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The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments.Sixty participants (male, 71.7%; 13.5 ± 22.5 [mean ± standard deviation] months post stroke; age 64.5 ± 12.5 years, with a Chedoke-McMaster Stroke Assessment score of 4.9 ± .9 of the leg) underwent 6MWT, CPET, balance, strength, and cognition assessments.6MWT heart rate (hr) was significantly lower than VAT-hr (92.3 ± 14.8 beats⋅min(-1) versus 99.8 ± 15.7 beats⋅min(-1), respectively, P .001; correlation r = .7, P .001). Bland-Altman analysis revealed that the 6MWT underestimated the VAT-hr by 7.7 ± 11.5%. The 95% confidence interval of the mean bias was large (14.8% and -30.3%), reflecting poor agreement, with 71.7% (n = 43) of the participants unable to reach a walking intensity at or above the VAT-hr. Lower oxygen uptake at the VAT (β = .655, P = .004), higher 6MWT-hr (β = 1.07, P = .01), and better balance (β = 1.128, P = .04) were associated with greater utility of the 6MWT for prescribing exercise.The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included.

PURPOSE: Cardiac rehabilitation (CR) has been recommended to provide exercise guidance poststroke. However, it has not been established whether minimal exercise training levels, sufficient for obtaining health benefits, can be attained in CR. Therefore, we assessed the ability of stroke patients to achieve recommended exercise levels during a single standard CR session following completion of CR. METHODS: Sixteen patients (10 males and 6 females) with mild/moderate motor impairments who had completed CR participated in the study. Resting metabolic rate and oxygen uptake during 30 minutes each of aerobic and resistance training (AT, RT, respectively) were assessed by ambulatory oxygen monitor. Obtained values were compared with recommended minimal levels, that is, 20 or more minutes of exercise at 40% or more of peak oxygen uptake ( O2peak), 30 or more minutes of exercise at 3 or more metabolic equivalents (METs) (multiples of resting metabolic rate), and an energy expenditure of approximately 200 kcal per session. RESULTS: Mean time sustaining 40% or more of O2peak was 47.6 +/- 9 minutes, exceeding the minimal target of 20 minutes (P < .001). Time sustaining 3 or more METs was 30.8 +/- 12.2 minutes, matching the target of 30 minutes (P = .8). Total energy expenditure (252 +/- 49.9 kcal) was significantly greater than the target value of 200 kcal (P = .001). CONCLUSIONS: Chronic stroke patients with mild/moderate motor impairments are able to meet or exceed minimal recommended exercise target levels for intensity, duration, and energy expenditure during a typical exercise session consisting of 30 minutes of AT combined with 30 minutes of RT after completing CR. These data contribute to the evidence promoting the efficacy and feasibility of CR for people following stroke.

Marzolini S, Oh PI, Alter D, Stewart DE, Grace SL; on behalf of the Cardiac Rehab: Care Continuity through Automatic Referral Evaluation Investigators. Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization. Objectives To describe the prevalence of musculoskeletal conditions (MSKC) in patients with coronary artery disease (CAD); to examine the sociodemographic, clinical, and psychosocial predictors of these comorbidities; and to describe health care utilization by musculoskeletal comorbidity status. Design This was a cross-sectional, observational study in which patients were administered a questionnaire in the hospital and 1 year later. Setting Eleven hospitals in Ontario, Canada. Participants CAD patients (N=1803). Interventions Not applicable. Main Outcome Measures Sociodemographic, MSKC, clinical, and psychosocial factors were ascertained via questionnaire and in-hospital chart extraction. A health care utilization questionnaire was mailed 1 year later. Results Over half (56%) of the patients with CAD had MSKCs, with arthritis/joint pain accounting for 64.4% of these MSKCs. Patients who were older (odds ratio [OR]=1.03), women (OR=1.87), white (OR=1.80), with higher body mass index (OR=1.05), depressive symptoms (OR=1.92), and lower family income (OR=1.46) were more likely to present with MSKCs. One year posthospitalization, a greater proportion of those with MSKCs reported ≥1 cardiac-related emergency department visit (33.2% vs 28.3%, P=.03), hospital admission (30.7% vs 22%, P=.006), more primary care physician visits (6.6±5.6 vs 5.7±4.6, P Conclusions Over half of the patients hospitalized for CAD have MSKCs. Those with MSKCs have a physical and psychosocial profile that places them at greater cardiovascular risk than those with CAD only, explaining, in part, their greater health care utilization. Despite a greater need for comprehensive risk factor management in patients with MSKCs, fewer were referred to cardiac rehabilitation.

Background and Purpose— Despite the importance of exercise training in mitigating cardiovascular risk, the development of exercise programs for people poststroke has been limited by lack of feasibility data concerning cardiopulmonary exercise testing (CPET) to inform the exercise prescription. Therefore, we examined the feasibility of CPETs for developing an exercise prescription in people ≥3 months poststroke. Methods— CPET results from 98 consecutively enrolled patients poststroke with motor impairments and 98 age- and sex-matched patients with coronary artery disease were examined at baseline and after 6 months of exercise training. Results— The proportion of patients with stroke and coronary artery disease attaining an intensity sufficient for prescribing exercise at baseline was 68.4% versus 82.7%, respectively ( P =0.02) and 84.7% versus 83.8% ( P =0.9) at 6 months. Women were less likely than men poststroke to achieve a sufficient intensity at baseline (40% versus 80.9%, P P =0.3). A clinically relevant abnormality occurred in 11.2% of stroke and 12.2% of patients with coronary artery disease on baseline CPETs ( P =0.8) and 10.6% of stroke and 5.9% of patients with coronary artery disease on the 6-month CPET ( P =0.4). No serious cardiovascular events occurred during 349 CPETs. Conclusions— Most patients after stroke achieved a level of exertion during the CPET sufficient to inform an exercise prescription. At least 1 of 10 patients poststroke developed a clinically relevant abnormality on baseline and postprogram CPETs with no serious cardiovascular events. These data support the feasibility and safety of CPETs for prescribing exercise poststroke. Strategies to improve use of baseline CPETs for women poststroke require further investigation.

Aim. The study purpose was to examine how and under what circumstances immigrants combine diabetes self-care with cardiac rehabilitation recommendations. Background. Cardiac rehabilitation can improve and lengthen life in people with coronary heart disease as it promotes healthy physical and psychosocial behaviours and outcomes. This study is the first to examine the convergence of two common issues on participation: (1) the problems posed when cardiac rehabilitation patients must also contend with type II diabetes and (2) the experiences of immigrants in cardiac rehabilitation. Design. A critical ethnographic approach was employed. Methods. Two in depth interviews were conducted with 18 immigrants (eight men, ten women) enrolled in cardiac rehabilitation. Data were collected from 2008–2010. Findings. Threaded throughout immigrant participants’ descriptions were biographical accounts of crossing geographical borders, establishing a sense of belonging in their adopted country and trying to feel ‘at home’ in cardiac rehabilitation. Participants described creative hybridization of transnationally informed knowledges and particularized practices to manage diabetes self-care and to reduce cardiac risk. Participants judiciously considered, assessed and blended knowledges from cardiac rehabilitation, experience with their own bodies and general ‘wisdoms’ passed on within their own and other immigrant communities. Conclusion. These findings suggest that migration constitutes an important social positioning that contextualizes individual efforts to activate diabetes self-care and cardiac rehabilitation. Support to immigrants may improve when nurses recognize the significance of such experiences. Efforts are needed in practice and research to recognize and explore immigrants’ creative efforts to engage in cardiac rehabilitation.

