Kontext: Většina pacientů s optimální farmakologickou léčbou plicní arteriální hypertenze vykazuje klinické příznaky a trpí sníženou tolerancí zátěže i špatnou kvalitou života. V roce 2019 byl publikován dokument pracovní skupiny Evropské respirační společnosti (European Respiratory Society) pro cvičení a rehabilitaci pacientů s těžkou chronickou plicní hypertenzí, v němž se uvádí, že individuálně navržené a monitorované cvičební programy jsou pro z klinického hlediska stabilizované pacienty s farmakoterapií plicní hypertenze nejspíše bezpečné. V současné době je práce na rehabilitačních intervencích specifických pro jedince s plicní arteriální hypertenzí teprve ve stadiu výzkumu. Předkládáme předběžné výsledky rozsáhlejší studie s cílem ukázat účinnost individuálně navrženého 12týdenního domácího cvičebního programu v tom, že zlepšuje toleranci zátěže i kvalitu spánku a omezuje emoční vypětí pacientů s plicní arteriální hypertenzí. Metody: Popisované výsledky byly získány v prospektivní randomizované kontrolované intervenční studii. Do analýzy byly zařazeny údaje 16 pacientů s plicní arteriální hypertenzí. Celá skupina absolvovala komplexní tréninkový program sestávající z 12týdenního individuálně navrženého cvičení, edukace, informací o zásadách sebeovládání a telerehabilitace. Součástí programu byly i posilování svalstva, dechové aerobní cvičení i relaxační techniky. Výsledky: V trénované skupině bylo zaznamenáno statisticky významné průměrné prodloužení vzdálenosti překonané v 6minutovém testu chůze (6MWT) (Δ = 51,7 ± 45,1 m). U šesti účastníků studie (66,7 %) z trénované skupiny a dvou pacientů (28,6 %) z kontrolní skupiny byl pozorován minimální klinicky významný rozdíl ve vzdálenosti překonané v 6MWT (25-33 m). V trénované skupině se výsledky IPsubmax testu změnily statisticky významně (Δ = 9,8 ± 4,7 cm H20). V sebeposuzovacím dotazníku kvality spánku se hodnoty PSQI zlepšily ze špatné na dobrou u čtyř (44,5 %) pacientů z trénované skupiny. Skóre podškál nemocniční deprese a úzkosti (HADS) potvrdila klinicky významný úbytek symptomů úzkosti v obou skupinách. U symptomů deprese nebyly klinicky významné změny nalezeny. Nebyly zaznamenány žádné nežádoucí účinky. Závěr: U pacientů se stabilizovanou plicní arteriální hypertenzí námi hodnocený 12týdenní individuálně navržený domácí cvičební program účinně zlepšuje jejich funkční kapacitu (toleranci zátěže) i kvalitu spánku. Další zdokonalení metodologie cvičebních programů v oblasti plicní arteriální hypertenze si vyžádá další studie. Tento text přináší předběžné výsledky dosud probíhající studie.
Background: Most patients with optimal PAH-targeted medical therapy suffer from clinical symptoms, reduced exercise tolerance and have a poor quality of life. The 2019 European Respiratory Society task force statement on physical exercise and rehabilitation in patients with severe, chronic PH suggests that individually adjusted and monitored exercise programs are likely to be safe for PH patients, who are clinically stable on medical therapy. Currently, the development of PAH-specific rehabilitation interventions is still in the research stage. We present the preliminary results of a more extensive study with the aim to show the effectiveness of a 12-week individualized, home-based exercise program in promoting physical capacity, quality of sleep and reducing signs of emotional distress in patients with PAH.
Introduction: This systematic review and meta-analysis aimed to investigate adherence and retention rates to home-based video exercise programs and identify key factors associated with these rates in older adults to understand the effectiveness of home-based video exercise interventions. Methods: We searched PubMed, Web of Science, and Scopus for articles addressing adherence to and retention of home-based video exercise programs. The study was conducted following PRISMA recommendations. Results: A total of 26 articles, including 1,292 participants older than 65, were included in the final qualitative and quantitative syntheses. The weighted mean of the retention rate was 91.1, and of the attendance rate was 85.0, with low I2 = 3.5, not significant p = 0.409 heterogeneity. The generalized regression models showed a positive effect of session duration on the attendance rate (%), where the possible change from <20 min to >60 min duration could decrease the attendance rate (%) B = -24.390 (p <0.001). The delivery method had a significant effect, where the absence of live contact with the coach in web-based or DVD-delivered interventions could decrease the attendance rate (%) compared to the online sessions B = -11.482 (p = 0.010). The lockdown during the COVID-19 pandemic had a positive effect on both the attendance rate (%) B = 10.321 (p = 0.019) and retention rate (%) B = 9.577 (p = 0.032). Conclusions: This systematic review and meta-analysis indicate that supervised home-based video exercise programs lasting less than 60 min might be a suitable and sustainable exercise mode to keep older adults active, especially in times resembling feelings of confinement.
