==================================HSR17================================== 17. Effectiveness of comprehensive outpatient cardiac rehabilitation on reducing the risk factors associated with heart diseases, primarily for individuals with heart disease recently discharged from hospitals. 1 UI - 87086747 AU - Lovibond SH ; Birrell PC ; Langeluddecke P TI - Changing coronary heart disease risk-factor status: the effects of three behavioral programs. AB - Seventy-five persons (57 male and 18 female) with a high risk of coronary heart disease (CHD) were randomly assigned in equal numbers to three 8-week behavioral treatment programs. All three treatments were designed to alter simultaneously a number of risk-elevating behavior patterns, in the expectation that change in any one behavior pattern would reinforce change in others. Weight, blood pressure, and aerobic fitness were regularly assessed in all subjects. Serum lipids were also measured, but less frequently. All three interventions produced significant beneficial changes in the major objective measures, and the changes were well maintained after 12 months. The most improved group exhibited the following mean changes: weight loss of 9.2 kg, reductions in blood pressure of 12.9/8.8 mm Hg, improvement in aerobic capacity of 33%, reduction in serum cholesterol of 0.45 mmol/liter, and reduction in current overall CHD risk of 41%. The effectiveness of the interventions was positively related to the degree to which the programs emphasized training in, and detailed application of, behavioral change principles. MH - Adult ; Behavior Therapy/*METHODS ; Blood Pressure ; Body Weight ; Cholesterol/BLOOD ; Coronary Disease/*PREVENTION & CONTROL ; Diet, Reducing ; Dietary Fats/ADMINISTRATION & DOSAGE ; Exercise Therapy ; Feedback ; Female ; Goals ; Health Education ; Human ; Life Style ; Male ; Middle Age ; Physical Fitness ; Random Allocation ; Relaxation Technics ; Risk ; Smoking/PREVENTION & CONTROL ; Triglycerides/BLOOD SO - J Behav Med 1986 Oct;9(5):415-37 2 UI - 87058507 AU - Chaitman BR ; Davis KB ; Dodge HT ; Fisher LD ; Pettinger M ; Holmes DR ; Kaiser GC TI - Should airline pilots be eligible to resume active flight status after coronary bypass surgery?: a CASS registry study. AB - Medical certification to return to work after coronary bypass surgery in occupations that carry a risk to public safety is controversial, particularly for airline pilots. To address this issue, 10,312 patients from the CASS registry who underwent coronary bypass surgery were studied and 2,326 men with clinical and postoperative characteristics similar to those of the average airline pilot who might apply to renew his license after surgery were selected. The 5 year probability of remaining free of an acute cardiac event, defined as acute coronary insufficiency, myocardial infarction or sudden death, was 0.92 +/- 0.01 (mean +/- SE) for the 1,207 men without previous myocardial infarction and 0.98 +/- 0.01 for the 122 men who never smoked and did not have a history of hypertension. Among the 1,119 men with a previous myocardial infarction, the probability of remaining free of acute cardiac events was 0.91 +/- 0.02 and 0.92 +/- 0.02 when left ventricular contraction score was 5 to 9 and 10 or greater, respectively. In this patient subgroup, mortality rate was similar to that of the age-matched U.S. male population when the left ventricular contraction score was 5 to 9 (4.0% versus 4.3%; p = NS) but significantly worse when the left ventricular contraction score was 10 or greater (7% versus 4.2%; p = 0.05). The data from this CASS registry study are pertinent to the question of operationally unlimited first-class medical certification of carefully selected airline pilots after coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Adult ; *Aerospace Medicine ; Aortocoronary Bypass/*REHABILITATION ; Certification ; Heart Diseases/ETIOLOGY ; Human ; Male ; Middle Age ; Postoperative Complications ; Regression Analysis ; Risk ; Support, U.S. Gov't, P.H.S. SO - J Am Coll Cardiol 1986 Dec;8(6):1318-24 3 UI - 86289587 AU - Chirikos TN ; Nickel JT TI - Socioeconomic determinants of continuing functional disablement from chronic disease episodes. AB - Functional disablement of persons with chronic disease is a complex outcome shaped by a variety of medical and socioeconomic factors, including those