Background Cardiac rehabilitation (CR) participation is associated with significantly lower mortality, and this benefit has been established as dose-dependent. Because it has been suggested that women are adherent to CR programs less than men, the objective of this study was to review CR adherence among women and men, and to determine whether a sex difference exists. Methods MedLine, CINAHL, EMBASE, PsycINFO, and the Cochrane databases were systematically searched. Titles and abstracts were screened, and selected full-text articles were independently considered on the basis of predefined inclusion/exclusion criteria. Data from included articles were extracted by 2 authors independently and assessed for quality. The meta-analysis was undertaken with predefined subgroup analyses. Results The search identified 5148 articles, of which 149 were fully examined for inclusion consideration. Fourteen studies reporting data on 8176 participants (2234 [27.3%] women) were included. Overall, CR adherence ranged from 36.7% to 84.6% of sessions, with a mean of 66.5 ± 18.2% (median, 72.5%). Men and women enrolled in CR adhered to 68.6% and 64.2% of prescribed sessions, respectively (mean difference = −3.6; 95% confidence interval, −6.9 to −0.3). The sex difference persisted in studies of high quality, that were undertaken in Canada, published since 2010, and where programs were longer than 12 weeks' duration and offered fewer than 3 sessions per week. Conclusions To our knowledge, this is the first meta-analysis to systematically report CR adherence rates, and results suggest that patients adhere to more than two-thirds of prescribed sessions. CR adherence is significantly lower among women than men. Identified strategies to promote adherence need to be tested among women.

Objective: To assess cognitive performance as a predictor of noncompletion of cardiac rehabilitation (CR) using a standardized verbal memory test. Methods: This was a prospective cohort study of consecutive patients with coronary artery disease (n = 131) entering 1-year outpatient CR between April 2007 and May 2009. Verbal memory performance was assessed using the California Verbal Learning Test, Second Edition. Attendance at weekly CR sessions was recorded, and completion or noncompletion was determined according to comprehensive CR criteria. Depression was diagnosed according to DSM-IV criteria as a possible confounder. Results: Verbal memory performance at entry into CR differed significantly (F(1,130) = 7.80, p =.006) between noncompleters and completers (mean [SD] cumulative California Verbal Learning Test, Second Edition, score, −1.15 [2.59] versus 0.47 [3.12]) in analysis of covariance controlling for pertinent clinical confounders. Better verbal memory performance predicted a reduced risk of noncompletion (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.77-0.96, p =.009) in time-to-event analysis adjusted for depression (HR = 2.62, 95% CI = 1.33-5.17, p =.006) and smoking history (HR = 2.03, 95% CI = 0.98-4.22, p =.06). A post hoc analysis suggested that better verbal memory performance predicted a reduced risk of noncompletion for medical reasons (HR = 0.83, 95% CI = 0.70-0.99, p =.03). Conclusions: Poorer verbal memory performance was associated with an increased risk of noncompletion of CR among participants with coronary artery disease. Further studies exploring practical methods for screening and targeted support might improve rehabilitation outcomes.

To assess serum brain derived neurotrophic factor (BDNF) concentrations as a correlate of cardiopulmonary fitness and as a predictor of cognitive performance in subjects with coronary artery disease (CAD).Serum BDNF concentrations were assayed by ELISA and fitness was assessed using a standardized exercise stress test. The Mini Mental Status Examination (MMSE), California Verbal Learning Test 2nd Ed., Stroop, Trail Making Test B and the Digit Symbol-Coding task were administered. The val66met BDNF genotype and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were determined as potential confounders.In subjects with CAD (n=88; 85.2% male, mean age 62.8±10.5 yr), cardiopulmonary fitness was associated with higher serum BDNF concentrations (β=.305, p=.013). Higher serum BDNF concentrations were associated with higher MMSE scores (F(1,87)=15.406, p.0005) and better performance on the Digit Symbol-Coding task (F(1,87)=9.620, p=.003). IL-6, TNF-α and the val66met genotype did not influence these results.Serum BDNF concentrations were associated with cardiopulmonary fitness, psychomotor processing speed and overall cognition in subjects with CAD.

OBJECTIVES: To investigate the association between cardiopulmonary fitness and cognitive performance in subjects with coronary artery disease (CAD). DESIGN: Cross-sectional observational study. SETTING: Outpatient cardiac rehabilitation. PARTICIPANTS: Eighty-one subjects with CAD. MEASUREMENTS: Cardiopulmonary fitness was assessed by measuring peak oxygen uptake (VO2Peak) in a standardized exercise stress test. The fraction of the predicted age and sex norm for VO2Peak was computed for each patient. A battery of neuropsychological tests including the Stroop, Trail-Making Test Part B, Digit Symbol Coding, Revised Brief Visuospatial Memory Test, California Verbal Learning Test 2nd Edition, and Mini Mental State Examination (MMSE) was administered, from which composite Z-scores were computed for tasks involving executive function and memory. RESULTS: Executive function, memory, and MMSE scores were correlated with VO2Peak, but only performance in the executive domain was independently associated with VO2Peak in multiple linear regression. In a multiple linear regression model controlling for potential clinical confounders, VO2Peak (β=.666, P

Purpose People with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders. Methods Eight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise (n = 7) or usual care (control) (n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM. Results The exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score (p Conclusions A 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.

Background— Cardiac rehabilitation (CR) is recommended after coronary artery bypass graft surgery; however, the consequences of longer wait times to start CR have not been elucidated. Method and Results— Cardiopulmonary, demographic, and anthropometric assessments were conducted before and after 6 months of CR in consecutively enrolled patients from January 1995 to October 2012. Wait times were ascertained from referral forms and charts. Neighborhood characteristics were ascertained using census data and cross-referencing with patients’ home geographic location. Among 6497 post- coronary artery bypass graft participants, mean and median total wait time (time from surgery to first exercise session) was 101.1±47.9 and 80 days, respectively. In multiple linear regression, correlates of longer total wait time and the 2 wait-time phases, time from surgery to CR referral and time from CR referral to first exercise session, were determined. Factors influencing longer wait times included female sex, greater age, being employed, less social support, longer drive time to CR, lower neighborhood socioeconomic status, higher systolic blood pressure, abdominal obesity, and a complex medical history. After adjusting for correlates of delayed entry, longer wait time for each of the total and 2 wait-time phases was significantly associated with less improvement in cardiopulmonary fitness (VO 2peak ; β=−0.165, P P P P P Conclusions— Strategies for timely access to CR at each phase of the process are important given the negative impact that wait time has on key clinical outcomes. This is relevant because optimizing VO 2peak and attendance to CR has been shown to confer a mortality advantage.

Exercise-based cardiac rehabilitation (CR) programs help patients with coronary heart disease (CHD) reduce their risk of recurrent cardiac illness, disability, and death. However, men with CHD and Type 2 diabetes mellitus (T2DM) demonstrate lower attendance and completion of CR despite having a poor prognosis. Drawing on gender and masculinity theory, we report on a qualitative study of 16 Canadian diabetic men recently enrolled in CR. Major findings reflect two discursive positions men assumed to regain a sense of competency lost in illness: (a) working with the experts, or (b) rejection of biomedical knowledge. These positions underscore the varied and sometimes contradictory responses of seriously ill men to health guidance. Findings emphasize the priority given to the rehabilitation of a positive masculine identity. The analysis argues that gender, age, and employment status are powerful mechanisms of variable CR participation.

