Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic review A Behavior Change Intervention for Women in Cardiac Rehabilitation Cardiac rehabilitation after myocardial infarction. A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease. Association of Cardiac Rehabilitation with Improvement in High Sensitive C-Reactive Protein Post-Myocardial Infarction The remote exercise monitoring trial for exercise-based cardiac rehabilitation (REMOTE-CR): a randomised controlled trial protocol The ACTonHEART study: rationale and design of a randomized controlled clinical trial comparing a brief intervention based on Acceptance and Commitment Therapy to usual secondary prevention care of coronary heart disease A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. The Effects of an Intensive Lifestyle Modification Program on Carotid Artery Intima-Media Thickness: A Randomized Trial Predicting cardiac rehabilitation enrollment: the role of automatic physician referral Motivational counselling for physical activity in patients with coronary artery disease not participating in cardiac rehabilitation Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease [The impact of comprehensive cardiac rehabilitation in patients up to 55 years old after acute myocardial infarction treated with primary coronary intervention]. Rehabilitation outcomes following percutaneous coronary interventions (PCI). Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study) The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial A pilot randomised controlled trial comparing a health-related lifestyle self-management intervention with standard cardiac rehabilitation following an acute cardiac event: Implications for a larger clinical trial. Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe: Baseline data from the EU-CaRE multicentre observational study Brief psychological intervention in phase I of cardiac rehabilitation after acute coronary syndrome. Choice of Health Options in Prevention of Cardiovascular Events (CHOICE) Replication Study. Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Factors influencing health-related quality of life in cardiac rehabilitation patients.
Background The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established . Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low . Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors . Objectives The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease . Search strategy A literature search was performed using the following data bases MEDLINE ( 1966‐2006 ) , CINAHL ( 1982‐2006 ) , EMBASE ( 1980‐current ) and up to the Cochrane Controlled Trials Register ( Issue 2 , 2006 of Cochrane Library ) . In addition , the reference lists of relevant trials and conference proceedings were also scrutinised . Company representatives , experts and investigators were contacted to elicit further information . Selection criteria All r and omised and quasi‐r and omised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were considered for inclusion in the review . Data collection and analysis Eligibility of the trials for inclusion in the review , details of eligible trials and the method ological quality of the trials were assessed independently by two review ers . Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95 % confidence intervals . Where synthesis was inappropriate , trials were considered separately . Main results Seventeen trials involving a total of 4725 participants were included in the final review : three trials compared the effects of brief structured interventions  on diet modification ; seven on smoking cessation ; and seven on multiple risk factors . Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification . Although there was a tendency for more participants in the intervention arm to lose weight at the 12‐week follow up and achieve target cholesterol levels at the 6‐month follow up , these results were not statistically significant . Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary  modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention . However , no difference in fish , fruit and vegetable intake between the groups was evident . Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation . There was no difference in the smoking cessation rates at the 3‐ and 6‐week follow up , however , there was evidence of a benefit of brief structured interventions  for smoking cessation at the 3‐ , 6‐ and 12‐month follow up . In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups . In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake , weight loss and consequently on reduction in the body mass index , smoking cessation and physical activity among the participants . The findings concerning the effect on blood pressure , blood glucose levels and the lipid profile , however , remain inconclusive . Conclusions There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease . This review , however , supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease . Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors There is undeniable evidence for physical and psychosocial benefits of cardiac rehabilitation programs for individuals suffering from coronary heart disease . Yet , fewer women than men are referred to , begin , or complete cardiac rehabilitation programs . The numerous logistical , economic , and motivational barriers to healthy behavior change place women at risk for subsequent CHD events . To close this gender gap and improve outcomes , novel , efficacious , and individualized rehabilitative approaches for women with coronary heart disease are needed . The purpose of this article is to describe a theory-driven behavioral intervention design ed exclusively for women with coronary heart disease . The 12-week intervention is being tested in a r and omized controlled trial involving women referred to a cardiac rehabilitation program .  The tenets of the Transtheoretical Model of behavior change and motivational interviewing guided the development and implementation of the stage-matched , individualized intervention to promote healthy behavior change for women with coronary heart disease . The ongoing trial will examine the efficacy of the intervention on physiological and psychosocial outcomes Cardiac rehabilitation/ secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease ( CHD ) , and as such are recommended as useful and effective ( Class I ) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD . The term cardiac rehabilitation refers to coordinated , multifaceted interventions design ed to optimize a cardiac patient 's physical , psychological , and social functioning , in addition to stabilizing , slowing , or even reversing the progression of the underlying atherosclerotic processes , thereby reducing morbidity and mortality . Cardiac rehabilitation , aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient . The program involves education , exercise , risk factor modification and counselling . A meta- analysis based on a review of 48 r and omized trials that compared outcomes of exercise-based rehabilitation with usual medical care , showed a reduction of 20 % in total mortality and 26 % in cardiac mortality rates , with exercise-based rehabilitation compared with usual medical care . Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants . During exercise , the patients ' ECG is continuously monitored through telemetry , which serves to optimize the exercise prescription and enhance safety . The safety of cardiac rehabilitation exercise programs is well established , and the occurrence of major cardiovascular events during supervised exercise is extremely low . As hospital stays decrease , cardiac rehabilitation is assuming an increasingly important role in secondary prevention . In contrast with its growing importance internationally , there are very few cardiac rehabilitation centers in India at the present moment BACKGROUND AND AIMS Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men . Women also have lower participation rates than men in cardiac rehabilitation . This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs . METHODS The Heart Awareness for Women program ( HAFW ) commenced in 2003 with phase I involving development of program elements and seeking validation through consumers and clinical experts . The program was then trialed in an 8-week program in a convenience sample of 6 women . Phase II applied the revised program using action research principles focusing on enabling clinical staff to implement the ongoing program . A total of 54 women participated in this phase , 48 of whom completed baseline question naires . A mixed- method evaluation , using question naires , interviews , and observation , assessed the impact of the intervention on psychological and social aspects of women 's recovery following an acute coronary event . RESULTS Women welcomed the opportunity to discuss their individual stories , fears , and challenges and to derive support from contact with other women . Via health professional facilitation , women were able to develop strategies collectively to address risk factor modification and achieve optimal cardiovascular health . No statistically significant changes in depression , anxiety , stress , cardiac control , role integration , or perceived social support were found ; however , descriptive and qualitative findings revealed decreases in anxiety and an increased sense of social support . CONCLUSIONS On the basis of this study , a cardiac rehabilitation program tailored to the needs of women appears to be feasible and acceptable . The efficacy of this intervention to improve health-related outcomes needs to be tested in a r and omized , controlled trial Dear Editor , Atherosclerotic cardiovascular diseases are the major cause of death in middle-aged and older-adults.[1][2 ] Today , inflammation is regarded as the key pathogenic mechanism in both initiation and progression of atherosclerosis.[3]Inflammatory markers such as high sensitive C-reactive protein ( CRP ) have been used to identify patients at higher risk for coronary events . The prognostic value of CRP has been established for patients with acute coronary syndrome , stable coronary artery diseases[4 ] and in apparently healthy people.[5][6 ] Comprehensive cardiac rehabilitation is probably the most effective approach for cardiovascular reduction and long-term care of cardiac patients as well as subjects with multiple coronary risk factors.[7][8 ] Secondary prevention , through cardiac rehabilitation program is now regarded as an essential component of contemporary management of patients with various presentations of coronary disease.