- MeSH
- Patient Compliance * statistics & numerical data MeSH
- COVID-19 epidemiology prevention & control MeSH
- Humans MeSH
- Aged MeSH
- Home Care Services organization & administration MeSH
- Exercise Therapy * methods MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
BACKGROUND: Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR. OBJECTIVES: To examine the incidence and severity of adverse events of HBCR. METHODS: The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome. RESULTS: Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise. CONCLUSION: The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly.
- MeSH
- Exercise MeSH
- Cardiovascular Diseases * MeSH
- Cardiac Rehabilitation * methods MeSH
- Humans MeSH
- Exercise Therapy methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Systematic Review MeSH
Úvod: Je prokázáno, že rehabilitační cvičení je přínosnou formou nefarmakologické léčby pacientů se stabilní plicní arteriální hypertenzí (PAH). Většina studií hodnotila i výsledky programů nabízených v nemocnicích a prováděných pod odborným dohledem. Je třeba zajistit lepší přístup pacientů k této významné formě intervence; současně je nutno zaměřit výzkum i na dlouhodobé účinky programů cvičení prováděného samotnými pacienty v domácím prostředí. Cílem naší studie bylo zhodnotit adherenci, bezpečnost i účinek 12týdenního individualizovaného programu cvičení v domácím prostředí pro pacienty s idiopatickou PAH. Metody: Náš projekt byla prospektivní pilotní nekontrolovaná intervenční studie. Pro účast v ní bylo z lotyšského registru PAH vybráno šest pacientů s idiopatickou PAH, potvrzenou pravostrannou srdeční katetrizací. Následně byl vypracován 12týdenní cvičební program přizpůsobený každému pacientovi podle jeho funkčního stavu a domácího prostředí. Program byl zaměřen na posilování, dechová, aerobní cvičení i techniky relaxace nervového systému i svalstva, monitorování sebekontroly, každotýdenní kontrolu pacienta telefonem a osobní návštěvy v ordinaci, kde fyzioterapeut mohl upravovat režim i sledovat jeho dodržování pacientem; současně se dbalo o maximální bezpečnost pacientů. Primárními sledovanými parametry z hlediska účinku programu byly zátěžová kapacita, způsob dýchání a kvalita života, z hlediska adherence to byly dny s cvičením a z hlediska bezpečnosti jakákoli příhoda jako "varovaní" během cvičení, neúplné zotavení a zhoršení symptomů plicní hypertenze. Výsledky: Výsledky prokázaly poměrně vysokou míru adherence k předepsanému cvičebnímu režimu (průměr 92,5 %). V průběhu programu nebyly zaznamenány žádné nežádoucí příhody. Výsledky prokázaly význam zajištění optimálních dovedností jak z hlediska objektivních sledovaných parametrů, tak subjektivních symptomů. Výsledky šestiminutového testu chůze (6-minute walking test, 6MWT) prokázaly, že vypracovaný program významně zlepšuje zátěžovou kapacitu (průměrné zlepšení 39 ± 17,5 m). U čtyř účastníků (66,7 %) byl pozorován minimální klinicky významný rozdíl (minumum clinically important difference, MCID) ve vzdálenosti překonané pacienty s PAH při 6MWT (25-33 m). Statisticky významné zlepšení ve výchylkách pohybu hrudníku potvrzují změny ve způsobu dýchání naznačující větší zapojení bránice při dýchání po absolvování programu. Výsledky neprokázaly významné zlepšení v žádné z domén z dotazníku SF-36. Nicméně polovina účastníků studie dosáhla po absolvování programu hodnoty MCID (11 %) podle příslušných stupnic fyzického zdraví. Závěr: Předběžné výsledky této studie prokázaly, že vypracovaný individualizovaný program pro cvičení v domácích podmínkách je bezpečný, snadno jej lze provozovat a umožňuje postupně zvyšovat intenzitu zátěže; současně zlepšuje fyzický funkční stav klinicky stabilizovaných pacientů s idiopatickou PAH. Hypotéza této studie podporuje představu o nutnosti provádět další výzkum formou randomizovaných kontrolovaných studií s ověřováním dosud získaných výsledků. © 2019, ČKS.
