Research with clinical populations: Cardiac rehabilitation

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Research with clinical populations Cardiac
rehabilitation

• Shawn N Fraser
• University of Alberta

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Research program-CR

• The enduring impact of social influences on
  exercise tolerance
• Determinants of self-efficacy to overcome
  barriers to exercise in cardiac rehabilitation
• Determinants of CVR to stress among post-MI
  patients

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Research program-CR

• Health care costs of those who have and have not
  attended CR
• Changes in QOL among men and women who have
  attended CR
• Social support and coping
• Social psychological influences of behavior and
  outcomes of CR patients

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Introduction

• CVDs leading causes of death in Canada and in the
  industrialized world
• 1/3 of deaths globally (WHO, 2002)
• 80,000 Canadians
• Roughly equal numbers of men and women
• Men higher incidence but survive more

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Introduction

• Heart disease, stroke
• Much due to lifestyle factors
• Smoking, diet, exercise

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Cardiac rehabilitation

• Secondary and tertiary prevention of CVDs
• Intervene early or treatment efforts
• Exercise based rehabilitation
• Demonstrated efficacy
• Increased survival
• Reduced recurrent events
• Psychological benefits

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Cardiac rehabilitation

• Exercise based rehabilitation improves
• Survival
• Prognosis
• Functional outcomes
• Risk profiles (cholesterol, etc.)
• Psychological outcomes

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Cardiac rehabilitation

• Cardiac rehabilitation offers
• Nutritional counseling
• Stress management
• Aerobic exercise
• Resistance training
• Other educational classes

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CR-concerns

• Most people qualify for CR
• CABG, MI, Angioplasty
• About 20-30 of eligible are referred
• Of those attending ½ will stop exercising within
  6 mos.

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CR-concerns

• Those referred are typically
• Men
• Younger
• Healthier
• Those with most to gain?

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CR-Research challenges

• Research team
• Cardiologist
• Exercise technologist
• Exercise specialist
• Nurses
• Researcher
• Patient

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CR-Research

• Outcomes
• Death
• Recurrent events
• Prognostic factors
• Functional factors QOL, etc.
• Behavior smoking, exercise, etc.

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CR-Research

• Prognostic factors
• Cholesterol levels
• Weight
• Depression
• Exercise tolerance
• Mental stress tolerance
• Other physiological markers
• Other behavioral factors

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Exercise tolerance

• Exercise tolerance
• Diagnostic tool determines patients capacity for
  exercise
• Diagnose CAD
• Provide exercise prescription
• Useful prognostic indicator
• And indicator of progress

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Exercise tolerance

• Exercise stress test
• Exercise (walk, cycle) until
• Patient cannot continue
• BP, HR too high
• Silent ischemia

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CR-Research challenges

• Adherence
• Many stop exercising
• Most were not referred
• Effects?

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CR-Research challenges

• Problem
• Within the last month youve had a heart attack,
  bypass, and/or angioplasty
• Efficacy to exercise?
• Mental stress (fear) of test?
• Accurate exercise tolerance?
• Effort, stress response
• Interpretation of test cessation?