influencing the competing risk of death from the disease. The increasingly important task of explaining trends in the functional health status of various populations requires more detailed knowledge about the respective roles of these disability determinants. This paper reports the results of an analysis of the determinants of continuing functional incapacity after an episode of heart disease. A proportional hazards regression model is used to estimate the relative effects of socioeconomic and disease factors on the duration of work disablement and functional incapacitation of 976 surviving and nonsurviving patients hospitalized for presumptive myocardial infarction. The analysis shows that socioeconomic variables play a prominent role in disability outcomes, especially in work resumption. Evidence of aging effects on disability prevalence is also found. MH - *Activities of Daily Living ; Age Factors ; Aged ; Disability Evaluation ; Female ; Human ; Income ; Male ; Marriage ; Middle Age ; Models, Biological ; Myocardial Infarction/*REHABILITATION ; Risk ; Sex Factors ; Socioeconomic Factors SO - Soc Sci Med 1986;22(12):1329-35 4 UI - 86282127 AU - Van Camp SP ; Peterson RA TI - Cardiovascular complications of outpatient cardiac rehabilitation programs. AB - To determine the incidence of major cardiovascular complications in outpatient cardiac rehabilitation programs, we obtained data from 167 randomly selected cardiac rehabilitation programs via mailed questionnaires and follow-up telephone calls. These 167 programs reported that 51 303 patients exercised 2 351 916 hours from January 1980 through December 1984. Twenty-one cardiac arrests (18 in which the patient was successfully resuscitated and three fatal) and eight nonfatal myocardial infarctions were reported. The incidence rates per million patient hours of exercise were 8.9 for cardiac arrests (one per 111 996 patient-hours), 3.4 for myocardial infarctions (one per 293 990 patient-hours), and 1.3 for fatalities (one per 783 972 patient-hours). There was no statistically significant difference in frequency of these events among programs of varying size or extent of electrocardiographic monitoring. These data indicate that current cardiac rehabilitation practice allows for prescribed supervised exercise by patients with cardiovascular disease to be performed at a low risk of major cardiovascular complications. MH - Ambulatory Care ; Coronary Disease/DIAGNOSIS/*REHABILITATION ; Data Collection ; Electrocardiography ; Exercise Therapy/*ADVERSE EFFECTS ; Heart Arrest/ETIOLOGY ; Human ; Monitoring, Physiologic ; Myocardial Infarction/ETIOLOGY ; *Rehabilitation Centers ; Resuscitation ; Risk ; Support, Non-U.S. Gov't ; United States SO - JAMA 1986 Sep 5;256(9):1160-3 5 UI - 86218454 AU - Campbell S ; Barry J ; Rocco MB ; Nabel EG ; Mead-Walters K ; Rebecca GS ; Selwyn AP TI - Features of the exercise test that reflect the activity of ischemic heart disease out of hospital. AB - To better understand the relationship between the transient myocardial ischemia seen during an exercise test and ischemic activity out of hospital, 39 patients with well-documented coronary artery disease underwent standard treadmill exercise testing (Bruce protocol) and 24 to 48 hr of continuous ambulatory electrocardiographic monitoring during normal daily activities. A total of 245 episodes of transient ischemia were recorded in 21 of 32 patients with positive exercise electrocardiograms (group I), whereas seven patients with negative test results (group II) had no episodes of transient ischemia, during monitoring out of hospital (p less than .01). Certain measures in the exercise test were related to the severity of ischemia out of hospital: there were more episodes and a greater total duration of transient ischemia per 24 hr of ambulatory monitoring in patients who developed ischemic electrocardiographic changes before 6 min of exercise (p less than or equal to .021) or at a heart rate of less than 150 beats/min (p = .005) and in those in whom these ST segment changes persisted for more than 5 min after exercise (p less than or equal to .016). In contrast, there was no relationship between transient ischemia out of hospital and the commonly quoted exercise variables: chest pain, total exercise duration, and the maximum levels of heart rate, systolic blood pressure, and double product. Thus, patients with coronary artery disease and negative exercise electrocardiograms are most unlikely to experience active ischemia during normal daily life.