Background: People from ethnic minority immigrant groups living in host countries are known to have higher risk factors for cardiovascular diseases. The role of acculturation, or assimilation into a different and dominant culture, is often studied from social and medical views when focusing on individuals diagnosed with cardiovascular diseases and their recovery after cardiac events. However, the effects of the complex roles of acculturation and religious coping on these individuals are rarely considered in the research. There is limited knowledge regarding the complex roles of acculturation and religious coping in adopting healthy lifestyle behaviours and managing stress among individuals with cardiovascular diseases from Arab communities in the Ottawa region. This research project’s general purpose was to explore and understand the complex roles of acculturation and religious coping through the experiences of individuals diagnosed with CVD from Arab communities in the Ottawa region. Objectives: The specific objectives were to 1) identify and understand the challenges among Arab immigrants related to acculturation and religiosity in adopting healthy lifestyle behaviours and managing stress; 2) measure and describe the levels of religious beliefs as well as religious coping strategies, acculturation, perceived stress, and healthy lifestyle behaviours among Arab individuals living in the region of Ottawa, Ontario, Canada who have been diagnosed with cardiac events or who are at high risk for cardiovascular diseases; and 3) explore the role of acculturation and religious coping in shaping male Arab individuals’ lived experiences after a cardiac event and to explore their ways of understanding lifestyle behaviours and cardiac rehabilitation during recovery. Methods: A mixed-method approach was adopted in this research, which included three separate studies: Study 1 was a qualitative study (views of key informants with first-hand knowledge) in which three face-to-face focus groups were conducted with 17 Arab health promoters; Study 2 was a cross-sectional survey study was conducted with 63 individuals from local Arab communities who had been diagnosed with cardiac events or who were at high risk for cardiovascular diseases; and Study 3 consisted of a phenomenographic qualitative study, semi-structured in-depth interviews with male Arab individuals (N=10), selected from Study 2, who identified themselves as having had cardiac events while living in Canada. Results: From the perspective of Arab health promoters, there was an overlapping between various aspects of acculturation and religious beliefs that may have impacted the healthy lifestyle of Arab immigrants. These challenges were coded in four themes: “Culture first!”: dominant influence of home country culture; “Religiosity alone does not make you healthy!”: limited religious influence; “It is not easy!”: difficulties adapting to the Canadian lifestyle; and “We are not young!”: generational differences in adopting a healthy lifestyle. Findings from the survey study indicated that most participants were oriented more toward their Arabic culture than Canadian culture. Participants tended to be religious, and their nutritional behaviours were healthier than physical activity behaviours. However, age, gender, and interestingly, length of time living in Canada did not affect the participants’ results in any of the questionnaires. Based on lived experiences of 10 participants in the interview study, five core themes were identified: “Stressful events or cardiac events!”: acculturative stress effects; “It was a dreamlike event!”: dismissing perceptions of cardiac events; “recognizing risk factors is not enough to avoid them”: perceived threat; religious coping outcomes: satisfaction and fatalism; Cardiac Rehabilitation programs: who refers and who participates. Conclusion: This dissertation showed that acculturation level plays an essential role in Arab immigrants’ beliefs and behaviours regarding their health status and their experiences in preventing cardiovascular diseases risk factors or in recovery after cardiac events. Religious coping seems to be a way for less acculturated Arab immigrants to manage stress and mental burdens and find internal peace and satisfaction. From the perspective of Arab health promoters, some religious or cultural beliefs may be barriers to engaging in physical activity, especially for women and older people, and these barriers may be exacerbated by acculturative stress. Religiosity may also play an essential indirect role in managing stress through socialization, family support, and the adoption of coping strategies. Arab individuals living in the region of Ottawa, Ontario, Canada, who have been diagnosed with cardiac events or who are at high risk for cardiovascular diseases may have been more religious and less acculturated in Canadian society. Their lifestyle health behaviours related to physical activity and nutrition may have been influenced by their health status, religious beliefs, and the practices or traditions of their culture of origin. Stress and mental burdens while living in Canada reflected negatively on Arab male individuals’ experiences with cardiac events. Stress was perceived as a potential cause of cardiac events and a factor leading to low self-efficacy in changing lifestyle behaviours. There is a need to promote healthy lifestyle messages and raise awareness about cardiovascular diseases risk factors among Arab communities. Future research is needed to design culturally adapted cardiac rehabilitation programs for Arab individuals and to evaluate the effectiveness of interventions with both physical and mental health components.