[9 ] There are some evidence s that protective effects of cardiac rehabilitation may in part be related to lowering of inflammation . The goal of this prospect i ve study was to assess the effect of cardiac rehabilitation on high sensitive CRP as a marker of increased risk of coronary artery disease . The subjects were r and omly selected from patients with recent anterior wall myocardial infa rct ion referring to Alzahra Cardiac Rehabilitation Center in Shiraz from May to December 2007 . Inclusion criteria were males and females aged 30 - 75 years with anterior wall MI in past 1 month . Patients were divided into two groups . Group A consisted of 30 participants who received cardiac rehabilitation  and group B consisting of 26 participants which did not receive any cardiac rehabilitation program .  CRP levels were assessed before starting the program and eight weeks later . We used CRP Quantitative Diagnostic Kit for serum and plasma-Photometry technique . The data were analyzed by Wilcoxon Signed Rank and Mann-Whitney tests . The cardiac rehabilitation program included 8 weeks of exercise training , education and behavior modification therapy 3 times per week . The exercise training included arm and leg ergometry and treadmills . Behavioral modifications were smoking cessation , healthy nutrition , hypertension control , etc . The average age of patients was 62.7 years old . At enrollment , 66 % ( n=20 ) of participants in cardiac rehabilitation ( group A ) had CRP levels in the intermediate and high-risk range of > 1 mg/dl and after completion of cardiac rehabilitation only 27 % ( n= 5 ) of patients had elevated CRP levels ( P=0.0009 ) . In the group B , 73 % ( n=19 ) of participants had CRP levels > 1 mg/dl and after eight weeks , 53 % ( n=14 ) of them had CRP levels > 1 mg/dl ( p=0.50 ) . A higher CRP level was observed in patients 65 years , but both age groups demonstrated significant improvements in CRP postcardiac rehabilitation . This study showed a significant decrease in CRP levels in patients with cardiac disease after participation in cardiac rehabilitation program .  The findings showed that cardiac rehabilitation decreased vascular inflammation accompanying improvement in risk factors . Regardless of gender , there was a significant decrease in CPR at the completion of cardiac rehabilitation . The decrease in inflammation along with previously described benefits of cardiac rehabilitation supports the recommendations of American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation that participation in cardiac rehabilitation should be a part of comprehensive care of cardiac patients . The findings in our study had two important clinical implication s. First , the potential independent effect of cardiac rehabilitation in lowering CRP levels was demonstrated which is independent from weight in our study . The non-pharmacologic mechanism for this observation may be due to dietary modifications , weight management and exercise components of the program . Secondly , the decrease in vascular inflammation associated with cardiac rehabilitation is evident regardless of gender , age and metabolic syndrome Background Exercise is an essential component of contemporary cardiac rehabilitation programs for the secondary prevention of coronary heart disease . Despite the benefits associated with regular exercise , adherence with supervised exercise-based cardiac rehabilitation remains low . Increasingly powerful mobile technologies , such as smartphones and wireless physiological sensors , may extend the capability of exercise-based cardiac rehabilitation by enabling real-time exercise monitoring for those with coronary heart disease . This study compares the effectiveness of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( REMOTE ) to st and ard supervised exercise-based cardiac rehabilitation in New Zeal and adults with a diagnosis of coronary heart disease . Methods / Design A two-arm , parallel , non-inferiority , r and omised controlled trial will be conducted at two sites in New Zeal and . One hundred and sixty two participants will be r and omised at a 1:1 ratio to receive a 12-week program of technology-assisted , home-based , remote monitored exercise-based cardiac rehabilitation ( intervention ) , or an 8 - 12 program of st and ard supervised exercise-based cardiac rehabilitation (control).The primary outcome is post-treatment maximal oxygen uptake ( V̇O2max ) . Secondary outcomes include cardiovascular risk factors ( blood lipid and glucose concentrations , blood pressure , anthropometry ) , self-efficacy , intentions and motivation to be active , objective ly measured physical activity , self-reported leisure time exercise and health-related quality of life . Cost information will also be collected to compare the two modes of delivery . All outcomes are assessed at baseline , post-treatment , and 6 months , except for V̇O2max , blood lipid and glucose concentrations , which are assessed at baseline and post-treatment only . Discussion This novel study will compare the effectiveness of technology-supported exercise-based cardiac rehabilitation to a traditional supervised approach . If the REMOTE program proves to be as effective