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Cardiac Rehabilitation: State of the Art and Perspectives

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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Epidemiology, Lifestyle, and Cardiovascular Health".

Deadline for manuscript submissions: closed (31 August 2022) | Viewed by 26180

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Special Issue Editors

Prof. Dr. Kentaro Kamiya

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Guest Editor

Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan
Interests: physical therapy; exercise; cardiac rehabilitation; skeletal muscle; heart failure; sarcopenia/frailty

Dr. Tasuku Terada

E-Mail Website
Guest Editor

Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
Interests: atrial fibrillation, rehabilitation; sports cardiology

Special Issue Information

Dear Colleagues,

Cardiac rehabilitation has been recognized as a hot topic in cardiovascular medicine. This can be highlighted by an exponential increase in the number of hits for “cardiac rehabilitation” in PubMed: 65 in 1990, 139 in 2000, 304 in 2010, and 897 in 2020.

However, many issues in cardiac rehabilitation research remain unresolved, such as cardiac rehabilitation for patients with acute conditions, frailty, sarcopenia, malnutrition, a history of cancer, or sex-related differences, thus constituting an urgent clinical need as the world population ages.

Various exercise modalities such as inspiratory muscle training, neuromuscular electrical stimulation, high-intensity interval training, and functional training, as well as aerobic exercise and resistance training, have been proposed for this condition, but further evidence needs to be accumulated. Additionally, the low utilization, regional disparity, and low adherence of cardiac rehabilitation have emerged as more important concerns now that the effectiveness of cardiac rehabilitation has been proven in various patients.

In this Special Issue, we welcome the submission of original studies, meta-analyses, and systematic reviews that bridge the gap between evidence and real-world practice in cardiac rehabilitation.

Prof. Dr. Kentaro Kamiya
Dr. Tasuku Terada
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cardiac rehabilitation
exercise
exercise tolerance
secondary prevention
cardiovascular disease
heart failure
coronary artery disease
sarcopenia / frailty
nutrition

Published Papers (10 papers)

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Research

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13 pages, 703 KiB

Open AccessArticle

Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal

by André Alexandre, Cristine Schmidt, Andreia Campinas, Catarina Gomes, Sandra Magalhães, José Preza-Fernandes, Severo Torres and Mário Santos

J. Cardiovasc. Dev. Dis. 2022, 9(10), 344; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9100344 - 09 Oct 2022

Cited by 1 | Viewed by 2212

Abstract

Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01–1.07), higher education level (adjusted OR 3.31; 95% CI 1.63–6.70), stroke (adjusted OR 3.29; 95% CI 1.06–10.27), COPD (adjusted OR 4.82; 95% CI 1.53–15.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36–5.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians’ awareness, patients’ comorbidities, and geographical issues should be pursued. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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10 pages, 1296 KiB

Open AccessArticle

Life-Space Activities Are Associated with the Prognosis of Older Adults with Cardiovascular Disease

by Kakeru Hashimoto, Akihiro Hirashiki, Koharu Oya, Junpei Sugioka, Shunya Tanioku, Kenji Sato, Ikue Ueda, Naoki Itoh, Manabu Kokubo, Atsuya Shimizu, Hitoshi Kagaya and Izumi Kondo