The purpose of this study was to discern the effectiveness of Cardiac Rehabilitation/ Secondary Prevention Programs (CR/ SPP’s) by evaluating increased functional capacity in the form of MET (metabolic equivalent) scores post-myocardial infarction (MI) or heart attack. The Duke Activity Status Index (DASI) survey is administered as part of the Standard Operating Procedure (SOP) for participation in the Secondary Prevention Program. Criterion for the research included patients 65 and older, with a history of one myocardial infarction, and had completed all 36 sessions of CR. The scores from 11 SPP surveys were analyzed and compared in three time increments from sessions 1-18 (initial, or “pre”), sessions 19-36 (“pan”), and sessions 1-36 (“post”). A total of 11 (n=11) surveys were collected and analyzed at The Computing and Statistical Technology Laboratory in Education (CASTLE) in the Teaching Academy on UCF Main Campus. Results from the data showed mean MET scores of 6.21 at session 1, 7.59 at session 18, and 8.15 at session 36. The mean changes over time represented in METs were 1.38 (1), .56 (18), and 1.93 (36). Percent changes over time were 27% (1), 8% (18), and 36% (36). This study showed increased functional capacity over time and will improve program design in terms of frequency and duration.

Cardiac rehabilitation (CR) exercise training, which traditionally involves the prescription of moderate intensity continuous exercise, can slow the progression of heart disease and improve cardiorespiratory fitness (CRF). Cardiac function is typically investigated using calculations of ejection fraction (EF) from echocardiography, yet EF measures do not provide information about the unique twisting motion of the heart. Novel measures of cardiac function, such as LV twist, myocardial performance index (MPI) and global longitudinal strain (GLS), may provide additional information about changes in LV mechanics associated with exercise training for individuals with coronary artery disease (CAD). The aims of this study were to investigate the changes in cardiac function, using both standard and novel measures, at baseline (0 weeks; T1), post-initial training (4 weeks; T2), and post-training (12 weeks; T3) in response to either stair climbing-based high intensity interval training (STAIR) or traditional moderate intensity continuous training (TRAD). We recruited 16 individuals with CAD (61±7years; 1W) and randomized them into TRAD and STAIR groups (n=8/group). Standard (CRF and EF), and novel (LV twist, MPI, GLS), measures of cardiovascular function were assessed at all three timepoints. CRF improved in both groups, after 4 and 12 weeks (STAIR: T1:22.1±4.2, T2:24.7±4.9, T3:25.4±5.2 and TRAD: T1:22.8±2.5, T2:25.2±4.9, T3:26.0±5.0 mL/kg/min; P<0.005) of CR exercise. We observed an increase in apical rotation (P=0.01) and LV twist (P=0.03), but no changes in either traditional (EF P=0.15), or novel (MPI P=0.19; GLS P=0.81) measures of cardiac function over time, in either group. It is possible that the relatively short training period (12 weeks) was not sufficient to result in significant changes in cardiac function, despite improvements in CRF. Future research should assess both standard and novel indices of cardiac function over longer exercise training periods to determine the ideal indices for tracking changes over time with interventions in this population. / Thesis / Master of Science (MSc) / Cardiac rehabilitation exercise is an important part of recovery after a heart attack, and it has been shown to improve heart function measured using standard ultrasound assessments. Studies have suggested that novel measures of heart function may be more sensitive in comparison to these standard ultrasound measures, yet these novel measures have not been examined in individuals completing stair-climbing based high intensity cardiac rehabilitation exercise training. This work examined the changes in both novel and standard ultrasound measures of heart function after either stair climbing-based high intensity interval training or traditional moderate intensity exercise training in individuals who have heart disease. While this study found that both stair climbing based high intensity interval training and traditional cardiac rehabilitation both resulted in increases in cardiorespiratory fitness after 12 weeks of training, no changes were observed in any of the standard measures of heart function. Supporting the concept that novel measures of heart function might be more sensitive, as some training associated changes were observed in the novel measures of heart function.