People with diminished ventricular contraction who develop heart failure have higher sympathetic nerve firing rates at rest compared with healthy individuals of a similar age and this is associated with less exercise capacity. During handgrip exercise, sympathetic nerve activity to muscle is higher in patients with heart failure but the response to leg exercise is unknown because its recording requires stillness. We measured sympathetic activity from one leg while the other leg cycled at a moderate level and observed a decrease in nerve firing rate in healthy subjects but an increase in subjects with heart failure. Because these nerves release noradrenaline, which can restrict muscle blood flow, this observation helps explain the limited exercise capacity of patients with heart failure. Lower nerve traffic during exercise was associated with greater peak oxygen uptake, suggesting that if exercise training attenuated sympathetic outflow functional capacity in heart failure would improve.The reflex fibular muscle sympathetic nerve (MSNA) response to dynamic handgrip exercise is elicited at a lower threshold in heart failure with reduced ejection fraction (HFrEF). The present aim was to test the hypothesis that the contralateral MSNA response to mild to moderate dynamic one-legged exercise is augmented in HFrEF relative to age- and sex-matched controls. Heart rate (HR), blood pressure and MSNA were recorded in 16 patients with HFrEF (left ventricular ejection fraction = 31 ± 2%; age 62 ± 3 years, mean ± SE) and 13 healthy control subjects (56 ± 2 years) before and during 2 min of upright one-legged unloaded cycling followed by 2 min at 50% of peak oxygen uptake (V̇O2,peak). Resting HR and blood pressure were similar between groups whereas MSNA burst frequency was higher (50.0 ± 2.0 vs. 42.3 ± 2.7 bursts min(-1), P = 0.03) and V̇O2,peak lower (18.0 ± 2.0 vs. 32.6 ± 2.8 ml kg(-1) min(-1), P0.001) in HFrEF. Exercise increased HR (P0.001) with no group difference (P = 0.1). MSNA burst frequency decreased during mild to moderate dynamic exercise in the healthy controls but increased in HFrEF (-5.5 ± 2.0 vs. 6.9 ± 1.8 bursts min(-1), P0.001). Exercise capacity correlated inversely with MSNA burst frequency at 50% V̇O2,peak (n = 29; r = -0.64; P0.001). At the same relative workload, one-legged dynamic exercise elicited a fall in MSNA burst frequency in healthy subjects but sympathoexcitation in HFrEF, a divergence probably reflecting between-group differences in reflexes engaged by cycling. This finding, coupled with an inverse relationship between MSNA burst frequency during loaded cycling and subjects' V̇O2,peak, is consistent with a neurogenic determinant of exercise capacity in HFrEF.

Cardiovascular disease continues to be among the leading causes of morbidity and mortality among men and women globally. However, research suggests that women are significantly underrepresented in cardiac rehabilitation (CR), programmes which are shown to reduce recurrent cardiac events and related premature death. However, sex differences in referral rates have not been systematically and quantitatively reviewed. Hence, the objective of the study was to assess whether a significant sex difference exists.We searched Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases for studies reporting CR referral rates in women and men published between July 2000 and July 2011. Titles and abstracts were screened, and the selected full-text articles were independently screened based on predefined inclusion/exclusion criteria. Included articles were assessed for quality using STROBE.Of 623 screened articles, 19 observational studies reporting data for 241,613 participants (80,505 women) met the inclusion criteria. In the pooled analysis, women (39.6%) were significantly less likely to be referred to CR compared to men (49.4%; odds ratio 0.68, 95% confidence interval 0.62-0.74). Heterogeneity was considered significant (I (2 )= 90%). There was no change in significant findings when subgroup analyses were conducted, examining fee for service vs. no fee, high-quality studies vs. others, or studies pooled by different study methodologies.CR referral remains low for all patients, but is significantly lower for women than men. Evidence-based interventions to increase referral for all patients, including women, need to be instituted. It is time to ensure broader implementation of these strategies.

Risk of hip fracture is greater poststroke than in an age-matched healthy population, in part because of declining hip BMD. We found that individuals may be at risk of loss of hip BMD from muscle atrophy, asymmetrical gait, and poor affected-side ankle dorsiflexor strength. These impairments may be targeted during rehabilitation. This study aimed to determine predictors of low hip BMD on the stroke-affected side in people living in the community. Forty-three participants (female; 27.9 %), mean age 62.4 ± 13.5 and 17.9 ± 32.8 months, poststroke with motor impairments underwent dual energy X-ray absorptiometry scans. Gait characteristics, isometric strength, body composition, and fasting plasma lipids were measured. At entry, 34.9 % (15/43) of the participants had low total hip BMD on the stroke-affected side. Of those with low BMD, 93.3 % (14/15) had a step length symmetry ratio >1, indicating greater reliance on the non-paretic leg for weight bearing. Logistic regression analysis revealed that lower affected-side ankle dorsiflexor strength (s = 0.700, p = 0.02), lower total body fat-free mass index (s = 0.437, p = 0.02), and greater step length symmetry ratio during walking (s = 1.135 × 103, p = 0.03) were predictors of low hip BMD. Low BMD of the stroke-affected side hip is prevalent in over a third of individuals with lower limb motor impairments. These individuals may be at particular risk of accelerated loss of BMD at the hip from asymmetrical gait pattern and poor affected-side ankle dorsiflexor strength. These impairments are intervention targets that may be addressed during rehabilitation which includes resistance training and addresses gait impairments.

Individuals referred to cardiac rehabilitation programs (CRPs) after stroke have demonstrated postprogram improvements in cardiovascular fitness (VO2peak). However, the effect of CRPs on other physiological/quality-of-life outcomes and effect of time from stroke on these results has not been investigated. The objectives of the present study are (1) to evaluate the effects of a CRP in participants with motor impairment after stroke and (2) to explore the effects of elapsed time from stroke on physiological/quality-of-life outcomes.The CRP included 24 weeks of resistance and aerobic training. Primary outcomes in 120 participants, 25.4±42.3 (mean±standard deviation) months after stroke, included 6-minute walk distance (6MWD), VO2peak, timed repeated sit-to-stand performance, and affected-side isometric knee extensor strength (IKES). Secondary measures included gait characteristics (cadence, step lengths, and symmetry), walking speed, balance (Berg Balance Scale), affected-side range of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and perceptions of participation/social reintegration.After adjusting for multiple comparisons, participants demonstrated significant improvements (all P.001) in 6MWD (283.2±126.6 to 320.7±141.8 m), sit-to-stand performance (16.3±9.5 to 13.3±7.1 seconds), affected-side IKES (25.9±10.1 to 30.2±11 kg as a percentage of body mass), and VO2peak (15.2±4.5 to 17.2±4.9 mL·kg·min(-1)). Participants also demonstrated post-CRP improvements in secondary outcomes: anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric elbow flexor strength, participation, walking speed, cadence (all P.001), and bilateral step lengths (P.04). In a linear regression model, there was a negative association between the change in 6MWD and time from stroke (β=-42.1; P=.002) independent of baseline factors.A CRP yields improvements over multiple domains of recovery; however, those who start earlier demonstrate greater improvement in functional ambulation independent of baseline factors. These data support the use of adapted CRPs as a standard of care practice after conventional stroke rehabilitation.

