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Research with clinical populations: Cardiac rehabilitation

Research with clinical populations: Cardiac rehabilitation. Shawn N Fraser University of Alberta. Research program-CR. The enduring impact of social influences on exercise tolerance Determinants of self-efficacy to overcome barriers to exercise in cardiac rehabilitation

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Research with clinical populations: Cardiac rehabilitation

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  1. Research with clinical populations: Cardiac rehabilitation Shawn N Fraser University of Alberta

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

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

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

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

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

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

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

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

  10. CR-concerns • Those referred are typically: • Men • Younger • Healthier • Those with most to gain?

  11. CR-Research challenges • Research team • Cardiologist • Exercise technologist • Exercise specialist • Nurses • Researcher • Patient

  12. CR-Research • Outcomes • Death • Recurrent events • Prognostic factors • Functional factors: QOL, etc. • Behavior: smoking, exercise, etc.

  13. CR-Research • Prognostic factors • Cholesterol levels • Weight • Depression • Exercise tolerance • Mental stress tolerance • Other physiological markers • Other behavioral factors

  14. Exercise tolerance • Exercise tolerance • Diagnostic tool determines patient’s capacity for exercise • Diagnose CAD • Provide exercise prescription • Useful prognostic indicator • And indicator of progress

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

  16. CR-Research challenges • Adherence • Many stop exercising • Most were not referred • Effects?

  17. CR-Research challenges • Problem • Within the last month you’ve had a heart attack, bypass, and/or angioplasty • Efficacy to exercise? • Mental stress (fear) of test? • Accurate exercise tolerance? • Effort, stress response • Interpretation of test cessation?

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