J. Cardiovasc. Dev. Dis. 2022, 9(10), 323; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9100323 - 24 Sep 2022

Viewed by 1507

Abstract

Life-space activities are a measure of daily activity level. Here, we examined the association between life-space activities and prognosis in 129 cardiovascular diseases (CVD) patients 65 years of age or older (average age, 79.2 ± 7.6 years; mean left ventricular ejection fraction, 56.7 ± 13.2%) who had been admitted to our hospital for worsening CVD. Subjects were followed, and the primary endpoints were cardiovascular hospitalization and cardiovascular death. Receiver operating characteristic analysis produced a cutoff value for life-space assessment (LSA) score for increased risk of cardiovascular hospitalization for two years of 53.0 points (sensitivity, 55.9%; specificity, 82.1%). Kaplan–Meier analysis using this cutoff value revealed that the rates of cardiovascular hospitalization and cardiovascular death were significantly higher in subjects with an LSA score below the cutoff than in those with a score above the cutoff (both p < 0.001). Cox proportional analysis revealed that low LSA score was independently associated with cardiovascular hospitalization (HR, 2.540; 95% CI, 1.135–5.680; p = 0.023) and cardiovascular death (HR, 15.223; 95% CI, 1.689–137.180; p = 0.015), even after adjusting for age, sex, left ventricular ejection fraction, and log-transformed brain natriuretic peptide level. Thus, life-space activities are associated with prognosis in older adults with CVD. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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7 pages, 914 KiB

Open AccessArticle

The Acute-Phase Ambulation Program Improves Clinical Outcome for Acute Heart Failure

by Yusuke Funato, Yuji Kono, Hideki Kawai, Meiko Hoshino, Akira Yamada, Takashi Muramatsu, Masahide Harada, Hiroshi Takahashi, Yohei Otaka, Masanobu Yanase and Hideo Izawa

J. Cardiovasc. Dev. Dis. 2022, 9(10), 314; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9100314 - 20 Sep 2022

Cited by 1 | Viewed by 1680

Abstract

It remains unclear whether the acute-phase ambulation program (AAP) improves the prognosis of heart failure (HF) patients. We examined the association between the initiation of AAP and the prognosis of patients with worsening HF. We enrolled 560 consecutive patients admitted due to worsening HF from March 2019 to April 2021. Our hospital introduced AAP in May 2020, but we did not perform AAP until April 2020. We retrospectively compared cardiac events within 180 days after discharge between patients admitted before April 2020 (conventional group) and after May 2020 (AAP group). Primary endpoints were all-cause mortality and readmission for worsening HF. The Kaplan–Meier survival curves showed a significantly lower event rate in the AAP group in HF readmission or the primary endpoint (p = 0.020 and p = 0.014). The occurrence of the primary endpoint was associated with age, history of HF, systolic blood pressure, medications including renin–angiotensin system inhibitors or angiotensin receptor blocker, hemoglobin, NT-proBNP, and AAP participation. After adjusting for these parameters and sex, participation in AAP was an independent factor associated with a reduced risk of primary endpoint occurrence (hazard ratio of 0.62 (0.41–0.95), p = 0.028). The AAP for patients with acute HF might lead to improved short-term prognosis and should be considered for implementation. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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12 pages, 1458 KiB

Open AccessArticle

Sex Differences in Frequency of Instrumental Activities of Daily Living after Cardiac Rehabilitation and Its Impact on Outcomes in Patients with Heart Failure

by Kohei Nozaki, Nobuaki Hamazaki, Kentaro Kamiya, Hidenori Kariya, Shota Uchida, Takumi Noda, Kensuke Ueno, Emi Maekawa, Atsuhiko Matsunaga, Minako Yamaoka-Tojo and Junya Ako

J. Cardiovasc. Dev. Dis. 2022, 9(9), 289; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9090289 - 31 Aug 2022

Cited by 3 | Viewed by 1776

Abstract

Although instrumental activities of daily living (IADL) are included in the outcomes of cardiac rehabilitation (CR), the relationship between IADL frequency at the end of CR and outcomes between the sexes remains unclear. We aimed to investigate the differences in frequency of IADL between the sexes and its impact on the outcomes. We retrospectively investigated 490 consecutive patients who were admitted for heart failure (HF) and participated in CR post-discharge. IADL frequency was assessed using the questionnaire-based Frenchay Activities Index (FAI). The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death and readmission due to HF. The cut-off values of the FAI for all-cause death in the overall cohort, females, and males were 23, 22, and 23 points, respectively. After adjusting for several factors, IADL assessed using the FAI was independently associated with all-cause mortality (hazard ratio [HR]: 0.961, 95% confidence interval [CI]: 0.937–0.986) and combined events (HR: 0.968, 95% CI: 0.952–0.985), respectively. Additionally, there was no interaction between sex and all-cause mortality. In conclusion, higher IADL frequency after CR was associated with favourable outcomes in patients with HF. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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14 pages, 900 KiB