This study investigated the associations among trait perfectionism, perfectionistic self-presentation, Type D personality, and illness-specific coping styles in 100 cardiac rehabilitation patients. Participants completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Type D Scale-14, and the Coping with Health Injuries and Problems Scale. Correlational analyses established that emotional preoccupation coping was associated with trait perfectionism, perfectionistic self-presentation, and Type D personality. Perfectionism was linked with both facets of the Type D construct (negative emotionality and social inhibition). Our results suggest that perfectionistic Type D patients have maladaptive coping with potential negative implications for their cardiac rehabilitation outcomes.

Objective: Community exercise programs are effective in improving aerobic capacity after stroke, but individual variability in training responses has not previously been studied. This study examined explanatory factors for post-program responses in aerobic capacity (VO 2peak ) with respect to training parameters and participant characteristics. Design: Secondary analysis of data from a prospective cohort study. Subjects: Thirty-two participants, mean age 63 years (standard deviation (SD) 13), 29 months (SD 26) post-stroke. Method: Following a 6-month community exercise program, multivariate regression analysis was performed to assess for correlates with change in VO 2peak with respect to training parameters (exercise duration and intensity) and participant characteristics (lower limb and balance impairment, aerobic and walking capacity). Results: The mean improvement in VO 2peak was 11% (SD 19), but individually, changes ranged from 32% decline to 56% improvement. Regression analysis revealed that only 2 variables, baseline aerobic capacity and balance impairment, accounted for the training-related change in VO 2peak (R 2 = 0.20, p = 0.045). Conclusions: There is considerable inter-individual variability in stroke exercise program responses in aerobic capacity. Lower baseline aerobic capacity and better balance were associated with greater training-related improvements in VO 2peak . Identifying individuals who are more likely to respond to exercise programs may inform future work in establishing effective interventions suited for different subsets of the stroke population.

The study purpose was to examine how and under what circumstances immigrants combine diabetes self-care with cardiac rehabilitation recommendations.Cardiac rehabilitation can improve and lengthen life in people with coronary heart disease as it promotes healthy physical and psychosocial behaviours and outcomes. This study is the first to examine the convergence of two common issues on participation: (1) the problems posed when cardiac rehabilitation patients must also contend with type II diabetes and (2) the experiences of immigrants in cardiac rehabilitation.A critical ethnographic approach was employed.Two in depth interviews were conducted with 18 immigrants (eight men, ten women) enrolled in cardiac rehabilitation. Data were collected from 2008-2010.Threaded throughout immigrant participants' descriptions were biographical accounts of crossing geographical borders, establishing a sense of belonging in their adopted country and trying to feel 'at home' in cardiac rehabilitation. Participants described creative hybridization of transnationally informed knowledges and particularized practices to manage diabetes self-care and to reduce cardiac risk. Participants judiciously considered, assessed and blended knowledges from cardiac rehabilitation, experience with their own bodies and general 'wisdoms' passed on within their own and other immigrant communities.These findings suggest that migration constitutes an important social positioning that contextualizes individual efforts to activate diabetes self-care and cardiac rehabilitation. Support to immigrants may improve when nurses recognize the significance of such experiences. Efforts are needed in practice and research to recognize and explore immigrants' creative efforts to engage in cardiac rehabilitation.

Objectives We sought to describe temporal trends in the sociodemographic and clinical characteristics of participants referred to cardiac rehabilitation (CR), and its effect on programme participation and all-cause mortality over 14 years. Setting A large CR centre in Toronto, Canada. Participants Consecutive patients between 1996 and 2010. Primary and secondary outcome measures Referrals received were deterministically linked to administrative data, to complement referral form abstraction. Out-of-hospital deaths were identified using vital statistics. Patients were tracked until 2012, and mortality was ascertained. Percentage attendance at prescribed sessions was also assessed. Results There were 29 171 referrals received, of which 28 767 (98.6%) were successfully linked, of whom 22 795 (79.2%) attended an intake assessment. The age of the referred population steadily increased, with more females, less affluent and more single patients referred over time (p

Although aerobic training (AT) and resistance training (RT) have been shown to improve functional abilities in patients post stroke, few patients participate, with many doing so for only a short duration.To retrospectively identify factors that affect adherence to a home-based exercise program adapted for stroke patients in a cardiac rehabilitation program during and after program completion.Fourteen participants (age 63 ± 3 years, 37 ± 34 months post stroke) attended the rehabilitation center on a weekly (24 weeks) and then monthly (2 months) basis. Patients were required to complete 4 AT and 1 to 2 RT sessions away from the center each week. A 16-item survey exploring adherence to home-based workouts was administered.Seven patients were currently participating (mean time in program, 19.4 ± 8 weeks) and 7 had graduated (mean of 32.8 ± 28 weeks post graduation) from the program. Current participants had higher adherence than graduated participants to AT (100% vs 76%; P.01) and RT (100% vs 55%; P.01). The most common factors motivating participants were to improve overall health, improve functional abilities, and enhance confidence and to reduce musculoskeletal issues. The most common factors preventing workouts were lack of motivation, musculoskeletal issues, and fatigue. There was a negative correlation between age and adherence to AT in the graduated group.Adherence to home-based exercise is superior during participation in an organized group program, with decline after graduation.

Resistance training (RT) has only a permissive role as an adjunct to aerobic training (AT) in cardiac rehabilitation.To compare the effect of AT with combined RT and AT (CT) we searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, PreMedline, SPORT DISCUS, CINAHL (from the earliest date available to October 2009) for randomized controlled trials (RCTs), examining effects of CT versus AT on body composition, cardiovascular fitness (VO(2peak)), strength, and quality-of-life (QOL) in coronary artery disease (CAD) (excluding heart failure). Two reviewers selected studies independently.Twelve studies met the study criteria (229 AT patients, 275 CT patients). Compared with AT, CT decreased percent body fat by -2.3% (WMD (weighted mean difference); 95% CI: -3.59 to -1.02), decreased trunk fat (SMD (standardized mean difference): -0.56; 95% CI: -0.96 to -0.15) and increased fat-free mass by 0.9 kg (WMD; 95% CI: 0.39 to 1.36) in three studies (n = 106). Similarly CT was associated with larger increases in lower body strength (seven studies, n = 225, SMD: 0.77; 95% CI: 0.49 to 1.04) and upper body strength (eight studies, n = 262, SMD: 1.07; 95% CI: 0.76 to 1.38). Compared to AT, CT improved peak work capacity (three studies, n = 92, SMD: 0.88; 95% CI: 0.45 to 1.31) and there was a trend for CT to increase VO(2peak) by 0.41 ml/kg/min (nine studies, n = 399, WMD; 95% CI: -0.05 to 0.88). Qualitative analysis of QOL data favors CT. Study withdrawals were similar for AT (14.2% ± 13.2) and CT (11.5% ± 15.5). No serious adverse events were reported.CT is more effective than AT in improving body composition, strength, and some indicators of cardiovascular fitness, and does not compromise study completion or safety when compared to AT.