Twenty subjects were audio and video taped during their exercise leadership examination. The tapes were used to code the interactions that occurred between the exercise leaders and the participants in the simulated cardiac rehabilitation exercise session using an interaction analysis system developed specifically for this physical activity setting group. The system identified interactions that could occur during the warm-up, stimulus, and cool-down phases of the session. The tapes were coded using the Datamyte 801 Observational Recorder. The phases of the sessions were coded individually. A frequency count was made as the interaction categories occurred. The frequencies were converted into rates of interaction (f•min⁻¹) for comparison. The mean rates of interaction were low for the phases and overall (warm-up= .38/min; stimulus= .59/min; cool-down= .29/min; total= .46/min). The individual subject's rates of interaction were all less than 1 interaction per minute (minimum= .28/min; maximum= .72/min). Related t-tests across category facets between phases showed the instruction and explanation facets in the warm-up phase differed significantly from the same facets in the stimulus phase. The compliance facet differed significantly in the stimulus phase from the compliance facet in the other two phases. The monitor facet in the stimulus phase differed significantly from the monitor facet in the cool-down phase. There was no significant differences across facets between the warm-up and cool-down phases. Higher rates of interaction occurred more frequently in the stimulus phase. The coding showed the differences in the interactions of the exercise leaders in the different phases in the simulated exercise session. The low rates of interaction suggest that the exercise leaders may have been reactive to the specific examination situation in which these data were collected. / M.S.

Quality of life (QOL) is an extremely important concept in the promotion of appropriate and successful health care programmes. However, there is a need for conceptual clarity to unravel the complexities of terminology in different medical conditions and the underlying factors that have a direct influence on the quality of life for people with coronary heart disease. The primary objective of this thesis is to propose a theoretical model which specifies the domains of QOL and the interrelationships among these domains. The objectives of the study are four-fold: (1) To examine whether a cardiac rehabilitation programme has a beneficial effect on cardiac heart disease patients; (2) To evaluate the primary components of generic health-related quality of life assessment tools for people with coronary heart disease; (3) To identify the main factors governing disease-specific health-related quality of life assessment tools amongst patients with coronary heart disease; (4) To examine a variety of conceptual models of QOL and to determine their relevance to cardiac patients. First, in order to provide conceptual clarity, a comprehensive review of QOL measures was undertaken. Second, data was collected on a cardiac rehabilitation programme in a county hospital using Short Form-36 (SF-36) and Quality of Life for Myocardial Infarction (QLMI) instruments. This data was analysed using a number of techniques including (l)meta-analysis; (2)discriminant analysis; (3)factor analysis and (4)structural equation modelling. Analysing the data in this way enabled the development and clarification of the specific domains of the quality of life model. Meta-analysis involved pooling the results of several studies, these were then analysed to provide a systematic, quantitative review of the data. The results found that the related studies did not have consistent outcomes to support the positive effects of a cardiac exercise rehabilitation programme on quality of life in coronary patients. Findings from the SF-36 indicate that older people with coronary heart disease gain more pain relief than their younger counterparts. After a cardiac exercise rehabilitation progranune, statistically significant improvements occurred in physical function, social function, role limitation/physical, energy/vitality, body pain, and change in health-related dimensions of quality of life. The first-order five domains model includes the symptom domain, the restriction domain, the confidence domain, the self-esteem domain and the emotion domain. This model represents an appropriate model of quality of life for people with coronary heart disease compared to the three-domain model and the four-domain model. In terms of the second-order QOL model, the five-domain model also has an adequate fit to the data. According to the result of structural equation modelling, three models, including the null model, the alternative model I and the alternative model n, did not fit the data perfectly. However, the construct of full latent variable model gradually increased the fit statistics from the null model to the alternative model I and from the null model to alternative model n. Therefore, it can be concluded that the paths and indicators of the three models need to be further adjusted in order to provide a more appropriate model. Nevertheless, this is a first trial to examine a full model of quality of life for people with coronary heart disease using the structural equation analyses. As such, this study provides a new approach to examining the difference between empirical studies and theoretical approaches.