as traditional cardiac rehabilitation , it has potential to augment current practice by increasing access for those who can not utilise existing services . Trial registration Australian New Zeal and Clinical Trials Registry Study ID number : ACTRN12614000843651 . Registered 7 August Background Modifiable risk factors , including life-style habits and psychological variables , have been increasingly demonstrated to have an important role in influencing morbidity and mortality in cardiovascular patients , and to account for approximately 90 % of the population risk for cardiac events . Acceptance and Commitment Therapy ( ACT ) has shown effectiveness in promoting healthy behaviors , and improving psychological well-being in patients with chronic physical conditions . Moreover , a first application of an acceptance-based program in cardiac patients has revealed high treatment satisfaction and initial evidence s of effectiveness in increasing heart-healthy behaviour . However , no clinical trial to date has evaluated the efficacy of an acceptance-based program for the modification of cardiovascular risk factors and the improvement of psychological well-being , compared to usual secondary prevention care . Methods Approximately 168 patients will be recruited from an outpatient cardiac rehabilitation unit and r and omly assigned to receive usual care or usual care + a brief ACT-based intervention . The ACT group will be administered five group therapy sessions integrating educational topics on heart-healthy behaviours with acceptance and mindfulness skills . Participants will be assessed at baseline , six weeks later ( post treatment for the ACT condition ) , at six and twelve months follow-up . A partially-nested design will be used to balance effects due to clustering of participants into small therapy groups . Primary outcome measures will include biological indicators of cardiovascular risk and self-reported psychological well-being . Treatment effects will be tested via multilevel modeling after which the mediational role of psychological flexibility will be evaluated . Discussion The ACTonHEART study is the first r and omized clinical trial design ed to evaluate the efficacy of a brief group-administered , ACT-based program to promote health behavior change and psychological well-being among cardiac patients . Results will address the effectiveness of a brief treatment created to simultaneously impact multiple cardiovascular risk factors . Conducted in the context of clinical practice , this trial will potentially offer empirical support to alternative interventions to improve quality of life and reduce mortality and morbidity rates among cardiac patients .Trial registration clinical trials.gov/ ( NCT01909102 AIM The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu , China . BACKGROUND Epidemiological studies indicate a dose- , level- and duration -dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality . Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes . DESIGN METHODS A r and omized controlled trial was conducted . Coronary heart disease patients ( n = 167 ) who met the sampling criteria in two tertiary medical centres in Chengdu , south-west China , were r and omly assigned to either an intervention group ( the cardiac rehabilitation programme ) or control group ( the routine care ) . The change of health behaviours ( walking performance , step II diet adherence , medication adherence , smoking cessation ) and physiological risk parameters ( serum lipids , blood pressure , body weight ) were assessed to evaluate the programme effect . RESULTS Patients in the intervention group demonstrated a significantly better performance in walking , step II diet adherence , medication adherence ; a significantly greater reduction in serum lipids including triglyceride , total cholesterol , low-density lipoprotein ; and significantly better control of systolic and diastolic blood pressure at three months . The majority of these positive impacts were maintained at six months . The effect of the programme on smoking cessation , body weight , serum high-density lipoprotein , was not confirmed . CONCLUSIONS A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients . Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients . Furthermore , the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care Purpose . This study evaluated the effect of the Dr. Dean Ornish Program for Reversing Heart Disease on cardiovascular disease as measured by the intima-media thickness of the common carotid artery and compared this effect to outcomes from patients participating in traditional cardiac rehabilitation . Design . R and omized clinical trial . Setting . SwedishAmerican Health System . Subjects . Ninety three patients with clinical ly confirmed coronary artery disease were r and omly assigned to the intervention ( n = 46 ) or traditional cardiac rehabilitation ( n = 47 ) . Intervention . Dr. Dean Ornish Program for Reversing Heart Disease . Measures . Ultrasound of the carotid artery and other cardiovascular risk factors were measured at baseline , 6 , and 12 months . Analysis . Intent-to-treat analysis . Results . There was no significant reduction in the carotid intima-media thickness of the carotid artery in the Ornish group or the cardiac