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Activities of Daily Living ; Adult ; Aged ; Ambulatory Care ; Angiography ; Comparative Study ; Coronary Disease/*PHYSIOPATHOLOGY/RADIOGRAPHY ; Electrocardiography ; *Exercise Test ; Female ; Heart Rate ; Human ; Male ; Middle Age ; Monitoring, Physiologic ; Prognosis ; Risk ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Time Factors SO - Circulation 1986 Jul;74(1):72-80 6 UI - 86208030 AU - Conroy RM ; Cahill S ; Mulcahy R ; Johnson H ; Graham IM ; Hickey N TI - The relation of social class to risk factors, rehabilitation, compliance and mortality in survivors of acute coronary heart disease. AB - We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality. MH - Angina, Unstable/PSYCHOLOGY ; Coronary Disease/MORTALITY/*PSYCHOLOGY/ REHABILITATION ; Employment ; Exertion ; Follow-Up Studies ; Human ; Hypertension/COMPLICATIONS ; Male ; Middle Age ; Myocardial Infarction/ PSYCHOLOGY ; Occupations ; Patient Compliance ; Risk ; Smoking ; *Social Class ; Time Factors SO - Scand J Soc Med 1986;14(2):51-6 7 UI - 86183605 AU - Fletcher BJ ; Thiel J ; Fletcher GF TI - Phase II intensive monitored cardiac rehabilitation for coronary artery disease and coronary risk factors--a six-session protocol. AB - To evaluate phase II intensive monitored cardiac rehabilitation using a 6-level, 6-session protocol, 31 patients were placed in a progressive 6-level exercise protocol with careful supervision and assessment of heart rate, rhythm, blood pressure and perceived exertion. Duration after the cardiac event ranged from 12 days to 8 years (median 10 months). Each exercise prescription was based on exercise testing with oxygen consumption determinations. Exercise activities were individually prescribed according to percentages of maximal MET level achieved on the exercise test. Each exercise session incorporated calisthenics, treadmill exercise, and bicycle and arm ergometry with progressively greater workloads on the various stations. All patients completed the 6 levels within 6 sessions of approximately 1 hour each, and achieved their designated 50 to 75% target heart rate with perceived exertion level 13 or less. There were no critical cardiac events, i.e., high-grade ventricular arrhythmias or myocardial infarction. All completed the 6-level protocol and progressed to a nonmonitored exercise program with no difficulty. The results of this short-term method of telemetry-monitored rehabilitation suggest benefits of proper exercise instruction, successful achievement of the 50 to 75% exercise target heart rate, detection of minor new arrhythmias and alterations of blood pressure response, adequate use of the perceived exertion scale, and a safe and effective transition to subsequent exercise programs. MH - Adult ; Blood Pressure ; Comparative Study ; Coronary Disease/ PHYSIOPATHOLOGY/*REHABILITATION ; Drug Evaluation ; *Exertion ; Female ; Heart Function Tests ; Human ; Male ; Middle Age ; Risk SO - Am J Cardiol 1986 Apr 1;57(10):751-6 8 UI - 86180799 AU - Becker C ; Howard G ; McLeroy KR ; Yatsu FM ; Toole JF ; Coull B ; Feibel J ; Walker MD TI - Community Hospital-based Stroke Programs: North Carolina, Oregon, and New York. II: Description of study population. AB - The three Community Hospital-based Stroke Programs collected data on 4132 stroke patients admitted to acute care hospitals during 1979 and 1980. White female stroke patients were older than the white male, nonwhite female and nonwhite male stroke patients. Nearly one-fourth (23%) of stroke patients were employed at the time of the event. Most (77%) of the patients were hospitalized for first stroke episodes. Eighty-three percent of the patients had at least one of the four major risk factors for stroke, namely, hypertension, diabetes, transient ischemic attacks and cardiac disease. Half (49%) of the patients were alert at the time of admission. The three diagnostic categories included infarction (60%), stroke not otherwise specified (30%) and hemorrhage (10%). Fourteen days was the median length of hospitalization; 50% of the stroke patients were discharged to a home setting, 31% were institutionalized and 19% died while in the hospital. The mean Barthel Index score for 2400 patients at the time of discharge was 61.8 (normal is 100). Of those patients who were working at the time of the stroke, 22% returned to work. In comparison to the patients in the National Survey of Stroke, patients in this Study were less severe at the time of admission (49% of patients in the National Survey of Stroke were stuporous or comatose compared to 21% of the patients in the current Study). The inhospital fatality was 30.7% in the National Survey of Stroke, and 19.7% in the current Study. MH - Activities of Daily Living ; Adult ; Aged ; Caucasoid Race ; Cerebral Ischemia, Transient/COMPLICATIONS ; Cerebrovascular Disorders/*OCCURRENCE ; Coma ; Diabetes Mellitus/COMPLICATIONS ; *Diagnostic Related Groups ; Employment ; Female ; Heart Diseases/COMPLICATIONS ; *Hospitals, Community ; Human ; Hypertension/COMPLICATIONS ; Male ; Middle Age ; New York ; North Carolina ; Oregon ; Risk ; Support, U.S. Gov't, P.H.S. ; Time Factors SO - Stroke 1986 Mar-Apr;17(2):285-93 9 UI - 86175305 AU - Goldberg AP ; Geltman EM ; Gavin JR 3d ; Carney RM ; Hagberg JM ; Delmez JA ; Naumovich A ; Oldfield MH ; Harter HR TI - Exercise training reduces coronary risk and effectively rehabilitates hemodialysis patients. AB - This study examines the effects of 12 months of endurance exercise training (cycling, walking and jogging) on lipid profiles, glucose metabolism, blood pressure, anemia and psychological function in 14 hemodialysis patients. Maximal aerobic capacity (VO2max) increased 18% in the exercisers (p less than 0.01), but did not change in 11 controls. This was associated with a reduction in depression, a decrease in dosages of antihypertensive medications, a significant increase in hematocrit and hemoglobin levels (red cell mass rose, plasma volume did not change), a decrease in plasma triglyceride by 23% (p less than 0.05) and an increase in high-density lipoprotein cholesterol (HDL-C) levels by 21% (p less than 0.01) (both HDL-C and triglyceride levels worsened in the sedentary controls), and an 18% increase in glucose disappearance rates (p less than 0.05) in spite of a 52% decrease in fasting insulin levels (p less than 0.01), suggesting that insulin sensitivity improved. These results demonstrate that some of the complications present in hemodialysis patients may be caused by their sedentary life-style, rather than endstage renal disease itself. This suggests that rehabilitation through exercise is possible for these patients. By reducing coronary risk factors in hemodialysis patients, exercise training may also decrease their heightened morbidity and mortality from atherosclerotic complications. These possibilities need to be examined in a longitudinal study. MH - Adult ; Aged ; Anemia/BLOOD/ETIOLOGY/THERAPY ; Antihypertensive Agents/ ADMINISTRATION & DOSAGE ; Blood Pressure ; Coronary Disease/*PREVENTION & CONTROL ; Female ; Glucose/METABOLISM ; Hemodialysis/PSYCHOLOGY/ *REHABILITATION ; Human ; Hypertension/THERAPY ; Kidney Failure, Chronic/ BLOOD/COMPLICATIONS/THERAPY ; Lipids/BLOOD ; Male ; Middle Age ; Physical Endurance ; *Physical Therapy ; Risk ; Support, U.S. Gov't, P.H.S. SO - Nephron 1986;42(4):311-6 10 UI - 86122263 AU - Shephard RJ TI - Exercise in coronary heart disease. AB - Population levels of habitual activity have probably contributed to both the recent epidemic of cardiovascular disease and its waning. Evidence supporting the exercise hypothesis can be drawn from comparisons of individuals with differing levels of occupational and leisure activity. Both suggest that regular, endurance-type activity may halve the incidence of cardiac morbidity and mortality. This is an important prophylactic benefit, although Bradford Hill's criteria of a causal association have yet to be fully satisfied. Following the onset of clinical disease, both uncontrolled and randomised controlled trials suggest that progressive exercise rehabilitation improves prognosis by a useful 20 to 30%, but formal statistical proof is again difficult for technical reasons. Although over-enthusiastic vigorous physical activity can cause an immediate rise of cardiovascular events, this disadvantage is substantially outweighed by long term gains from regular physical activity. Classical epidemiology has proven its case by the experimental step of removing exposure to the causal agent. It is difficult to carry out such an analysis linking physical activity with the recent epidemic of ischaemic heart disease, although the recent waning of the disease may be attributed in part to an increase of habitual physical activity in many western nations. Evidence linking exercise to the prevention of clinical disease ('secondary prevention') is derived from large scale surveys of groups with supposed differences in occupational activity, athletic participation, active leisure pursuits or overall lifestyle. The majority of occupational comparisons have shown advantages to active workers in terms of deaths from cardiac disease, sudden death, cardiac morbidity, ECG abnormalities, and cardiac abnormalities at postmortem. However, concerns have been raised with regard to the accuracy of job classification, the intensity of occupational activity relative to active leisure, the adequacy of disease classification, and confounding influences due to differences of social class, stress and potential alienation. Studies comparing athletes and non-athletes have been faulted on grounds of initial selection for sport by body-build and uncertainties regarding continuing differences of endurance activity between recognised university athletes and their classmates. In general, no advantage of life expectancy has been seen in athletes, Karvonen and associates reported a 4 to 5 year advantage of longevity in Finnish cross-country skiing champions, although this might be attributable to other facets of their lifestyle.(ABSTRACT TRUNCATED AT 400 WORDS) MH - Animal ; Clinical Trials ; Coronary Disease/*PREVENTION & CONTROL/ PHYSIOPATHOLOGY ; Ethnic Groups ; *Exertion ; Female ; Human ; Jogging ; Leisure Activities ; Life Style ; Male ; Myocardial Infarction/ REHABILITATION ; Occupational Diseases/PREVENTION & CONTROL/ PHYSIOPATHOLOGY ; Physical Fitness ; Random Allocation ; Review ; Risk ; Social Class SO - Sports Med 1986 Jan-Feb;3(1):26-49 11 UI - 86111114 AU - Burke LJ ; Gabriel LM ; Fischer LE ; Zemke SL TI - Nursing diagnoses, indicators, and interventions in an outpatient cardiac rehabilitation program. AB - This study identified two nursing diagnoses used in an outpatient cardiac rehabilitation program. The indicators and interventions for these diagnoses were also identified. We feel that nurses in cardiac rehabilitation programs will find these diagnostic labels to be clinically useful. The indicators may also help nurses decide when to use the diagnostic labels. The interventions will provide direction on how to treat these nursing diagnoses. The use of nursing diagnoses in this setting helps clarify nursing's unique role in a multidisciplinary team providing services to participants in outpatient cardiac rehabilitation programs. MH - Adult ; Aged ; Cardiac Output, Low/NURSING ; Cardiovascular Diseases/ NURSING/PSYCHOLOGY/*REHABILITATION ; Coronary Disease/NURSING ; Data Collection ; Exercise Therapy ; Female ; Human ; Male ; Middle Age ; Motivation ; *Nursing Assessment ; *Nursing Process ; Outpatient Clinics, Hospital ; Patient Education ; Risk SO - Heart Lung 1986 Jan;15(1):70-6 12 UI - 86086851 AU - Cobb LA ; Weaver WD TI - Exercise: a risk for sudden death in patients with coronary heart disease. AB - Although sudden arrhythmic death is usually unrelated to exertion, there is more than anecdotal evidence that strenuous exercise in patients with coronary heart disease carries an additional risk for sudden death. When cardiac arrest has been observed after exercise stress testing or within seconds after collapse associated with exertion, ventricular fibrillation has usually been present and has responded to the prompt application of a defibrillatory shock. Exertion-related cardiac arrest is typically a "primary: arrhythmic event not due to acute myocardial infarction. As estimated here, the additional risk of exercise for cardiac arrest may be more than 100-fold during or after a few minutes of vigorous exertion. MH - Adult ; Aged ; Coronary Disease/*COMPLICATIONS/PHYSIOPATHOLOGY ; Death, Sudden/*ETIOLOGY ; Exercise Test ; Exercise Therapy/ADVERSE EFFECTS ; *Exertion ; Heart Arrest/ETIOLOGY/PHYSIOPATHOLOGY ; Heart Diseases/ COMPLICATIONS/PHYSIOPATHOLOGY/REHABILITATION ; Human ; Male ; Middle Age ; Review ; Risk ; Support, Non-U.S. Gov't ; Ventricular Fibrillation/ COMPLICATIONS/PHYSIOPATHOLOGY SO - J Am Coll Cardiol 1986 Jan;7(1):215-9