Les maladies cardio et cérébro-vasculaires représentent la première cause de mortalité et de handicap dans le monde. Du fait des progrès thérapeutiques dans la prise en charge de ces pathologies à la phase aigüe, le nombre de patients porteurs de formes chroniques de ces affections limitant leurs capacités d’effort est en augmentation constante. La problématique de ce travail de thèse s’articule autour de l’utilisation des tests de marche standardisés dans l’évaluation des capacités d’effort des patients porteurs de pathologies coronariennes. Nous avons dans un premier temps rappelé les notions de handicap et de qualité de vie appliqués aux maladies chroniques, et la nécessité d’évaluations fonctionnelles spécifiques pour en apprécier le retentissement et l’évolution. Puis nous avons fait le point sur les modalités actuelles de la réadaptation cardiaque, en développant plus particulièrement la place de l’activité physique. Nous avons entrepris ensuite l’étude des sollicitations physiologiques induites par un test de marche rapide de 200 mètres (TMR200) chez des sujets âgés sains, puis sur une population de patients coronariens. Ce test s’est avéré bien toléré, et correspond à une intensité d’exercice intermédiaire entre le premier seuil ventilatoire et les capacités maximales d’exercice. Il apparaît ainsi particulièrement intéressant pour apprécier les capacités à effectuer des efforts fréquents de la vie quotidienne, plus intenses que ceux correspondant à la marche à vitesse spontanément adoptée au cours du classique tes de marche de 6 minutes (correspondant à un effort essentiellement aérobie). Par la suite nous avons cherché à définir la différence minimale cliniquement pertinente du test de marche (MCID) de 6 minutes (TM6) et du TMR200, afin de mieux interpréter les progrès fonctionnels des patients intégrés dans les programmes de réadaptation cardiaque après un syndrome coronarien aigu. Cette dernière a été estimée à 25 mètres pour le TM6. Enfin, nous avons étudié l’intérêt de ces tests de marche dans l’aide à l’individualisation de la prescription de l’intensité du réentraînement chez les patients coronariens. Ces modalités permettent aux patients d’être plus souvent proches des intensités d’entraînement conventionnellement préconisées, en aboutissant à des résultats comparables, sans la nécessité de pratiquer un test d’effort maximal mobilisant des moyens significatifs en personnel et en matériel. Au total, ce travail apporte des arguments pour l’utilisation en pratique clinique courante de ces tests de marche standardisés. Ils apparaissent complémentaires dans le cadre de l’évaluation objective des capacités fonctionnelles et de la qualité de vie perçue des patients âgés et coronariens. Ces résultats ouvrent des perspectives pour poursuivre l’étude de leurs propriétés métrologiques et de leurs applications cliniques au cours des affections chroniques incapacitantes. / Cardiovascular and cerebrovascular diseases remain the first cause of mortality and handicap in the world. With the improvements in the management of the acute phase, the number of patients with limited exercise capacity due to chronic cardiovascular disease is increasing. The aim of this thesis was to conduct a thorough study of the use of standardized walk tests to assess exercise capacity in coronary artery disease patients. We first explain the concepts of handicap and quality of life in chronic diseases, and the need for functional evaluations in order to assess their impact and evolution. We then present the current modalities of cardiac rehabilitation, emphasizing the importance of physical activity. We studied the physiological demands of a 200-meter fast-walk test (200MFWT) in healthy elderly subjects, and in coronary artery disease patients. This test was well tolerated, and corresponds to an effort intensity lying between the ventilatory threshold and maximal exercise capacity. It therefore appears interesting to assess the capacities of an individual to perform activities encountered in daily life that are more intense than walking at a self-selected comfortable speed, as during the 6-minute walk test (6-MWT) (corresponding to a moderate submaximal intensity solicitation, mainly aerobic). We then investigated the minimal clinically important difference of the 6MWT and 200MFWT, in order to better appraise functional improvements in patients undergoing cardiac rehabilitation after an acute coronary syndrome. This difference has been estimated at 25 metres for the 6MWT. Finally, we studied the interest of using these walk tests to individualize training intensity prescription in these patients. These modalities bring patients closer to the recommended intensity, while leading to results comparable to those of more traditional training programs, without the need for repeated expensive tests. In conclusion, this work supports the use of these standardized walk tests in routine clinical setting. They bring complementary information in the assessment of functional capacity and perceived quality of life in elderly patients and those with coronary artery disease. These results are a basis for further investigations regarding their metrological properties and clinical applications in various chronic diseases that reduce exercise capacity.