Of the 40,000–50,000 people diagnosed with stroke in Canada each year, approximately one-third are recurrent cases of stroke.2 Physical inactivity is a particularly powerful risk factor for stroke and has been identified by the INTERSTROKE study as one of the five main health hazards that account for more than 80% of the global risk of stroke.3 Moreover, Towfighi and colleagues, in a recent cross-sectional study of US civilians with previous stroke (n=388), demonstrated that regular exercise and abstinence from smoking were each independently associated with lower all-cause mortality after stroke.4 Despite the importance of physical activity for people following stroke, few stroke survivors exercise regularly.4–6 This may be because structured programmes aimed at reducing risk of recurrent stroke and comorbid cardiac disease are not widely available or accessible.7,8 The issues of inactivity, lack of access to exercise programmes, and risk of secondary stroke may be intensified with people who have both physical and communication deficits following a stroke. Unfortunately, people with communication issues—approximately 30% of all people with stroke9—are often excluded from studies or are not examined as a distinct cohort within larger studies. We therefore know less about their experiences with barriers to exercise programmes and the short-term and long-term effects of these barriers. To fill this knowledge gap, Blonski and colleagues have conducted a qualitative study exploring the communication, environmental, and personal facilitators and barriers that people with post-stroke aphasia experience when they attempt to access and participate in community-based exercise programmes.1 They conducted face-to-face interviews with 10 people with stroke recruited from the Aphasia Institute in Toronto, Canada. Most participants (80%) had mild to moderate forms of aphasia; more than half were male (60%), and all were trained in supported conversation at the Aphasia Institute. Most (90%) were participating in at least one supervised exercise programme for people with stroke, including the in-house exercise programme offered at the Aphasia Institute (90%), stroke-specific exercise programmes (20%), and community-based exercise programmes (40%). In the interviews, people with aphasia identified nonverbal communication, patience, and clear, simple instructions delivered in a slow, unhurried manner were important facilitators of exercise participation. They also identified a need for aphasia-specific exercise programming, presence of a communication partner, family support, transportation resources, and extra exercise instructors. In addition, they noted that lack of general public awareness about aphasia, the high cost of exercise programmes, and lack of knowledge of exercise programme locations represent further challenges. Improved advertising of available programmes specific to people with aphasia and greater availability of accessible programmes were identified as areas of need. Blonski and colleagues report that although the interviewers focused on communication-related facilitator and barriers, physical impairments such as mobility deficits and hemiparesis repeatedly emerged as primary barriers for study participants.1 This finding of physical impairment as a primary barrier concurs with those of Wallace and colleagues, who measured motor impairment, communication, and participation in 16 life activities in 41 people with aphasia.10 While participants in Wallace and colleagues' study rated communication issues as a greater barrier than physical limitations to overall life participation, physical limitations interfered more than communication issues in the subcategory of exercise and recreation. While removing the barriers posed by physical limitations is important, Blonski and colleagues' study highlights the importance of addressing specific communication issues as well.1 Future studies examining barriers and facilitators for accessing and participating in exercise programmes should embrace the full spectrum of stroke deficits—particularly because people with aphasia are likely to be older, with more severe strokes and decreased rates of functional recovery,9,11 than those who do not experience aphasia after stroke. The results of Blonski and colleagues' study are especially important because exercise training, both aerobic and resistance, is emerging as an important treatment in post-stroke recovery and secondary prevention,12 and Blonski and colleagues' findings reinforce that both physical and communication barriers to participation must be addressed.

To investigate the association between cardiopulmonary fitness and cognitive performance in subjects with coronary artery disease (CAD).Cross-sectional observational study.Outpatient cardiac rehabilitation.Eighty-one subjects with CAD.Cardiopulmonary fitness was assessed by measuring peak oxygen uptake (VO(2Peak) ) in a standardized exercise stress test. The fraction of the predicted age and sex norm for VO(2Peak) was computed for each patient. A battery of neuropsychological tests including the Stroop, Trail-Making Test Part B, Digit Symbol Coding, Revised Brief Visuospatial Memory Test, California Verbal Learning Test 2nd Edition, and Mini Mental State Examination (MMSE) was administered, from which composite Z-scores were computed for tasks involving executive function and memory.Executive function, memory, and MMSE scores were correlated with VO(2Peak) , but only performance in the executive domain was independently associated with VO(2Peak) in multiple linear regression. In a multiple linear regression model controlling for potential clinical confounders, VO(2Peak) (β=.666, P.001) and covariates accounted for 36% of the variance in executive function scores.Poorer VO(2Peak) is associated with poorer cognition, particularly executive function, in subjects with CAD independent of other cardiac risk factors. Cardiopulmonary fitness may be a protective factor for cognition in patients with CAD.

BACKGROUND: With the demographic of patients entering cardiac rehabilitation (CR) indicating an older and more obese population, musculoskeletal comorbidities (MSKCS) may be escalating. METHODS: Musculoskeletal comorbidities affecting exercise were ascertained in 322 patients (233 men and 89 women) by a questionnaire and then an interview before and after 3 months of CR. Outcome variables were measured at baseline and 6 months. RESULTS: Musculoskeletal comorbidities perceived to affect exercise were reported by 50% of subjects at CR entry (48.1% of males, 55.1% of females; P = .26); most commonly occurring in the knee(s) (25%) and back (19%) due predominantly to arthritis (36.6%) and strains/sprains (28.6%). Multivariate regression revealed that greater body mass, older age, and lower peak oxygen uptake (VO2peak) were predictors of baseline MSKCs. At entry, patients with MSKCs were less likely to be exercising 30 minutes or more, 5 times per week than those without MSKCs (17.4% vs 28%, respectively, P = .03). Exercise modifications were required for 33.5% of patients with MSKC. By 3 months, 15.2% of patients developed 62 new MSKCs (26.5% strains/sprains). Six months of CR yielded significant (P < .001) and similar improvements in (VO2peak) for patients with and without baseline MSKCs (16.3% and 18.8%, respectively, P = .28). The improvement was mitigated in those with arthritic conditions compared with others (7.8% vs 20%, respectively, P = .01). By 6 months, 31.1% and 29.8% of patients with and without baseline MSKCs respectively, discontinued CR (P = .81). CONCLUSIONS: At entry to CR, patients reporting MSKCs had a poorer health profile than those without mskcs, including lower levels of physical activity and cardiovascular fitness, and unfavorable anthropometric measures. With exercise modifications, significant benefits were achievable without affecting compliance.

OBJECTIVE To compare completion, adherence, and cardiac rehabilitation (CR) outcomes between participants with and without major depressive disorder (MDD) undertaking CR. METHOD In a prospective cohort study of consecutive patients with coronary artery disease (n = 195) entering 1-year outpatient CR between January 2006 and August 2008, rates of noncompletion (comprehensive CR criteria), nonadherence (< 70% attendance at scheduled CR visits), and CR outcomes were compared between patients with and without MDD based on the Structured Clinical Interview for DSM-IV criteria. RESULTS Major depressive disorder was diagnosed in 22.1% of participants. Rates of noncompletion were 44.2% and 28.9%, and rates of nonadherence were 53.0% and 34.9% for those with and without MDD, respectively. Major depressive disorder was associated with increased risks of noncompletion (multivariate hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.3-4.7) and nonadherence (multivariate HR, 2.4; 95% CI, 1.3-4.2). More participants with MDD failed to complete CR for medical reasons than those without MDD (25.6% vs 12.3%, respectively; P = .031) in post hoc comparisons. Participants with MDD achieved poorer cardiopulmonary fitness increases (change in mean ± SD peak oxygen uptake of 3.3 ± 3.2 vs 6.6 ± 5.7 mL/kg/min; P = .021) and poorer body fat outcomes (a mean ± SD increase of 2.1% ± 4.5% vs a decrease of 0.4% ± 3.4%, P = .009) than those without MDD. CONCLUSIONS Major depressive disorder was associated with poorer rates of completion and adherence in CR, and it mitigated improvements in clinical outcomes. Despite depression screening and psychosocial support as structured components of care, MDD remained a significant barrier to effective CR.