Open AccessArticle

Benefits of a Balance Exercise Assist Robot in the Cardiac Rehabilitation of Older Adults with Cardiovascular Disease: A Preliminary Study

by Kakeru Hashimoto, Akihiro Hirashiki, Kenichi Ozaki, Koki Kawamura, Junpei Sugioka, Shunya Tanioku, Kenji Sato, Ikue Ueda, Naoki Itoh, Kenichiro Nomoto, Manabu Kokubo, Atsuya Shimizu and Izumi Kondo

J. Cardiovasc. Dev. Dis. 2022, 9(6), 191; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060191 - 12 Jun 2022

Cited by 1 | Viewed by 2304

Abstract

We examined whether adding robot-supported balance exercises to cardiac rehabilitation improves the ability to balance in older adults with cardiovascular disease (CVD). We conducted a prospective study in 52 older adults who had been hospitalized for worsening CVD. Once weekly for four months, for a total of sixteen sessions as outpatients, the subjects used a Balance Exercise Assist Robot (BEAR) to perform balance exercises and an ergometer for aerobic exercises. Participants’ mean age was 76.9 ± 6.8 years (range, 65–95 years), and their mean brain natriuretic protein level was 164.0 ± 190.0 pg/mL. After the intervention, participants showed significant improvements in gait speed (before, 1.06 ± 0.33 m/s; after, 1.23 ± 0.30 m/s; p < 0.001), Short Physical Performance Battery score (before, 10.02 ± 2.25; after, 10.88 ± 1.79; p ˂ 0.001), timed up-and-go (before, 11.11 ± 5.07 s; after, 9.45 ± 3.45 s; p ˂ 0.001), and knee extension (before, 26.97 ± 11.78 kgf; after, 30.13 ± 13.04 kgf; p = 0.001). Cardiac rehabilitation including exercises using BEAR improved physical functioning and the ability to balance in older adults with CVD. Frail and prefrail patients improved, whereas robust ones did not change. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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12 pages, 1919 KiB

Open AccessEditor’s ChoiceArticle

Efficacy and Safety of Acute Phase Intensive Electrical Muscle Stimulation in Frail Older Patients with Acute Heart Failure: Results from the ACTIVE-EMS Trial

by Shinya Tanaka, Kentaro Kamiya, Yuya Matsue, Ryusuke Yonezawa, Hiroshi Saito, Nobuaki Hamazaki, Ryota Matsuzawa, Kohei Nozaki, Masashi Yamashita, Kazuki Wakaume, Yoshiko Endo, Emi Maekawa, Minako Yamaoka-Tojo, Takaaki Shiono, Takayuki Inomata and Junya Ako

J. Cardiovasc. Dev. Dis. 2022, 9(4), 99; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9040099 - 27 Mar 2022

Cited by 5 | Viewed by 3803

Abstract

As frailty in older patients with acute heart failure (AHF) has an adverse effect on clinical outcomes, the addition of electrical muscle stimulation (EMS) to exercise-based early rehabilitation may improve the effects of treatment. Post hoc analysis was performed on a randomized controlled study for clinical outcomes and prespecified subgroups (ACTIVE-EMS: UMIN000019551). In this trial, 31 AHF patients aged ≥ 75 years with frailty (Short Physical Performance Battery [SPPB] score 4–9) were randomized 1:1 to receive treatment with an early rehabilitation program only (n = 16) or early rehabilitation with add-on EMS therapy (n = 15) for 2 weeks. Changes in physical function and cognitive function between baseline and after two weeks of treatment were assessed. There were no adverse events during the EMS period. The EMS group showed significantly greater changes in quadriceps’ isometric strength and SPPB compared to the control group, and EMS therapy showed uniform effects in the prespecified subgroups. There were no significant differences in the changes in other indexes of physical function and cognitive function between groups. There was no significant difference in the rate of heart failure hospitalization at 90 days between groups. In conclusion, older AHF patients with frailty showed greater improvement in lower extremity function with the addition of EMS therapy to early rehabilitation without adverse events. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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11 pages, 1046 KiB

Open AccessArticle

Acute-Phase Initiation of Cardiac Rehabilitation for Short-Term Improvement in Activities of Daily Living in Patients Hospitalized for Acute Heart Failure

by Kensuke Ueno, Kentaro Kamiya, Hidehiro Kaneko, Akira Okada, Hidetaka Itoh, Katsuhito Fujiu, Norifumi Takeda, Hiroyuki Morita, Nobuaki Michihata, Taisuke Jo, Hideo Yasunaga and Issei Komuro

J. Cardiovasc. Dev. Dis. 2022, 9(4), 97; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9040097 - 25 Mar 2022

Cited by 5 | Viewed by 4121

Abstract

Background: Whether acute-phase cardiac rehabilitation (CR) is beneficial for short-term improvement in activities of daily living (ADL) in patients hospitalized for acute heart failure (AHF) remains unclear. Aim: To investigate the association of acute-phase initiation of CR with short-term improvement in ADL in patients hospitalized for AHF. Methods: We retrospectively analyze data from the Diagnosis Procedure Combination Database, a nationwide inpatient database. Patients hospitalized for HF between January 2010 and March 2018 are included. Propensity score matching and generalized linear models are built to examine the association between improvement in ADL and acute-phase CR initiation, defined as the initiation of CR within two days of admission. Results: Among 306,826 eligible patients, CR is initiated in 45,428 patients (14.8%) within two days of hospital admission. Propensity score matching creates 45,427 pairs. CR initiation within two days of hospital admission is associated with ADL improvement (risk ratio: 1.018; 95% confidence interval: 1.004–1.032), particularly in elderly patients, females, and individuals with low ADL at admission, body mass index of 18.5–24.9 kg/m², and New York Heart Association class IV. Conclusions: Our analyses highlight the possibility that acute-phase CR initiation may result in short-term improvement in ADL in patients hospitalized for AHF. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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11 pages, 1455 KiB

Open AccessArticle

Depression and Anxiety Are Associated with Physical Performance in Patients Undergoing Cardiac Rehabilitation: A Retrospective Observational Study

by Maaya Sakamoto, Yasunori Suematsu, Yuiko Yano, Koji Kaino, Reiko Teshima, Takuro Matsuda, Masaomi Fujita, Rie Tazawa, Kanta Fujimi and Shin-ichiro Miura

J. Cardiovasc. Dev. Dis. 2022, 9(1), 21; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9010021 - 11 Jan 2022

Cited by 4 | Viewed by 2335

Abstract

Background: Cardiac rehabilitation (CR) combined with stress management training has been shown to be associated with fewer clinical events than CR alone. However, there have been no reports on the associations of CR with the psychological condition and detailed physical activities evaluated on the same day. Method: One hundred outpatients who participated in a CR program were graded on the hospital anxiety and depression scale (HADS). We divided them into a high HADS group (n = 32) and a normal HADS group (n = 68) and investigated by whole patients, ischemic heart disease (IHD) patients, and heart failure patients. Results: Overall, the patient age was 70.5 ± 9.6 years, the percentage of males was 73.0%, and the body mass index was 23.4 (21.7–26.0) kg/m². In the high HADS group, overall functional mobility was poor and the distance in a two-minute walking test was short. Especially in IHD patients, the high HADS group showed high fat mass in body composition and low exercise tolerance and ventilator equivalents in cardiopulmonary exercise test. Conclusions: Depression and anxiety involved poor physical performance in CR outpatients and particularly involved low exercise tolerance in IHD patients. To evaluate accurate physical performance, it is necessary to investigate psychological condition. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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Other