A Reabilitação Cardíaca (RC) composta de exercícios puramente dinâmicos (EPD) tem sido fortemente recomendada para pacientes com doença arterial coronariana (DAC). Contudo, os exercícios resistidos devem ser incluídos como parte de um programa formal, uma vez que contribuem para promover ganhos nas atividades de vida diária e assim na qualidade de vida (QV). Estudos recentes têm mostrado que a magnitude das respostas metabólicas e autonômicas cardíacas durante o exercício resistido dinâmico (ERD) também está associada com a determinação do limiar de anaerobiose (LA), o qual é um importante parâmetro para determinar a intensidade no EPD. Diante disso, não há informações sobre essas respostas metabólicas e autonômicas no ERD, para pacientes com DAC. Adicionalmente, pouco é sabido acerca da avaliação da funcionalidade/incapacidade percebidos por estes pacientes já incluídos em programas formais de RC, podendo ampliar informações para a tomada de decisões neste processo. Portanto, este estudo propõe ampliar o corpo do conhecimento acerca de duas vertentes, sendo uma mais fisiológica e outra abordagem mais ampliada, contendo aspectos bio-psico-sociais, Objetivamos 1) Determinar o LA pela variabilidade da frequência cardíaca (VFC) durante um protocolo de ERD, numa população diagnosticada com DAC, participante de um programa de RC composto somente de EPD; e 2) Aplicar a CIF (Classificação Internacional de Funcionalidade, Incapacidade e Saúde), tendo como base a vinculação da mesma com a QV auto-percebida, com o propósito de investigar se o programa formal de RC pode produzir impacto nos desfechos multidemensionais de funcionalidade e incapacidade. Vinte pacientes (idade: 63±7 anos) com DAC (FEVE: 60±10%), apresentando boa capacidade funcional e bom prognóstico, realizaram um protocolo de ERD incremental no leg-press. O protocolo iniciava em 10% de l-RM (repetição maxima), com subsequêntes aumentos de 10% até a exaustão física. A variabilidade da frequência cardíaca (VFC), através dos indices lineares (rMSSD e RMSM) e não-lineares (SD1, SD2, SD1/SD2), bem como o lactato sanguíneo, foram determinados no repouso e durante o ERD. Funcionalidade e incapacidade do grupo foram avaliadas através da aplicação do Processo de Vinculação entre o SF-36 com a CIF. ANOVA para medidas repetidas, análise de Bland-Altman, coeficientes de correlação de Pearson e estatística descritiva foram empregados. Admitiu-se nível de significância de 95%. Foram encontradas significativas alterações na VFC e lactato sanguíneo a partir de 30% de 1-RM (p<0.05). Análise de Bland-Altman revelou boa concordância entre limiar de lactato (LL) e limiar de rMSSD (LrMSSD), e de SD1 (LSD1). As cargas relativas obtidas (a partir de 1-RM) no LL, LrMSSD e LSD1 não diferiram (29%±5; 28%±5; 29%±5, respectivamente). A vinculação entre o SF-36 e a CIF permitiu detalhar uma relação de \"Funções corporais\" e principalmente as \"Atividades e Participações\" acometidas pela doença, bem como o grau de problemas/prejuízo destas, mesmo após o programa de RC. Concluímos que o uso da VFC durante o ERD poderia ser um método não-invasivo viável na prática clínica para determinar o LA em pacientes com DAC, auxiliando na definição de parâmetros de intensidade de exercício seguros e apropriados. Além disso, a funcionalidade e incapacidade de pacientes coronariopatas, percebidos sob o seu próprio ponto de vista, poderiam ser avaliadas utilizando-se o SF-36 sob o escopo da CIF, adicionando informações complementares ao processo da RC. / Cardiac Rehabilitation (CR) composed of dynamics purely exercises (DPE) has been strongly recommended for patients with coronary artery disease (CAD). However, resistance training should be included as part of a formal program, since they contribute to promote gains in daily activities and thus the quality of life (QoL). Recent studies have shown that the magnitude of the cardiac, metabolic, and autonomic responses during dynamic resistance exercise (DRE) is associated with the determination of the anaerobic threshold (AT), which is an important parameter to determine the intensity during DPE. Therefore, there is no information about these metabolic and autonomic responses in resistance exercise for patients with CAD. In addition, little is known about the assessment of functioning/disability perceived by these patients already included in formal CR programs, which may extend information for decision-making in this processo Therefore, this study proposes to extend the body in the knowledge of two approaches, with a more physiological and other broader