To retrospectively identify factors influencing long-term compliance to home-based resistance training (RT) in a cardiac rehabilitation (CR) programme.Five hundred and eighteen patients (447 males, 71 females) attending a CR programme consisting of aerobic exercise, education and lifestyle counselling were also offered RT exercises, which they performed over a 72-month period. These patients were sent a questionnaire to examine ongoing participation in RT and perceptions around RT.Sixty-nine percent of the surveys were returned. The mean follow-up time was 38.7+/-25.9 months post-RT prescription (about 2.5 years postgraduation from on-site CR). Among respondents, 50% (50.6% males, 42.9% females) were continuing RT at the time of the survey (compliers), and 50% (49.4% males, 57.1% females) had discontinued RT (dropouts). Compliers perceived greater support for RT participation than dropouts (41.3 and 22.5% perceived strong support, respectively, from family/friends and physicians, P0.005). Dropouts had a higher percentage of body fat at baseline than compliers (32% of dropouts and 20% of compliers had a body fat25%, P0.025). Men participated mainly to 'improve appearance' and women to 'prevent osteoporosis'. Weight reduction was a greater motivator to participate for dropouts than for compliers. The main reason for discontinuing RT was 'lack of motivation'. The most common injuries occurred in one shoulder or the lower back. Only 3% discontinued RT because of injury.One-half of patients starting an RT home-based programme were still under training at the time of the survey (mean 38.7 months). A lower percentage of body fat and support from family/friends and physicians seem to increase long-term compliance. There were sex differences in reasons for participation and dropout. Emphasizing achievable benefits that motivate men and women to participate may help to reduce dropout.

PURPOSE In North America, established long-term rehabilitation programs are commonly available for individuals following a cardiac event but are largely unavailable for stroke survivors. The purpose of this study was to determine (1) the availability of cardiac rehabilitation (CR) for individuals poststroke (survey of all programs in Ontario, Canada) and (2) the effects of CR, comparing individuals with primary and secondary diagnoses of stroke versus those with cardiac diagnoses only (retrospective review of a large outpatient North American program). METHODS An Ontario-wide survey was disseminated to CR programs to determine barriers to enrollment of stroke participants. Additionally, a retrospective analysis of data from 9,173 participants in 1 CR program in Toronto, Ontario, compared 3 subgroups (n = 19 each): (1) primary diagnosis of stroke or transient ischemic attack (TIA), (2) primary cardiac diagnosis and occurrence of stroke or TIA, and (3) cardiac diagnoses only. RESULTS Twenty-four of 40 (60%) programs surveyed included stroke participants, although the proportion was small (

MARZOLINI, S., P. I. OH, S. G. THOMAS, and J. M. GOODMAN. Aerobic and Resistance Training in Coronary Disease: Single versus Multiple Sets. Med. Sci. Sports Exerc., Vol. 40, No. 9, pp. 1557-1564, 2008. Purpose: The purpose of this study was to compare resistance training (RT) (one set vs three sets) combined with aerobic training (AT) versus AT alone in persons with coronary artery disease. Methods: Subjects (n = 72) were randomized to AT (5 dIwk j1 ) or combined AT (3 dIwk j1 ) with either one set (AT/ RT1) or three sets (AT/RT3) of RT performed 2 dIwk j1 .VO2peak, ventilatory anaerobic threshold (VAT), strength and endurance, body composition, and adherence were measured before and after 29 wk of training. Results: Fifty-three subjects (mean T SEM age 61 T 2) completed the training. The increase from baseline in VO2peak (LImin j1 ) averaged 11% for AT (P G 0.05), 14% for AT/RT1 (P G 0.01), and 18% for AT/RT3 (P G 0.001), however, the difference between groups was not significant. VAT improved significantly in the AT/RT3 group only (P G 0.05). The AT/RT3 group gained more lean mass than the AT group (1.5 versus 0.4 kg, P G 0.01), yet gains between AT/RT1 and AT were similar (P = 0.2). Only AT + RT groups demonstrated a reduction in body fat (P G 0.05). Strength and endurance increased more in the AT + RT groups than AT alone (P G 0.05). Adherence to number of sets performed was lower in AT/RT3 than AT/RT1 (P G 0.02). Conclusions: Combined AT + RT yields more pronounced physiological adaptations than AT alone and appears to be superior in producing improvements in VO2peak, muscular strength and endurance, and body composition. The data

This study examined the perceived health-benefits of music among avid-music listeners and non-avid music listeners with exercise, and compared these perceptions with self-reported more established population indicators of health. A cross-sectional survey was administered to 300 patients who were currently participating or previously participated in an outpatient cardiac rehabilitation program, evaluating perceptions of the role of music in exercise and health. Patients were categorized as avidmusic listeners and non-listeners based on their self-reported frequency of music-listening during exercise work-outs. Among the 149 patients who completed the survey (49.7% response rate), avid-music listeners were significantly more likely to perceive a positive impact of music on their exercise behaviours (i.e., frequency, duration, and intensity) and on their overall health than did those who listened rarely or not at all (p = 0.001). However, self-reported health status and exercise behaviours did not significantly differ between avid-music listeners and non-listeners. Tendencies to over-perceive positive health-benefits of music may exist among avid-music listeners, which in turn may suggest an underlying “healthy placebo- effect.” The long-term health and behavioral implications associated with positive health-music tendencies require further study.German:Die Beziehung von Musik, körperliche Übungen, Gesundheit in Selbstauskunft und Verhalten von Patienten in der Herzrehabilitation.Diese Studie untersuchte die erlebten positiven Auswirkungen auf die Gesundheit bei Menschen, die begeistert gerne Musik hören und solchen, die dies nicht tun, und vergleicht deren Wahrnehmungen mit berichteten etablierten allgemeinen Gesundheitsindikatoren. 300 Patienten, die derzeit an einem ambulanten Herzrehabilitationsprogramm teilnahmen oder zuvor teilgenommen hatten, wurde ein gekreuzt-sektionales Überblick gegeben, mit dem Ziel, deren Erfahrungen von Musik in Übungen und Gesundheit zu evaluieren.Die Patienten wurden kategorisiert als begeisterte Musikhörer und Nicht-Hörer, anhand ihrer selbst berichteten Häufigkeiten des Musikhörens während ihrer körperlichen Übungen. Unter den 149 Patienten, die diese Übersicht ausfüllten (49,7 % Antworten), erlebten diejenigen, die gerne Musik hörten, signifikant mehr positiven Einfluss auf ihr Übungsverhalten (z.B. Häufigkeit, Dauer und Intensität) und ihre gesamte Gesundheit als diejenigen, die wenig oder gar nicht (p = 0.001) Musik hören.Dennoch, der selbstberichtete Gesundheitsstatus und das Übungsverhalten zwischen Menschen, die begeistert Musik hören und den Nicht-Hörern unterscheidet sich nicht signifikant. Es ist möglich, dass begeisterte Musikhörer die erlebten positiven Auswirkungen auf ihre Gesundheit stärker wahrnehmen, was im Gegenzug an einen zugrundeliegenden „Gesundheits-Placebo-Effekt“ denken lässt. Langzeitaussagen zu Gesundheit und Verhalten im positiven Zusammenhang von Gesundheit und Musik erfordern weitergehende Studien.Spanish:La Relación entre música, ejercicio, salud autoreportada y conductas saludables entre pacientes cardíacos en rehabilitaciónEste estudio examinó los beneficios de la música para la salud percibidos entre aquellos ávidos por escuchar música durante sus ejercicios físicosy los no ávidos por la música, y se compararon estas percepciones con las autoreportadas por poblaciones indicadoras de salud más establecidas.Una encuesta cros-seccional se adminstró a 300 pacientes quienes participaban o habían participado de un programa de rehabilitación cardíaca ambulatoria, evaluando percepciones del rol de la música en el ejercicio y la salud. Loa pacientes fueron categorizados como ávidos y no ávidos por escuchar música basados en los autoreportes sobre la frecuencia de escuchar música durante los ejercicios físicos. Entre los 149 pacientes que completaron la encuesta (49.7%) aquellos ávidos por escuchar música fueron significativamente más propensos a percibir un impacto positivo de la música en sus conductas de ejercicio (p.ej. frecuencia, duración e intensidad) y en su salud en general comparados con aquellos que escuchaban música ocasionalmente o en ninguna ocasión (p=0.001). Sin embargo, el estado de salud autoreportado y las conductas de ejercicio no difieren entre los ávidos por escuchar y los no ávidos. Las tendencias a percibir por demás los beneficios positivos de la música para la salud puede existir entre los ávidos por escuchar música, lo cual puede sugerir un "efecto-placebo saludable" subyascente. La salud a largo plazo y las implicancias conductuales asociadas con las tendencias positivas salud-música requiere más estudio. Chinese:本研究旨在瞭解熱愛聆聽音樂者與非愛樂者對於音樂對健康益處的感受與想法， 並將這些感知與自陳報告及健康指標做比較。研究針對三百位目前正在進行或曾經參與心臟復健門診的病人進行橫向調查，評價音樂在運動與健康中所扮演角色的看法。依據參與病人自陳在運動健身時聆聽音樂的頻率，將受試者分為熱衷樂聆者與非熱衷樂聆者。在149位完成問卷的病人中(49.7%回應率)，熱衷樂聆者明顯較鮮少聆聽音樂或完全不聽音樂的病人更容易感受到音樂對於他們的鍛鍊行為(如，頻率、長度與強度)及整體健康帶來正面影響(p=0.001)。然而，兩組的自陳健康狀態與鍛鍊行為則未有顯著差異。此外，熱衷樂聆者表現出過度感知音樂對健康益處的傾向，因此建議對此標記為「健康安慰劑效應」。與積極健康的音樂傾向相關的長期健康和行為影響有待進一步研究。Japanese:心臓リハビリテーション患者の音楽、運動、自己申告による健康、健康行動の関係抄録この研究では、運動中に熱心に音楽を聴く人達と聴かない人達の健康への利益の認識について調査し、これらの認識をより確立された自己申告による健康の人口指標と比較した。現在もしくは過去に外来心臓リハビリテーションプログラムに参加した300人の患者を対象に断面調査が行われ、運動と健康における音楽の役割への認識を評価した。患者達は、運動中に音楽を聴く頻度の自己申告を基に、熱心な音楽リスナーと悲リスナーに分類された。アンケートを完了した149人の患者達（回答率49.7％ ）の間では、熱心な音楽リスナー達は、滅多にもしくは全く音楽を聴かなかった人々（p=0.001）よりも、 運動性質（頻度、持続時間、運動強度など）や全体的な健康に対して音楽のポジティブな影響がありそうであると認めた。しかし、自己申告の健康状態と運動性質では、熱心な音楽リスナーと非リスナーの間に著しい違いはなかった。熱心な音楽リスナー達の間では、音楽のポジティブな健康利益を感じる傾向があるかもしれず、それは潜在的な健康へのプラシーポ効果を示唆しているかもしれない。ポジティブな健康音楽傾向に関連した長期健康と行動の関連については、更なる研究が必要である。Korean:심장재활 환자들의 음악, 운동, 건강상태에 대한 자가보고, 건강관련 행동 간 관계초록본 연구는 음악 감상에 적극적인 참여자와 비적극적인 참여자들이 운동 중 인식하는 음악의 건강관련 혜택을 살펴보고 이 내용을 검증된 자가보고식 건강척도와 비교대조 하기 위하여 시행되었다. 따라서 본 단면적 조사 연구는 외래 심장재활 프로그램에 현재 참여 중이거나 또는 마친 300명의 환자들을 대상으로 운동 중 감상한 음악을 어떻게 인식 하는지에 대해 설문을 하였다. 연구자는 참여자들이 운동 시 얼마나 자주 음악 감상을 하였는지에 대해 보고한 내용을 바탕으로 적극적 음악감상자와 비적극적인 감상자로 분류하였다. 설문에 응한 149명의 참여자 중 (응답률: 49.7%) 적극적인 감상자들은 비적극적 감상자보다 유의한 수준에서 음악이 본인들의 운동관련 행동에 보다 더 긍정적으로 영향을 미친다고 보고하였으며(예: 운동 횟수, 지속시간 및 강도) 거의 음악감상을 하지 않거나 전혀 하지 않는 참여자에 비해 음악은 건강 전반에 긍정적으로 영향을 미친다고 기술 하였다 (p = 0.001). 하지만 자가보고식 건강척도와 운동관련 행동에서 이 두 그룹은 유의한 차이를 보이지 않았다. 따라서 적극적 음악감상자들이 음악의 건강 상 이점을 보다 과장되게 인식하는 경향이 있음이 나타났는데 이는 건강 상 플라시보 효과와 연관이 있다고도 볼 수 있다. 건강에 미치는 긍정적 영향과 관련하여 음악의 장기적 효과 및 행동에 대한 영향력 등에 대한 더 많은 연구들이 요구 된다.