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17 pages, 1169 KiB

Open AccessSystematic Review

The Comparison of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training after Coronary Artery Bypass Graft: A Systematic Review of Recent Studies

by Billie Schulté, Lisa Nieborak, Franck Leclercq, Jorge Hugo Villafañe, Eleuterio A. Sánchez Romero and Camilo Corbellini

J. Cardiovasc. Dev. Dis. 2022, 9(10), 328; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9100328 - 28 Sep 2022

Cited by 6 | Viewed by 2691

Abstract

Currently, no international consensus on cardiac rehabilitation exists, leading to great variability in the intensity recommendations for training programs for cardiac patients, including those undergoing coronary artery bypass graft surgery (CABG). While some countries prefer the high-intensity interval training (HIIT) method to improve cardiorespiratory fitness, other countries opt for moderate-intensity continuous training (MICT). The aim of this systematic review was to compare the effects of HIIT and MICT on aerobic fitness and quality of life (QoL) in patients undergoing CABG with the intention of providing support for a consensus on exercise therapy. Methods: A systematic review of randomized controlled trials (RCTs) was conducted using the online publication databases PubMed, the Cochrane Library and the Bibliothèque nationale du Luxembourg (BnL) covering the last ten years to July 2022. Relevant identified studies respecting the inclusion/exclusion criteria were selected, screened and extracted by four reviewers. Furthermore, the methodological quality of the clinical trials was assessed using the PEDro scale, which was reinforced using the Cochrane Risk of Bias Tool for Randomized Trials (RoB2) for the evaluation of the risk of bias to provide more detail in the evaluation. The certainty of the evidence analysis was established using different levels of evidence in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Results: A total of 379 patients from five RCTs diagnosed with coronary artery disease, including patients undergoing CABG, performed aerobic exercise over different time periods and were assessed based on peakVO2, VO₂max and QoL. Overall, both training methods provided improvements in cardiorespiratory fitness and quality of life, with greater changes in HIIT groups. Conclusion: Both trainings methods provide improvements in cardiorespiratory fitness and QoL, with greater increases from HIIT. The moderate quality of evidence supports the use of HIIT and MICT to improve cardiorespiratory fitness and QoL. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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7 pages, 619 KiB

Open AccessCase Report

Supervised and Individualized Lifestyle Medicine Therapy of a Patient after Myocardial Infarction—Case Study

by Márton Dvorák, Ilona Sztancsik, László Babai, Miklós Tóth and Pongrác Ács

J. Cardiovasc. Dev. Dis. 2022, 9(6), 177; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9060177 - 01 Jun 2022

Cited by 1 | Viewed by 1920

Abstract

Background: In the rehabilitation of patients with cardiovascular disease (CVD) and after myocardial infarction (MI), lifestyle modifications—exercise and nutritional therapy, smoking cessation, stress management—are essential and have a major, long-term impact on the overall health of patients. Methods: After MI and acute primary care, a lifestyle medicine team (medical doctors, dietitian, exercise physiologist) supervised the therapy of a 40 year-old male patient for 12 months. The program included assessments, regular medical controls, personalized diet, and exercise therapy monitored by a heart rate watch. Results: Gradual and continuous weight loss, major reduction in medication and significant improvement in fitness level, blood glucose level, and cardiac function were measured after the program. Due to these positive changes, the patient’s overall health improved to an even better level than before his MI. Conclusion: The results of this program highlight the benefits and importance of the personalized therapy and the lifestyle medicine team approach in the rehabilitation of CVD patients. Individualized and supervised lifestyle therapy should be part of the primary hospital care of CVD patients lead by medical doctors and supported by other health care providers. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: State of the Art and Perspectives)

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