Background: Exercise-based rehabilitation has been proved as a beneficial additional non-pharmacological treatment in patients with stable pulmonary arterial hypertension (PAH). Majority of studies include hospital-based supervised programs. To improve patient accessibility to this important intervention and long-term effect the research on home-based programs is warranted. The purpose of our study was to evaluate the adherence, safety, training effects of 12-week individualized home-based exercise program in patients with idiopathic PAH. Methods: This was a prospective pilot uncontrolled interventional study. Six patients with iPAH confirmed by right-heart catheterization from the Latvian PAH registry were selected. A 12-week exercise program adapt- able for each patient's functional state and home environment was created. The program included muscle strength training, respiratory, aerobic exercise and neuro-muscular relaxation techniques, self-control monitoring, weekly phone control and on-site re-assessment by physiotherapist were parts of the program to ensure both individualized adjustments and proper execution, and to maximize clinical safety. The primary outcome measures for training effects were exercise capacity, breathing pattern and quality of life, for adherence days of performance, for safety any event of "alarm sign" indicators during exercising, incomplete recovery, worsening of PH symptoms., Results: The results showed a rather high degree of adherence to the prescribed exercise regimen (in average 92.5%). No adverse events were observed during the course of the program. The results proved the importance of ensuring optimal self-control skills both for objective measures and subjective symptoms. The 6-minute walking test (6MWT) results show that the developed program significantly improves exercise capacity (mean improvement 39 ± 17.5 m). In four participants (66.7%) the minimum clinically important difference (MCID) for 6MWT distance in PAH patients was observed (25-33 m). Significant improvement in chest excursions confirm changes in breathing pattern suggesting better engagement of diaphragm dur- ing breathing after the program. Results did not show significant improvements in either SF-36 survey domain. However, half of the participants reached MCID (11%) after the program at the physical health subscales., Conclusion: The results of this preliminary study prove that the created individualized home-based exercise program is safe, easily followed and allows progression in exercise intensity and improves physical functional state in clinically stable iPAH patients. This study hypothesis supports the need for RCT to continue research and approve the results.
Background: Home-based video exercise programmes might be a suitable alternative to traditional physi¬cal activity in older adults to preserve muscle health. The aim of this systematic review and meta-analysis was to examine the effects of home-based video exercise programmes on physical fitness in older adults. Methods: A systematic review and robust variance estimation meta-analysis with meta-regression were carried out according to the recommendations and criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Thirteen studies involving 1,056 participants were included. Meta-analysis showed statistically significant positive changes in balance (p = 0.023), upper extremity strength (p = 0.049, and strength overall (p = 0.042), there was also statistically significant positive effect based on all the 28 outcomes in eight studies, including 696 participants (p = 0.008). Conclusion: The present systematic review and meta-analysis indicate that home-based video exercise programmes positively affect essential components of physical fitness, such as balance and strength, to prevent falls in older adults. Promoting home-based video exercise in clinical practice and ideally sup¬porting it through supervision is vital to effectively combat the age-related physical decline, especially for those in home isolation.
There is ample evidence that maintenance of basic physical fitness through exercise training is crucial for patients with chronic renal insufficiency. Rehabilitation based on neuromuscular electrical stimulation (NMES) of thigh muscles has been shown to have many beneficial effects in patients with chronic diseases. It is likely that NMES could have beneficial effects also in patients on chronic ambulatory peritoneal dialysis (CAPD). NMES was applied for 20 weeks to 14 patients on CAPD, mean age 61.9 (8.7) years, using battery-powered stimulators (CEFAR-REHAB X2; Sweden) and self-adhesive electrodes 80 × 130 mm (PALS Platinum; Denmark). Stimulation characteristics: biphasic current, pulse width 400 μs, 8 seconds contraction-12 seconds relaxation, frequency modulation 40-60 Hz, and maximal intensity 60 mA. NMES was home-based and applied simultaneously to quadriceps muscles of both legs (2 × 30 min/day). Functional performance, muscle power (Fmax ), arterial stiffness (assessed by cardio-ankle vascular index-CAVI), and quality of life by KDQOL-SF evaluation was done at baseline and at the end of program. Home NMES improved significantly the main functional parameters: VO2peak /kg increased by +2.2 (1.6) mL O2 /kg/min (P < 0.002), peak workload by +0.1 (0.1) W/kg (P < 0.005), and distance walked in 6 MWT by +44.7 (58.4) m (P < 0.008). Only insignificant changes were observed in CAVI and Fmax . KDQOL-SF analysis showed significant improvement in seven parameters of QoL (P < 0.012-0.049). This pilot study is the first clinical report dealing with the use of NMES in patients on CAPD. The results demonstrate that an improvement of exercise capacity and QoL can be achieved by home-based NMES in CAPD patients.