Echo: Improving Women’s Health in Ontario, a former agency of the Ontario Ministry of Health and Long-Term Care

Inflammatory activity plays a role in the development and progression of coronary artery disease (CAD), and exercise confers survival benefit. We performed a meta-analysis of changes in inflammatory biomarkers over the course of exercise interventions in patients with CAD.We searched MEDLINE, Embase, the Cochrane Collaboration, AMED, and CINAHL for studies reporting peripheral inflammatory biomarker concentrations before and after exercise interventions of ≥ 2 weeks in patients with CAD. Data were summarized using standard mean differences (SMD) and 95% CIs.Twenty-three studies were included. Concentrations of C-reactive protein (CRP; SMD -0.345, 95% CI -0.444 to -0.246, n = 1,466, P.001), interleukin 6 (SMD -0.546, 95% CI -0.739 to -0.353, n = 280, P.001), fibrinogen (SMD -0.638, 95% CI -0.953 to -0.323, n = 247, P.001), and vascular cell adhesion molecule 1 (SMD -0.413, 95% CI -0.778 to -0.048, n = 187, P = .027) were lower postintervention. Higher total cholesterol (B = -0.328, 95% CI -0.612 to -0.043, P = .026) and higher total/high-density lipoprotein cholesterol ratios (B = -0.250, 95% CI -0.425 to -0.076, P = .008) at baseline were associated with greater reductions in CRP. In controlled studies, follow-up concentrations of CRP (SMD -0.500, 95% CI -0.844 to -0.157, n(exercise/control) = 485/284, P = .004), and fibrinogen (SMD -0.544, 95% CI -1.058 to -0.030, n(exercise/control) = 148/100, P = .038) were lower in subjects who exercised compared with controls.Exercise training is associated with reduced inflammatory activity in patients with CAD. C-reactive protein and fibrinogen have provided the strongest evidence. Higher baseline CRP and adverse baseline lipid profiles predicted greater reductions in CRP.

BackgroundThe present systematic review and meta-analysis examines studies published in the past 10 years that described cardiac rehabilitation (CR) enrollment among women and men, to determine whether a significant sex difference persists despite the evidence supporting the benefits of CR to women as well as men.MethodsScopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the 623 selected full-text articles were independently screened based on predefined inclusion/exclusion criteria (guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA) and assessed for quality using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement form. The meta-analysis was undertaken using Review Manager software.ResultsTwenty-six eligible observational studies reporting data for 297,719 participants (128,499 [43.2%] women) were included. On average, 45.0% of men and 38.5% of women enrolled in CR. In the pooled analysis, men were more likely to be enrolled in CR compared with women (female enrollment vs male enrollment odds ratio, 0.64; 95% confidence interval, 0.57-0.72; P < 0.00001). Heterogeneity was considered high (I2 = 78%). In the subgroup analyses, systematic CR referral during inpatient tertiary care resulted in significantly greater enrollment among women than nonsystematic referral.ConclusionsOverall, rates of CR enrollment among women are significantly lower compared with men, with women being 36% less likely to enroll in a rehabilitation program.

BackgroundDespite the cardiovascular etiology of stroke, exercise and risk factor modification programs akin to cardiac rehabilitation (CR) are not available. This study aimed to establish the feasibility of adapting a CR model for individuals with mild to moderate stroke disability. A secondary objective was to determine the program's effects on aerobic and walking capacity, and stroke risk factors.MethodsA repeated measures design was used with a 3-month baseline period and 6-month adapted CR intervention (n = 43, mean ± SD age 65 ± 12 years, 30 ± 28 months post stroke). Feasibility was determined by the number of participants who completed the study, occurrence of adverse events and frequency, duration and intensity of exercise performed. To determine effectiveness of the program, outcomes measured included aerobic capacity (VO2peak, ventilatory threshold), 6-Minute Walk Test (6MWT) distance, and risk factors. Descriptive statistics characterized the classes attended and number and intensity of exercise sessions. Pairedt-tests, one-factor repeated measures analyses of variance contrasts and chi-square analyses were used to compare changes over time.ResultsTwo participants withdrew during the baseline period. Of the remaining 41 participants who commenced the program, 38 (93%) completed all aspects. No serious adverse effects occurred. Post-intervention, VO2peak improved relative to the stable baseline period (P= 0.046) and the increase in ventilatory threshold approached significance (P= 0.062).ConclusionsCR is feasible after stroke and may be adapted to accommodate for those with a range of post-stroke disability. It is effective in increasing aerobic capacity. CR may be an untapped opportunity for stroke survivors to access programs of exercise and risk factor modification to lower future event risk.Trial registrationClinicalTrials.gov registration number: NCT01067495

The optimal approach to prescribing resistance training (RT) combined with aerobic training (AT) for psychosocial and health-related quality of life (HRQOL) is unclear.To compare the effects of AT combined with RT (1 versus 3 sets) versus AT alone on HRQOL and psychosocial outcomes.Subjects (N.=72) were randomized to AT (5 d∙wk-1) or AT (3 d∙wk-1) with either 1 set (AT/RT1) or 3 sets (AT/RT3) of RT performed 2 d∙wk-1.Outpatient Cardiac Rehabilitation Program.Subjects with coronary artery disease.HRQOL and psychosocial parameters were assessed before and after 29 weeks of training by questionnaire.Fifty-three subjects (mean±SD age 60.6±10.6 years) completed training. There was a group effect for change in self-efficacy of lower body physical activity tasks (P=0.03) with significantly greater improvement for AT/RT3 than AT alone (17.5±16.6% vs. 3.2±12.8% respectively, p=0.04). Lower body self-efficacy improved for AT/RT1 (15.5±13.8%, p0.001) but not for AT alone (P=0.2). Self-efficacy for upper body tasks improved with AT/RT3 (18.2±19.9%, P=0.003) and AT/RT1 training (12.6±15.8%, P=0.005) but not with AT alone (8.3±16.1%, P=0.1). AT/RT3 and AT/RT1 training yielded improvements in depression score (-4.0±7.7, P=0.04 and -3.0±5.1, P=0.02 respectively) but not with AT alone (-0.5±4.7, P=0.71). The improvement from baseline in physical HRQOL score (MOS, SF-36) averaged 8.2±11.2% for AT (P=0.04), 10.4±11.9% for AT/RT1 (P=0.006) and 12.0±12.9% for AT/RT3 (P=0.004).Both AT+RT groups with either 1 or 3 sets (AT 3 d∙wk-1and RT 2 d∙wk-1) each yield more pronounced psychosocial and HRQOL adaptations than AT alone (5 d∙wk-1). RT prescription beyond 1 set may further augment selected parameters in cardiac patients.These results provide further rationale to develop combined AT+RT regimens for individuals with coronary artery disease.

Background Preference-based tempo-pace synchronized music has been shown to reduce perceived physical activity exertion and improve exercise performance. The extent to which such strategies can improve adherence to physical activity remains unknown. The objective of the study is to explore the feasibility and efficacy of tempo-pace synchronized preference-based music audio-playlists on adherence to physical activity among cardiovascular disease patients participating in a cardiac rehabilitation. Methods Thirty-four cardiac rehabilitation patients were randomly allocated to one of two strategies: (1) no music usual-care control and (2) tempo-pace synchronized audio-devices with personalized music playlists + usual-care. All songs uploaded onto audio-playlist devices took into account patient personal music genre and artist preferences. However, actual song selection was restricted to music whose tempos approximated patients’ prescribed exercise walking/running pace (steps per minute) to achieve tempo-pace synchrony. Patients allocated to audio-music playlists underwent further randomization in which half of the patients received songs that were sonically enhanced with rhythmic auditory stimulation (RAS) to accentuate tempo-pace synchrony, whereas the other half did not. RAS was achieved through blinded rhythmic sonic-enhancements undertaken manually to songs within individuals’ music playlists. The primary outcome consisted of the weekly volume of physical activity undertaken over 3 months as determined by tri-axial accelerometers. Statistical methods employed an intention to treat and repeated-measures design. Results Patients randomized to personalized audio-playlists with tempo-pace synchrony achieved higher weekly volumes of physical activity than did their non-music usual-care comparators (475.6 min vs. 370.2 min, P