF population than typically reported in the current evidence. Their profile involved a median age of 76 ± 16 years (mean: 67 years and range: 30 to 84 years). 98% of whom were prescribed beta-blockers, 66% were diagnosed with atrial fibrillation and 98% had two or more co-morbidities. Study 1 (Chapter 3a) verified the efficacy of a two-minute practice walk in comparison to the recommended six-minute practice walk prior to performing a baseline 6MWT in patients with CHF. Study 2 (Chapter 3b) demonstrated that a 4-inch Chester step test is a reliable assessment when space is an issue, but the criterion validity of the actual oxygen costs at each stage compared with those estimated in healthy populations were significantly lower than recommended estimations from healthy populations. Study 3 (Chapter 4) revealed individual variability in the acute response of NT-proBNP release to exercise that is worthy of further study. However the NT-proBNP data overall did not suggest a need for ‘rest days’ between exercise training sessions. The main intervention study (Study 4, Chapter 5) demonstrated a significant improvement in 6MWT performance responses, compared with control, where an increased walking distance of 25 m (p < .0001) was coupled with a reduction in heart-rate-walking speed index (T1 16.3 ± 7.3 vs T2 15.3 ± 8.7 beats per 10 walked; p < .0001). Perceptually, patients were walking faster for the same rating of perceived exertion (RPE 12 to 13). This improved aerobic functioning coincided with an improved NYHA class (T1 2.3 ± .5 vs T2 1.8 ± .6; p < .0001); however there was no change in resting NT-proBNP levels after 12 weeks. Patients in the “control group” who then went on to be offered the same 12-week intervention achieved similar outcomes, but delaying their commencement of an exercise programme by 12 weeks negatively impacted on participation uptake. Key findings and conclusions: These results have demonstrated that exercise training in CHF can lead to an improvement in both physical and perceived functioning (NYHA class). In light of some previous studies showing decreases in BNP following an exercise programme and others like this one showing no change, further questions are raised about the effect of different types and doses of activity being offered to CHF patients and the responsiveness to training of different types of patients (disease severity and demographics). The nature of the cross-over design of this study revealed that delayed commencement of exercise negatively affects participation uptake by patients, which supports current UK standards in aiming for early referral to CR.

Contexte : Les maladies cardiovasculaires dont l'angine et l'infarctus sont un fléau grandissant pour les Canadiens. En 2008, les femmes canadiennes sont 16% plus susceptibles de succomber à un infarctus que les hommes. Pour améliorer la qualité de vie des patients souffrant d'angine ou d'infarctus, la perfusion transluminale per cutanée (PTCA) s'avère le traitement de choix. Suite à celle-ci, il est recommandé d'effectuer des modifications d'habitudes de vie. Cependant, les femmes cardiaques devant modifier leurs habitudes de vie ont une perception de la maladie différente des hommes mais les caractéristiques présentes lors de changement d'habitude de vie ne sont pas connues. Le nouveau contexte de la PTCA n'est pas adapté à cette population grandissante. Objectif: Décrire les caractéristiques présentes lors d'un changement dans le processus de modification de comportements à risque des femmes ayant subi une PTCA. Méthodologie : Cette étude descriptive. L'échantillon non probabiliste de convenance est composé de 22 femmes (X= 65.4 ans) ayant subi une PTCA au CHUS-Fleurimont. Toutes les participantes complétaient le même questionnaire à 1- 2 semaines (Tl) et à 4 mois post-PTCA (T2) lors d'une rencontre à leur domicile. Les questions évaluaient les trois habitudes de vie en lien avec l'alimentation, l'activité physique et le tabagisme ainsi que les principales caractéristiques pouvant être présentes lors d'une modification de comportement à risque (soutien des proches, perception de la maladie, fatigue, dépression, stress, optimisme, variables sociodémographiques, facilitants et barrières perçues par les participantes). Des statistiques descriptives ont été réalisées. Des tests non paramétriques (a = 0.05) ont été faits pour comparer les participantes entre le Tl et le T2 (Wilcoxon) puis des sous-groupes de celles-ci en fonction de leur motivation à modifier leurs comportements à risque à T2 (Mann-Withney et Krustall-Wallis). Les données qualitatives ont été regroupées par catégorie à l'aide d'une analyse de contenu. Résultats : Les femmes de l'étude identifient plus de symptômes de la maladie, sont plus fatiguées (p=0.01) et plus stressées (p=0.04) au Tl (p=0.000) qu'au T2. Celles-ci perçoivent leur maladie cardiaque comme chronique (p=0.006) et ont une meilleure compréhension de celle-ci (p=0.007) 4 mois suivant la PTCA. Le soutien des professionnels de la santé ainsi que les programmes de réadaptation cardiaque sont perçus comme des facilitants à la modification de comportement au même titre que celui de la famille et des amis. Les symptômes physiques (douleurs aux jambes, au dos, etc.) et les symptômes dépressifs sont identifiés comme des barrières à la modification de comportement. Conclusion : Cette étude a permis de faire ressortir certaines caractéristiques présentes tant en post-PTCA que lors d'un changement dans le processus de modification de comportement. D'autres études doivent cependant être conduite afin de valider ces caractéristiques auprès d'un plus grand échantillon et ainsi pouvoir proposer des interventions infirmières d'enseignements solides et structurés à partir de solides assises sur les caractéristiques associées aux femmes ayant subi une PTCA.