rehabilitation group . Ornish Program participants had significantly improved dietary habits ( p < .001 ) , weight ( p < .001 ) , and body mass index ( p < .001 ) as compared with the rehabilitation group . The decrease in the number of patients with angina from baseline to 12 months was 44 % in Ornish and 12 % in cardiac rehabilitation . Conclusions . The Ornish Program appears to causes improvements in cardiovascular risk factors but does not appear to change the atherosclerotic process as it affects the carotid artery Background Despite the established benefits of cardiac rehabilitation , evidence suggests referral to , and subsequent enrollment in , cardiac rehabilitation following a coronary event remains low ( 10 - 25 % ) . The aim of this study was to identify predictors of attendance to cardiac rehabilitation intake  and subsequent enrollment in rehabilitation after coronary artery bypass graft surgery within the framework of an automatic referral system . Design and methods We conducted a historic prospect i ve study of patients who underwent coronary artery bypass graft surgery between 1 April 1996 and 31 March 2000 and lived within the geographic referral area of a multi-disciplinary cardiac rehabilitation center in central -south Ontario , Canada . Coronary artery bypass graft surgery patients are automatically referred to cardiac rehabilitation at the time of hospital discharge . Consecutive health records of eligible patients were review ed for medical history , cardiac risk factor profiles , and evidence of cardiac rehabilitation intake attendance and enrolment . Results A total of 3536 patients met eligibility criteria . Patients were predominantly male ( 79.1 % ) , approximately 64 years of age , living with a spouse or a partner , English-speaking , retired and had multiple cardiac risk factors . Of eligible patients , 2121 ( 60.0 % ) attended the cardiac rehabilitation intake appointment . Of patients who attended cardiac rehabilitation intake 1463 ( 69 % ) enrolled in at least one cardiac rehabilitation service , based on their risk factor profile . Selected cardiac rehabilitation services were exercise training ( n = 1287 ; 88 % ) , nutrition counseling ( n = 571 ; 39.0 % ) , nursing care ( n = 546 ; 37.3 % ) , and psychological intervention ( n = 223 ; 15.2 % ) . Conclusions An institutionalized , physician-endorsed system of automatic referral to cardiac rehabilitation result ed in higher rates of cardiac rehabilitation intake and enrollment following coronary artery bypass graft surgery than previously reported and should be adopted for all cardiac population Background : Many patients with coronary artery disease ( CAD ) fail to attend cardiac rehabilitation following acute coronary events because they lack motivation to exercise . Theory-based approaches to promote physical activity among non- participants in cardiac rehabilitation are required . Design : A r and omized trial comparing physical activity levels at baseline , 6 , and 12 months between a motivational counselling ( MC ) intervention group and a usual care ( UC ) control group . Method : One hundred and forty-one participants hospitalized with acute coronary syndromes not planning to attend cardiac rehabilitation were recruited at a single centre and r and omized to either MC ( n = 69 ) or UC ( n = 72 ) . The MC intervention , design ed from an ecological perspective , included one face-to-face contact and eight telephone contacts with a trained physiotherapist over a 52-week period . The UC group received written information about starting a walking programme and brief physical activity advice from their attending cardiologist .  Physical activity was measured by : 7-day physical activity recall interview ; self-report question naire ; and pedometer at baseline , 6 , and 12 months after r and omization . Results : Latent growth curve analyses , which combined all three outcome measures into a single latent construct , showed that physical activity increased more over time in the MC versus the UC group ( µadd = 0.69 , p < 0.05 ) . Conclusion : Patients with CAD not participating in cardiac rehabilitation receiving a theory-based motivational counselling intervention were more physically active at follow-up than those receiving usual care . This intervention may extend the reach of cardiac rehabilitation by increasing physical activity in those disinclined to participate in structured programmes Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of UNLABELLED The aim of our study was to evaluate the impact of comprehensive 3-phases cardiac rehabilitation in patients aged up to 55 years after acute myocardial infa rct ion treated with primary coronary intervention ( PCI ) of the infa rct ion related artery on the cardiovascular status , modification of coronary risk factors , psychological and physical status and exercise tolerance . METHODS Out of 106 consecutive patients aged up to 55 years with acute myocardial infa rct ion ( AMI ) with ST-segment elevation , treated with primary coronary intervention ( PCI ) of the infa rct ion related artery 71 patients entered the study and were r and omized either to the Study Group ( GB ) or to the Control Group ( GK ) . 