approach, containing bio-psycho-social aspects. We aimed to 1) Determine the A T by heart rate variability (HRV) during an DRE protocol in a population diagnosed with CAD who participated in a CR program with DPE only; and 2) Apply the ICF (International Classification of Functioning, Disability and Health), based on the binding of the same with self-perceived QoL (SF-36), in order to investigate whether the formal RC program may have an impact on multidemensionais outcomes of functionality and disability. Twenty men (age: 63±7 years old) with CAD (LVEF: 60±10%), with good functional capacity and good prognosis, underwent a DRE incremental protocol on leg press until maximal exertion. The protocol began at 10% of 1-RM (repetition maximum), with subsequent increases of 10% until maximal exhaustion. Heart rate variability (HRV) indices from Poincaré plots (SD1, SD2, SD1/ISD2) and time domain (rMSSD and RMSM), as well as blood lactate were determined at rest and during PRE. Functioning and disability were assessed by the linking process between the SF-36 and the ICF. ANOVA for repeated measures, Bland-Altman analysis, Pearson correlation coefficients, and descriptive statistics were used for statistical analysis. The significance level accepted was 95%. Significant alterations in HRV and blood lactate were observed from 30% of 1 RM (p<0.05). Bland- Altman analysis demonstrated a consistent agreement between blood lactate threshold (LT) and rMSSD threshold (rMSSDT) and LT with SD1 threshold (SD1T). Relative values of 1-RM in all LT, rMSSDT and SD1T did not differ (29% ± 5 vs 28% ± 5 vs 29% ± 5, respectively). Finally, the assessment of functioning and disability using the SF-36 and ICF, allowed to list in more detail the \"Body functions\" and especially the \"Activities and Participation\" affected by the disease, as well as the degree of problems/impairments of these aspects, even after the RC program. In conclusion, HRV during DRE could be a feasible noninvasive method in clinical settings to determine AT in CAD patients for planning safe and appropriaje exercise intensities during CR. Moreover, the functioning and disability of coronary patients, perceived under their own point of view, could be assessed using the SF-36 under the scope ofthe lCF, adding supplementary information to the CR process.

Introdução: O treinamento físico melhora a capacidade funcional e a qualidade de vida em pacientes com insuficiência cardíaca (IC) crônica. Entretanto, a aderência ao treinamento físico supervisionado é baixa por diversas razões. Como alternativa, o treinamento domiciliar tem sido proposto. Objetivo: Comparar os efeitos de um programa de treinamento domiciliar (domiciliar) com um programa de treinamento supervisionado (supervisionado) sobre a capacidade funcional, comportamento sedentário e qualidade de vida em pacientes com IC crônica ao longo de 12 semanas. Métodos: Este estudo incluiu 23 pacientes com IC (classe funcional da New York Heart Association II e III, fração de ejeção do ventrículo esquerdo 31±6%) randomizados em grupos de treinamento domiciliar (n=11) ou supervisionado (n=12). Durantes 12 semanas os pacientes exercícios aeróbicos (60-70% da frequência cardíaca de reserva): caminhadas para o grupo domiciliar e exercício em cicloergômetro para o supervisionado, combinados ao exercício resistido (50% de uma repetição máxima). No momento basal e após 12 semanas mensuramos variáveis do teste cardiopulmonar, teste da caminhada de seis minutos (TC6M), pressões respiratórias máximas, força muscular do quadríceps e de preensão palmar, atividade física e comportamento sedentário por meio de acelerometria, qualidade de vida e aderência. Resultados: Os grupos domiciliar e supervisionado tiveram altas taxas de adesão, com aumentos (p=0,037) similares no consumo de oxigênio pico (0,8 e 3,7 ml/kg/min, respectivamente, p=0,085), ventilação máxima (11,5 e 15,6 l/min, respectivamente, p=0,775), distância percorrida no TC6M (9% e 5%, respectivamente, p=0,805), força muscular do quadríceps (21% e 11%, respectivamente, p=0,155) e qualidade de vida avaliada por meio do questionário Minnesota Living with Heart Failure (1 e 13, respectivamente, p=0,092). O comportamento sedentário reduziu (p=0,05) nos dois grupos (p=0,472). Entretanto, o treinamento supervisionado foi mais efetivo em melhorar a força muscular inspiratória (p=0,042), o número de passos/dia (p=0,001) e o componente de saúde mental do questionário SF-36 (p=0,001). Conclusões: O programa de treinamento domiciliar pode ser uma alternativa ao treinamento supervisionado para reduzir o comportamento sedentário e melhorar a capacidade funcional e qualidade de vida em pacientes com IC crônica. Entretanto, o treinamento supervisionado, além dos benefícios acima citados para o grupo domiciliar, é superior em aumentar a força muscular inspiratória, número de passos/dia e melhora de aspectos de saúde mental em pacientes com IC crônica, quando comparado ao treinamento supervisionado / Background: Exercise training improves functional capacity and quality of life in chronic heart failure (HF) patients. However, centre-based adherence is lower for several reasons. As an alternative, home-based training has been proposed. Objective: To compare the effects of home-based program (home-based) and centre-based (centre-based) training programs on functional capacity, sedentary behavior and quality of life in HF patients along 12 weeks. Methods: This study included 23 chronic HF patients (New York Heart Association functional class II and III, left ventricular ejection fraction 31±6%) randomized to home-based (n=11) or centre-based (n=12) training programs. Patients underwent a 12-week period of aerobic training (60-70% reserve heart rate): walking outdoor for home-based and supervised cycling for centre-based, both combined with resistance training (50% of one maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test measures, six minute walk (6MW) test distance, maximal respiratory pressures, quadriceps muscle strength, handgrip strength, physical activity and sedentary behavior (accelerometer), quality of life and adherence. Results: Home-based and centre-based had high adherence rate and similar improvements (p=0.037) in peak oxygen consumption (0.8 and 3.7 ml/kg/min, respectively, p=0.085), maximal ventilation (11.5 and 15.6 L/min, respectively, p=0.775), 6MW test distance (9% and 5%, respectively, p=0.805), quadriceps muscle strength (21% and 11%, respectively, p=0.155) and quality of life assessed by Minnesota Living with Heart Failure questionnaire (1 and 13, respectively, p=0.092). Sedentary behavior reduced (p=0.05) in both groups (p=0.472). However, centre-based program was markedly effective in improving inspiratory muscle strength (p=0.042), number of steps/day (p=0.001) and mental health component of SF-36 questionnaire (p=0.001). Conclusion: Home-based program can be an alternative to centre-based program to reduce sedentary behavior and to improve functional capacity and quality of life in patients with chronic HF. However, the centre-based training, in addition to the benefits mentioned above to home-based training, is superior in increasing the inspiratory muscle strength, number of steps/day and mental health in chronic heart faiure patients compared to home-based training

Introdução: O treinamento físico melhora a capacidade funcional e a qualidade de vida em pacientes com insuficiência cardíaca (IC) crônica. Entretanto, a aderência ao treinamento físico supervisionado é baixa por diversas razões. Como alternativa, o treinamento domiciliar tem sido proposto. Objetivo: Comparar os efeitos de um programa de treinamento domiciliar (domiciliar) com um programa de treinamento supervisionado (supervisionado) sobre a capacidade funcional, comportamento sedentário e qualidade de vida em pacientes com IC crônica ao longo de 12 semanas. Métodos: Este estudo incluiu 23 pacientes com IC (classe funcional da New York Heart Association II e III, fração de ejeção do ventrículo esquerdo 31±6%) randomizados em grupos de treinamento domiciliar (n=11) ou supervisionado (n=12). Durantes 12 semanas os pacientes exercícios aeróbicos (60-70% da frequência cardíaca de reserva): caminhadas para o grupo domiciliar e exercício em cicloergômetro para o supervisionado, combinados ao exercício resistido (50% de uma repetição máxima). No momento basal e após 12 semanas mensuramos variáveis do teste cardiopulmonar, teste da caminhada de seis minutos (TC6M), pressões respiratórias máximas, força muscular do quadríceps e de preensão palmar, atividade física e comportamento sedentário por meio de acelerometria, qualidade de vida e aderência. Resultados: Os grupos domiciliar e supervisionado tiveram altas taxas de adesão, com aumentos (p=0,037) similares no consumo de oxigênio pico (0,8 e 3,7 ml/kg/min, respectivamente, p=0,085), ventilação máxima (11,5 e 15,6 l/min, respectivamente, p=0,775), distância percorrida no TC6M (9% e 5%, respectivamente, p=0,805), força muscular do quadríceps (21% e 11%, respectivamente, p=0,155) e qualidade de vida avaliada por meio do questionário Minnesota Living with Heart Failure (1 e 13, respectivamente, p=0,092). O comportamento sedentário reduziu (p=0,05) nos dois grupos (p=0,472). Entretanto, o treinamento supervisionado foi mais efetivo em melhorar a força muscular inspiratória (p=0,042), o número de passos/dia (p=0,001) e o componente de saúde mental do questionário SF-36 (p=0,001). Conclusões: O programa de treinamento domiciliar pode ser uma alternativa ao treinamento supervisionado para reduzir o comportamento sedentário e melhorar a capacidade funcional e qualidade de vida em pacientes com IC crônica. Entretanto, o treinamento supervisionado, além dos benefícios acima citados para o grupo domiciliar, é superior em aumentar a força muscular inspiratória, número de passos/dia e melhora de aspectos de saúde mental em pacientes com IC crônica, quando comparado ao treinamento supervisionado / Background: Exercise training improves functional capacity and quality of life in chronic heart failure (HF) patients. However, centre-based adherence is lower for several reasons. As an alternative, home-based training has been proposed. Objective: To compare the effects of home-based program (home-based) and centre-based (centre-based) training programs on functional capacity, sedentary behavior and quality of life in HF patients along 12 weeks. Methods: This study included 23 chronic HF patients (New York Heart Association functional class II and III, left ventricular ejection fraction 31±6%) randomized to home-based (n=11) or centre-based (n=12) training programs. Patients underwent a 12-week period of aerobic training (60-70% reserve heart rate): walking outdoor for home-based and supervised cycling for centre-based, both combined with resistance training (50% of one maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test measures, six minute walk (6MW) test distance, maximal respiratory pressures, quadriceps muscle strength, handgrip strength, physical activity and sedentary behavior (accelerometer), quality of life and adherence. Results: Home-based and centre-based had high adherence rate and similar improvements (p=0.037) in peak oxygen consumption (0.8 and 3.7 ml/kg/min, respectively, p=0.085), maximal ventilation (11.5 and 15.6 L/min, respectively, p=0.775), 6MW test distance (9% and 5%, respectively, p=0.805), quadriceps muscle strength (21% and 11%, respectively, p=0.155) and quality of life assessed by Minnesota Living with Heart Failure questionnaire (1 and 13, respectively, p=0.092). Sedentary behavior reduced (p=0.05) in both groups (p=0.472). However, centre-based program was markedly effective in improving inspiratory muscle strength (p=0.042), number of steps/day (p=0.001) and mental health component of SF-36 questionnaire (p=0.001). Conclusion: Home-based program can be an alternative to centre-based program to reduce sedentary behavior and to improve functional capacity and quality of life in patients with chronic HF. However, the centre-based training, in addition to the benefits mentioned above to home-based training, is superior in increasing the inspiratory muscle strength, number of steps/day and mental health in chronic heart faiure patients compared to home-based training

Objective. Coronary heart disease has been on the rise in poorer countries and decreasing in developed countries over the last twenty years. However, the cardiac-related health-related quality of life (HRQOL) in poorer countries has not been studied. This study aimed to compare HRQOL following heart attack in a developing country in the East with that of a developed country in the West. Using the self-regulation of health and illness behaviour, the relationships between illness beliefs, coping cognitions and HRQOL are studied. Design. This study was a cross-sectional correlational survey and data were collected shortly before myocardial infarction patients were discharged from hospital. Methods. A sample of 243 individuals from the UK and Indonesia were recruited. Illness beliefs were assessed with the B-IPQ, along with coping cognitions (Brief-COPE) and health-related quality of life (MacNew questionnaire). Results. Illness beliefs and coping cognitions predicted HRQOL in the combined sample. Some aspects of socio-demographic and clinical variables were concurrently associated with HRQOL. Conclusion. The results demonstrate that people in the East have low illness beliefs and these are associated with worse HRQOL compared with those in the West. The findings suggest that there is an urgent need for smoking cessation campaigns in the East, while the West could benefit more from tailored-cardiac rehabilitation programme.