- MeSH
- Renal Insufficiency, Chronic physiopathology therapy MeSH
- Quadriceps Muscle * physiopathology MeSH
- Electric Stimulation Therapy * methods MeSH
- Peritoneal Dialysis, Continuous Ambulatory * MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Pilot Projects MeSH
- Aged MeSH
- Muscle Strength MeSH
- Walk Test MeSH
- Exercise Tolerance MeSH
- Vascular Stiffness MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The lasting effects on cardiorespiratory fitness and physical activity are uncertain. Hence, a novel approach via telehealth management based on objectively measured exercise at home was proposed. OBJECTIVES: To improve self-monitoring, such as self-confidence, behavioral change, and goal setting for individual exercise, and afterward, increase long-term effects concerning cardiorespiratory fitness. DESIGN: This randomized controlled trial compares a 12-week guided home exercise telehealth intervention with a center-based exercise intervention of the same duration and intensity of exercise in lymphoma cancer survivors entering cardio-oncology rehabilitation after treatment. Participants will be instructed to exercise gradually at 60-85% of their maximum heart rate for 30-50 min 3 times a week. Participants will receive individual remote guidance (feedback about frequency, duration, and exercise intensity) by preferred contact (phone call, text message) once a week based on shared exercise data through the web platform. The primary outcome is a change in cardiorespiratory fitness expressed as maximal oxygen uptake assessed through cardiopulmonary exercise test at baseline, 12 weeks, and 1 year. Secondary objectives are quality of life, muscle strength, body composition, incidence of adverse events, and exercise adherence. This study will determine whether a telehealth model is effective and safe compared to a center-based model in cancer survivors and whether exercise prescriptions are followed by participants. Additionally, an overview of the long-term effectiveness of telehealth cardio-oncology rehabilitation will be provided. This approach aligns with the trend of moving non-complex healthcare services into the patients' home environment. TRIAL REGISTRATION: ClinicalTrials.Gov Identifier: NCT05779605.
- Publication type
- Journal Article MeSH
- Keywords
- domácí rehabilitační programy, elektrická svalová stimulace,
- MeSH
- Chronic Disease MeSH
- Electric Stimulation methods instrumentation MeSH
- Enzyme-Linked Immunosorbent Assay methods instrumentation utilization MeSH
- Endothelins isolation & purification blood adverse effects MeSH
- Human Experimentation MeSH
- Financing, Organized MeSH
- Evaluation Studies as Topic MeSH
- Cardiac Rehabilitation methods instrumentation utilization MeSH
- Middle Aged MeSH
- Humans MeSH
- Heart Failure rehabilitation therapy MeSH
- Statistics as Topic MeSH
- Muscle Strength physiology MeSH
- Exercise Therapy methods utilization MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
PURPOSE: Cardiovascular disease is a competing mortality cause in hematological cancer survivors due to toxic oncological treatment, accumulation of risk factors, and decline of cardiorespiratory fitness. Cardio-oncology rehabilitation (CORE) is an emerging treatment model to optimize the prognosis of hematological cancer patients and survivors; however, its accessibility during the COVID-19 pandemic is poor. The study aimed to evaluate the feasibility, safety, and effect of a 12-week home-based CORE intervention in telerehabilitation approach among hematological cancer survivors. METHODS: A prospective single-arm interventional study was conducted at a faculty hospital in Brno, Czech Republic. This study provided 12 weeks of the home-based CORE using a telerehabilitation approach that allows remote supervision by a clinician from a medical facility. The telerehabilitation approach consists of three components: a heart rate sensor (PolarM430, Kempele, Finland), a web platform compatible with the sensor, and telesupervising via telephone call (1 call per week). To improve adherence, a physiotherapist called participants to assess or address adverse effects, exercise feedback, and participant-related concerns. The anthropometry, body composition, and cardiorespiratory fitness were measured immediately after the intervention. RESULTS: Eleven hematological cancer survivors with an average age of 60.3 ± 10 years participated in the study. Most participants were diagnosed with Follicular lymphoma and received maintenance treatment. Participants had a significant (p < 0.05) increase in cardiorespiratory fitness by 2.6 ml/kg/min; and in peak workload, from 143.3 ± 60.6 W to 158.6 ± 67.5 W (p < 0.05). Improvement in anthropometry and body composition was observed but yielded no statistical significance. Most (80%) participants completed the three times/per week telesupervising exercise session for 12 weeks.No adverse event was identified. CONCLUSION: Findings from this study suggest that home-based CORE may provide hematological cancer survivors with an increase in CRF during the rehabilitation period after hospital discharge. The telerehabilitation CORE model is effective, feasible, safe, and has demonstrated good adherence. Further randomized controlled efficacy study with larger sample size is needed before clinical implementation. CLINICAL TRIAL REGISTRATION: Clinical trial registration number NCT04822389 (30/03/2021).
- Publication type
- Journal Article MeSH
INTRODUCTION: Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR. EVIDENCE ACQUISITION: PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531). EVIDENCE SYNTHESIS: Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR. CONCLUSIONS: Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.
- MeSH
- Cost-Benefit Analysis MeSH
- Exercise MeSH
- Cardiac Rehabilitation * MeSH
- Humans MeSH
- Telemedicine * MeSH
- Telerehabilitation * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Systematic Review MeSH