31 patients of GB underwent 3-phases cardiac rehabilitation program and 40 patients of GK did not participate in phase III of the program . At phase I of the rehabilitation and 6 months after myocardial infa rct ion physical examination , echocardiography and treadmill exercise test were performed . RESULTS At 6-months follow-up chest pain and symptoms of heart failure were significantly less common ( p < 0.001 ) and a tendency for fewer new cardiac events and re-PCI was noted in GB . Self-evaluated , significantly greater improvement in the emotional and physical status as well as in physical activity ( p < 0.001 ) was achieved in GB . In GB better exercise tolerance on treadmill exercise test , greater improvement in left ventricular ejection fraction ( p < 0.05 ) and contractile index ( p < 0.05 ) on echocardiography were observed . The effects of the secondary prevention in terms of smoking cessation and obesity were not satisfactory in both groups . CONCLUSION 3-phases comprehensive cardiac rehabilitation in patients with AMI treated with PCI of the infa rct ion related artery improves recovery at 6-month follow-up . It has a favorable impact on the anginal and heart failure symptoms , cardiac risk factors ( especially physical activity , restrictive diet ) , psychological and physical status . It contributes towards maintaining a further event-free period . It improves selected cardiovascular parameters such as exercise tolerance , segmental and global left ventricular function This prospect i ve study evaluated the effect of an individualized , comprehensive , home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors , psychological well-being , functional capacity , and work resumption in 99 post-percutaneous coronary interventions ( PCI ) patients r and omized to control ( st and ard care plus telephone follow-up  , n=49 ) or intervention ( individualized , comprehensive , home-based cardiac rehabilitation , n=50 ) groups . Data were collected at time 1 ( T(1 ) ) during hospital admission , time 2 ( T(2 ) ) approximately 2 months post-PCI , and time 3 ( T(3 ) ) approximately 12 months post-PCI . Results suggest that the allocation to an individualized , comprehensive , home-based cardiac rehabilitation program provided more advantageous outcomes . At both follow-ups , the intervention group showed within-group improvement in serum cholesterol levels ( P<0.02 ; P<0.01 ) and exercise participation ( P<0.001 ; P<0.001 ) with differences in exercise participation favoring the intervention group ( P<0.01 ) at T(2 ) . Repeated measures ANOVA showed significant improvements over time in body mass index ( BMI ) ( P<0.01 ) , psychological well-being ( P<0.001 ) , and functional capacity ( P<0.001 ) for both groups . More patients in the intervention group had returned to work at T(2 ) ( P<0.001 ) and did so more quickly ( P<0.01 ) . These findings suggest that an individualized , comprehensive , home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI Objectives 1 . To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases ( myocardial infa rct ion , acute coronary syndrome , percutaneous transluminal coronary angioplasty and coronary artery bypass grafting ) . 2 . To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group , in comparison with similar changes in the conventional care group . Design R and omized , controlled , parallel-group design ( intervention/conventional care ) . Setting Akershus County , southeast of Oslo City , Norway . Participants 500 patients , men and women , aged 40 - 85 years , who have sustained at least one of the above-mentioned cardiovascular diseases . Interventions 8 weeks of supervised , structured physical training of three periods of 20 min per week , targeting a heart rate of 60 - 70 % of the individual 's maximum ; home-based physical exercise training with the same basic schedule as in the supervised period ; quantification of patients ' compliance with the exercise programme by the use of wristwatches , information stored in the watch memory being retrieved once a month during the 3-year follow-up period ; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients , and has been found to be cost-effective . This report describes a comprehensive and low cost educational intervention design ed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery . Methods / Design A controlled prospect i ve intervention trial . The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel . This group received no additional treatment beyond usual care . The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006 . This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment . The medical staff attended a one-hour seminar on cardiac rehabilitation . In addition , it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital . Both study groups were interviewed before surgery and one-year post surgery . A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs , as well as the structure and content of the cardiac rehabilitation programs attended . Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records . The effect of cardiac rehabilitation on one- and three-year mortality was assessed . Discussion We report a low cost yet comprehensive intervention design ed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation . Trial registration Clinical Trials.gov : PURPOSE This pilot study was to assess the feasibility of the health-related lifestyle self-management ( HeLM ) intervention as a strategy to decrease cardiovascular risk  following acute coronary syndrome . METHODS Participants in this r and omised controlled trial were recruited from a tertiary teaching hospital in metropolitan Sydney Australia . The multifaceted HeLM intervention , using the principles of the transtheoretical model , involved the use of bibliotherapy , a structured evidence -based approach to cardiovascular risk reduction , a communication strategy with general practitioners , three supportive telephone calls to participants and provision of behavioural prompts and a health record diary . Differences in behavioural and clinical outcomes between the  HeLM intervention group ( n=29 ) and the st and ard cardiac rehabilitation  group ( n=22 ) were assessed . RESULTS A total of 125 participants screened were eligible for participation in the study . Fifty-one participants , mean age 57 years ( + /-8.78 ) were r and omised . At the 8-week follow-up , participants in the HeLM intervention group had a reduced systolic blood pressure compared to the st and ard care group ( 120.3 S.D. : 16.3 vs. 126.4 S.D. : 14.6 ) . There were no significant differences in diastolic blood pressure and cholesterol levels between the two groups . Participants in both the intervention and control group had a reduction in waist circumference although when compared to baseline values , women in the HeLM intervention group had a greater reduction compared to those receiving st and ard care . Patients reported high levels of satisfaction with this intervention . CONCLUSIONS Findings support the feasibility of implementing the health-related lifestyle self-management intervention for risk factor modification in patients with acute coronary syndrome . An adequately powered r and omised controlled trial is required to test the impact of the intervention on cardiovascular risk reduction Background Due to the progressive deconditioning , comorbidities and higher complication rates , elderly patients are in particular need of cardiac rehabilitation . We compared elderly patients ( 65 + years old ) participating in cardiac rehabilitation  , focusing on baseline characteristics , risk factor control and functional assessment . Methods The EU-CaRE study is a prospect i ve study comparing cardiac rehabilitation in eight centres across Western Europe . Consecutive patients with acute coronary syndrome , stable coronary artery disease and heart valve replacement undergoing cardiac rehabilitation were included . Results Of 1633 patients ( median age 72 years ) participating , 54 % had acute coronary syndrome , 33 % had stable coronary artery disease and 13 % followed valve replacement . Fifty-five per cent had undergone percutaneous coronary intervention and 29 % coronary artery bypass grafting .  Characteristics varied across centres : 23 % ( 17–27 % ) were women , 4 % ( 0–12 % ) were of non-European origin and 16 % ( 4–32 % ) were living alone . Median time from index event to start of cardiac rehabilitation varied from 11 to 49 days ( p < 0.001 ) . Mean VO2peak was relatively low ( 16 mL/kg per min ) and varied significantly between the participating centres , largely unaffected by multivariable adjustment . Overall patients received guideline recommended treatment : 93 % ( 87–97 % ) were on a statin and 70 % ( 55–85 % ) an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker .  However , risk factor control was inadequate : 58 % had three or more risk factors not controlled . Conclusion EU-CaRE provides a snapshot of the elderly population with heart disease participating in cardiac rehabilitation across countries in Western Europe . Risk factors and exercise capacity indicate the continued need for cardiac rehabilitation in these patients . Of concern , the lag-time to start of cardiac rehabilitation needs improvement in many centres INTRODUCTION Acute coronary syndrome ( ACS ) is an important cause of mortality and significant personal and financial costs . Cardiac rehabilitation ( CR ) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity . However , adherence is low and appears to be influenced by psychosocial factors , such as patients ' cognitions and emotional state . The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS . METHODS One hundred and twenty-one patients with ACS , admitted to a coronary care unit in a central hospital , were r and omized to an experimental group ( EG , n=65 ) and a control group ( CG , n=56 ) . Portuguese versions of the HADS and BIPQ  were used to measure emotional well-being and illness cognitions . Two 1 h 15 min sessions were conducted 2 - 3 days after hospital admission , and a 20-minute follow-up session took place one month after discharge . Patients were assessed at four different time points : pre-test , post-test , and at 1- and 2-month follow-up . RESULTS The intervention had significant effects on anxiety , depression and illness cognitions . Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group . For the EG , these changes were maintained or enhanced at 1- and 2-month follow-up , whereas for the CG there was a deterioration in psychosocial adjustment . CONCLUSIONS These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with st and ard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis BACKGROUND Globally , attendance at cardiac rehabilitation ( CR ) is between 15 and 30 % . Alternative models of individualised care are recommended to promote participation in CR , however there has been no prospect i ve testing of different duration s of such models . We aim ed to replicate the previously proven Choice of Health Options In prevention of  Cardiovascular Events ( CHOICE ) intervention , and to determine if an extended version ( CHOICEplus ) would confer additional benefits . METHODS Acute coronary syndrome ( ACS ) survivors not accessing centre-based CR ( n=203 ) were r and omised to CHOICE for 3 months ( n=100 ) or CHOICEplus for 24 months ( n=103 ) at four urban hospitals . The program comprised telephone-based tailored risk-factor reduction . RESULTS CHOICE and CHOICEplus were equivalent demographically and in risk profile at baseline . At 24 months , lipid profiles improved significantly and fewer patients had ≥3 risk factors above target compared to baseline in both groups . There were no significant differences between groups . CONCLUSIONS The 24-month CHOICEplus program did not confer additional benefit above the brief 3-month CHOICE intervention . However , participation in either CHOICE and CHOICEplus significantly improved cardiovascular risk profile in ACS survivors . Importantly , the study was feasible , and the intervention translated readily across four hospitals . Overall , this study adds to the existing evidence for brief individualised approaches to CR OBJECTIVES The authors examined clinical outcomes in 71 male and female patients with coronary atherosclerosis who enrolled in a 2-year , independent-living , lifestyle modification program . The findings in 43 patients who completed the program were compared with those in 28 patients who dropped out of the program . BACKGROUND Clinical studies suggest that lifestyle modification of risk factors for coronary atherosclerosis reduces subsequent cardiac events but there are very few reports of the effect of these programs in patients living independently . METHODS Patients with diagnosed coronary atherosclerosis were managed for a 2-year period in a structured multidisciplinary program by a team that included two cardiologists , a nurse , a dietitian , an exercise physiologist , and a clinical psychologist . The overall aim of the program was to normalize or control all major reversible cardiovascular risk factors . Patients were required to participate in several weekly sessions for exercise , meditation/stress reduction training , dietary education and counseling , and participatory dinners . There was a strong emphasis on patient 's self care , inclusion of support members , and regular monitoring of and feedback to patients . RESULTS Data comparing baseline and 2-year outcomes showed a significant reduction in body weight , dietary intake of total/saturated fat and cholesterol , serum low- and high-density lipoprotein concentration , and an increase in exercise capacity . In the compliant group , the incidence of cardiac events was 2.3 % over 2 years . CONCLUSION Multidisciplinary lifestyle modification programs addressing cardiovascular risk factors are known to have a significant impact upon cardiac risk factors in patients with coronary atherosclerosis . Data show that these changes can be accomplished in independent-living patients in a program offered through a routine cardiology service . However , compliance is an important issue in these self-regulated programs Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Associations of age , gender , cardiac procedure ( coronary artery bypass grafting or percutaneous transluminal coronary angioplasty )  , risk stratification , and number of comorbidities with health-related quality of life ( HRQL ) were examined among 217 men and 84 women ( mean age , 63+/-11 years ) consecutively enrolled in a phase II cardiac rehabilitation program . Female gender and high-risk stratification were independently associated with impaired treatment gains in most areas of HRQL . Older age and having a greater number of comorbidities were also associated with impaired gains in specific areas . HRQL was generally lower at baseline but not post-treatment in coronary artery bypass grafting vs. percutaneous transluminal coronary angioplasty patients . Cardiac rehabilitation patients also had lower HRQL scores than an age-matched , normative sample at baseline ( most areas ) and post-treatment ( mainly on role physical ) . Findings reinforce the need for cardiac rehabilitation programs to tailor assessment s and risk factor modification strategies to patient characteristics associated with low levels of HRQL , especially in women and those with higher risk stratification
There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease .
This review , however , supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease .
Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors
BACKGROUND The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established .
Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low .
Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors .
OBJECTIVES The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease .