An experiment was conducted to investigate three different treatment strategies in the rehabilitation of coronary artery bypass graft (CABG) patients. Fifteen CABG patients were randomly assigned to one of three training groups: an outpatient cardiac rehabilitation exercise group (which met three times per week for three months); a second group which participated in weekly stress management training for seven weeks in addition to the cardiac rehabilitation exercise sessions; and a third group which participated in a weekly discussion on social support in addition to the exercise sessions. The groups were compared (pre- and post training) on the following physiological dependent measures: systolic and diastolic blood pressure, mean heart rate, cholesterol, triglycerides, high density lipoproteins, and the cholesterol/high density lipoprotein ratio. Psychological self-report measures included: the Beck Depression Inventory, the Spielberger State/Trait Anxiety Index, the Jenkins Activity Survey, and the Hassles and Uplifts Questionnaire. The Structured Interview was given to each patient prior to training only. It was predicted that the group trained in stress management and exercise would show the most positive changes on physiological and psychological dependent measures compared to the other two groups. The results indicated no significant pre/post differences on any of the variables for any of the groups. Thus, the additional components of stress management training and the social support discussion group did not appear to effect more positive change in those patients compared to those who participated in exercise only. Findings may have been influenced by several factors including a small N in each group and large within group variability. Suggestions for future research are discussed.

The American College of Sports Medicine has published formulae that are widely used to predict functional aerobic capacity for any treadmill speed and grade combination. However, it has been demonstrated that these formulae overpredict oxygen consumption (V̇O₂) for patients with coronary artery disease as well as for apparently healthy individuals. To study this, we measured V̇O₂, ventilation (V̇_E), and respiratory exchange ratio (R) responses in 21 apparently healthy subjects (AH) and 16 coronary artery diseased subjects (CAD) during a modified Balke protocol. Modification of the protocol consisted of extending the stage time from two minutes to three minutes at the higher intensities to allow a greater time for a physiological steady-state to occur. The attainment of a steady-state may lead to the reduction of or the elimination of prediction errors. No differences were observed between two and three minute VO₂ responses at maximal and submaximal exercise for either group. At peak exercise, the AH group was significantly (P≤.05) different from the CAD group when compared for heart rate (164±2.6 vs 140±4.8 bts•min⁻¹ ), V̇O₂ (33.3±1.1 vs 26.7±2.3 ml•kg⁻¹•min⁻¹), and total treadmill time (9.9±.33 vs 8.1±.54 min). At submaximal exercise, V̇O₂ responses were also significantly (p≤.05) greater for the AH group when compared to the CAD group (26.6±.95 vs 21.9±1.8 ml•kg⁻¹•min⁻¹). No significant differences were observed for RPE and blood lactate at peak exercise and V̇_E and R responses at submaximal or peak exercise between the two groups. Predicted values for peak V̇O₂ were significantly (p≤.05) higher than measured values (33.3±1.1 vs 38.8±1.1 ml•kg⁻¹•min⁻¹) and (26.7±2.3 vs 34.1±1.7 ml•kg⁻¹•min⁻¹) for the AH and CAD groups, respectively. However, no significant differences were noted between predicted and measured V̇O₂ responses at submaximal exercise for either group. Individuals classified as Type A were not significantly different from classified Type B individuals when compared for the cardio-respiratory variables measured. These data demonstrate that the ACSM prediction formulae significantly overpredict V̇O₂ for both AH and CAD subjects at maximal treadmill intensities. However, at submaximal intensities, these prediction formulae are acceptable for both groups of subjects. Furthermore, these data suggest that two minutes per stage allows sufficient time for physiological steady-state to occur at clearly submaximal intensities. Although at the higher intensities, extending the stage time beyond two minutes may be indicated. / M.S.

Nine male CHD patients volunteered for testing to determine variations in heart rate response (HR), walk-jog velocity (W) and compliance to the target heart rate zone under three monitoring conditions. Determination of variations in W, peripheral perceived exertion (RPE_L) chest perceived exertion (RPE_C) and post-exercise lactate accumulation (La) during exercise which was held constant between 60-80% maximum HR reserve were also made. Procedures consisted of three 20 min walk-jog exercise conditions. First, two baseline condition (BC) trials were performed on separate days with exercise intensity regulated through intermittent defibrillator-ECG HR checks and radial/carotid artery palpation. Next, continuous telemetry monitoring of HR by staff was added during a single exercise trial (TC). Finally, two Exersentry_Rcondition (EC) trials were performed on separate days with continuous feedback concerning HR response provided to the patient via Exersentry_R devices. Evaluation of HR and W revealed no significant variation between conditions. However, % target HR reserve attained was significantly (p>0.05) lower during early and late BC, as compared to TC. Furthermore, "frequency in" vs "frequency out" of target HR zone was significantly (p>0.05) greater during EC, as compared to TC. During EC, no significant variations in HR, W, La, RPE_L and RPE_C were noted. Correlation coefficient values between 0.76-0.95 and 0.58-0.80 were reported for RPE_L and RPE_C, respectively. This data suggested that continuous feedback concerning HR response resulted in the greatest compliance to the target HR zone. With the exception of the first five min of EC, only RPE_L reliably mirrored HR and W. Index terms: Intermittent heart rate monitoring, continuous heart rate monitoring, heart rate response, walk-jog velocity, target heart rate compliance, peripheral perceived exertion, chest perceived exertion, post-exercise lactate accumulation. / M.S.

Controversy exists regarding the effects of beta-blocker medications on functional capacity in cardiac patients and in the effects of disease-related impairments on cardiorespiratory dynamics during exercise testing. Therefore, this study was conducted to examine the exercise responses of 26 subjects (ages 37-66 years) to a graded exercise test. Subjects were divided into three groups based on clinical status: apparently healthy (AH; N=8); cardiacs receiving beta-blockers (C-BB; N=8); cardiacs not receiving beta-blockers (Câ NBB; N=lO). / Master of Science

Introduction: Coronary artery bypass grafting surgery is an effective treatment for coronary heart disease for many patients; however, evidence suggests that there are some patients who do not report a good post-operative recovery. Although several studies have begun investigating possible reasons for these observations, little is known about the impact of CABG on quality of life and there still remains a lack of information that can help clinicians identify those people more likely to experience poorer recovery so that interventions can be targeted appropriately. Aims: The overall aim was to investigate barriers to and facilitators of recovery after CABG. Method: Phase 1 was a retrospective qualitative study involving semi-structured interviews with eleven patients who had undergone CABG and with ten health professionals experienced in caring for these patients. Data were analysed using thematic analysis. Phase 2 was a prospective study comprising two components, questionnaire and interview. The questionnaire included measures of quality of life, perceived recovery, demographic and psychosocial variables and was administered prior to surgery and at six and twelve months post-surgery. A sample of ten people who completed questionnaires were interviewed at the same time points and data analysed using framework analysis. Results: Interview data described the patient experience of undergoing CABG and identified components of a good recovery from the patient perspective. Patient and health professional participants identified numerous barriers and facilitators to recovery at three key time points - prior to surgery, during the hospital inpatient stay and post-CABG - and noted the complex inter-relationships between them, thus emphasising the need for a holistic approach to investigating recovery. Questionnaire data described the pattern of psychosocial functioning, quality of life and perceived recovery across the surgical pathway and identified depression and self-efficacy as the main predictors of post-CABG quality of life and perceived recovery. Using interview and questionnaire data a model of recovery is proposed. Conclusions: Findings from this research have identified a complex inter-related network of barriers and facilitators to recovery, suggested the possible mechanisms by which they impact on post-CABG outcome and identified recommendations for clinical practice.

BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.

(Uncorrected OCR) Abstract Many studies have been conducted in Caucasian populations on the optimal body mass index cut-off for obesity, as well as the relationship between body mass index and percentage body fat and their associations with cardiovascular risk factors. However, few studies of this kind have been conducted in the Hong Kong Chinese population, This research is deemed to be important due to ethnic differences between Asians and Caucasians, Therefore, this dissertation aims to determine any ethnic differences from a sample of the local Hong Kong Chinese population, in order to advance health care policies controlling known cardiovascular risk factors. A total of 800 subjects were randomly selected from a pool of subjects participated in a Hong Kong Cardiovascular Risk Factor Prevalence study conducted in 1994-1996. These subjects were contacted and 453 disease-free subjects (210 males and 243 females) consented to participate in the current study, Data collected included serum and blood pressure measurements, body mass index, percentage body fat measured by bioelectrical impedance analysis, and a self-completed cardiovascular risk factor questionnaire, The mean age of the 453 subjects was 51.64 years (SD=12.3). When obesity was defined as percentage body fat ~ 25 and 2: 30 in males and females respectively, 23 kg/m2 was found to be the optimum cut-off value, with 78% correct classification (95% CI = 69%-87%). The corresponding sensitivity and specificity were 88% (95% CI = 81 %-95%) and 67% (95% CI = 57%-77%) respectively. On the other hand, if obesity was defined as percentage body fat ~ 25 and 2: 35 in males and females respectively, then 25 kg/m2 was found to be the best cut-off value with 82% correct classification (95% CI = 74%-90%). The corresponding sensitivity and specificity were 78% (95% CI = 69%-87%) and 85% (95% Cl = 78%-92%) respectively. Moreover, body mass index was found to be quadratically body fat. The quadratic relationship did not appear two genders, except that the percentage body fat of of females by 9.97 (SE=0.33). Finally, except for total cholesterol, high density lipoprotein cholesterol, and fasting glucose, body mass index did not provide any substantial information additional to percentage body fat on serum and blood pressure measurements. was the only measure on which percentage body fat did additional to body mass index. When waist-hip body mass index and percentage body fat,. except for body mass index did not have additional information on measurements when percentage body fat or/and [n conclusion, the optimal body mass index cut-off for obesity in Hong Kong Chinese was lower than the 30kg/m2 recommended by the World Health Organization, a clear reflection of ethnic difference between Asians and Caucasians. The quadratic relationship between percentage body fat and body mass index was similar in Hong Kong Chinese as in Caucasians and Blacks. Moreover, percentage body fat together with waist-hip-ratio were found to be better indicators of cardiovascular risk factors in Hong Kong. This was the first time such findings were found in the Hong Kong Chinese population. II / abstract / toc / Medical Sciences / Master / Master of Medical Sciences

BACKGROUND Increasingly, it is recognised that the unique needs of people from culturally and linguistically diverse backgrounds (CaLDB) should be addressed within a framework of cultural competence. To date, there are limited data on the issues facing CaLDB patients in the Cardiac Rehabilitation (CR) setting. Appreciation of an individual???s values, attitudes and beliefs underpins negotiation of behaviour change in the CR setting. Therefore an understanding of patient and professional interactions is of key importance. OBJECTIVES The focus of this study has been to undertake an exploration of CR service delivery to people from culturally and linguistically diverse backgrounds, using Arabic speaking people as an exemplar of a CaLDB group. More broadly, this research project has sought to identify factors, which influence the practice of health professionals towards CaLDB patients, and to develop a model for evaluation of culturally competent health care in the CR setting. The study sought to achieve these aims by addressing the following research questions: 1. In what way do health practitioners in CR adjust their treatment and support to accommodate the perceived needs of CaLDB communities? 2. In what way do factors (such as individual and organisation perspectives) influence the adjustment of clinical practice and service delivery of CR practitioners; and what are practitioners??? and patients??? perception of barriers and facilitators to service delivery? 3. To what level are CaLDB patients satisfied with CR services? This study design is comprised of the following elements: (1) interviews with health practitioners and Arabic speaking background patients as an exemplar of CaLDB patients; (2) review of policy and procedure documents and medical records; and (3) field observation. METHOD This thesis embraces a qualitative approach as the primary method of investigation to align with the exploratory and descriptive nature of the study. The main methods used in the study were: in depth interviews with health professionals and patients; field observations; appraisal of relevant documents and consultation with expert panels. Study samples were selected through a purposive sampling strategy.Data were analysed using the method of content analysis, guided by the research questions. FINDINGS In total, 25 health professionals (20 female and 5 male) and 32 patients (21 male and 11 female) were interviewed. The method of qualitative content analysis was used for data analysis. Data analysis revealed four major themes: 1) The challenging context; 2) Tuning practices; 3) Influencing factors; and 4) Goodness of fit. The study demonstrated a challenging context for CR delivery, both from the perspective of patients and health professionals. Data reveal a process of reflection, negotiation, and navigation of care by CR health professionals in an effort to understand and meet the diverse needs of CALDB patients. CONCLUSION On the basis of the study findings, a process-oriented model of tuning practice to achieve cultural competence in CR delivery is proposed to inform policy, research and clinical practice.

Cognitive ratings that use bipolar constructs based upon similarity and contrast have been shown to be biased towards the similarity pole in approximately a 62/38 ratio. This bias has also been known to shift in the contrastive direction for individuals who have psychiatric problems. This quantitative measure of cognitive change has a potential for characterizing cognitive changes that occur during the disease process, including recovery from disease. The present study investigated changes in self-aspect ratings and bipolar construct use in adult male veterans who had undergone coronary artery bypass graft surgery. Results indicated that treatment subjects' self-aspect and construct ratings were more negative than controls'. Results also indicated that all subjects rated core interpersonal self-aspects closest to the expected bias, while self-aspects related to cardiac recovery problems were rated in the most contrastive direction. The results finally suggested that the greatest degree of change for the treatment subjects were in emotionally generated constructs. The results suggested a preliminary validation for characterizing cognitive changes in the disease process by measuring shifts in bipolar construct ratings.

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.