Describe cardiac rewabilptation and its various effects ?
A survival benefit cannot be attributed solely to exercise training because many studies involved multifunctional interventions. Meta-analysis of the randomized controlled trials 'of exercise rehabilitation in patients following myocardial infarction establishes a reduction in mortality approximating 25 per cent at three year follow-up. This reduction in mortality approaches that resulting from pharmacologic management of patients following myocardial infarction with beta-blocking drugs or patients with left ventricular systolic dysfunction with angiotensin-converting enzyme (ACE) inhibitor therapy. The reduction in cardiovascular mortality was 26 per cent in multifactorial randomized trials of cardiac rehabilitation and 15 per cent in trials that involved only an exercise intervention.
Cardiac rehabilitation exercise training is not recommended as a sole intervention for lipid modification because of its inconsistent effect on lipid and lipoprotein levels. Optimal lipid management requires specifically directed dietary and, as medically indicated, pharmacologic management, in addition to cardiac rehabilitation exercise training.
Nine randomized controlled trials reported changes in HDL cholesterol levels. Two documented statistically significant increases in HDL levels favouring intervention versus control patients; both were multifactorial studies.
Twelve randomized controlled trials reported changes in triglyceride levels. Seven documented significantly lower triglyceride levels in rehabilitation versus control patients; five of these were multifactorial studies.
Cardiac rehabilitation exercise training as a sole intervention has an inconsistent effect on controlling overweight and is not recommended as a sole intervention for this risk factor. Optimal management of overweight requires multifactorial rehabilitation including nutritional education and counselling and behavioural modification in addition to exercise training.
Rehabilitative exercise training, when a component of multifactorial intervention, appears to have a beneficial effect in improving body weight or other measures of excess body mass or percentage of body fat.
Rehabilitative exercise training as a sole intervention has no demonstrable effect in lowering blood pressure levels. Multifactorial cardiac rehabilitation, including exercise training, has an inconsistent effect in lowering blood pressure levels; major confounding variables include the use of antihypertensive medication and medication changes.
Review of the scientific evidence suggests that exercise-based cardiac rehabilitation has only modest effects in reducing blood pressure levels. The generalizability of these data is limited by the small numbers of women who were enrolled in these studies. The hallmark feature is that no study was specifically designed to address hypertension control in patients with elevated blood pressures participating in exercise-based cardiac rehabilitation. The confounding effects on blood pressure change of weight reduction, dietary habits, and anti-hypertensive medications were not addressed in any of the studies. It is unlikely that hypertensive patients with coronary disease would be provided solely exercise training without other appropriate therapies such as weight reduction, sodium restriction, moderation or abstinence from alcohol, or pharmacologic therapy, although these components may have been directed by the patient's treating physician.
Type-A behaviour pattern has received more attention than any other behavioural or psychological variable as a risk factor for CHD. Individuals who exhibit Type-A behaviour pattern display a variety of traits and behavioural dispositions, including hard-driving competitiveness, a persistent sense of time urgency, and .easily evoked hostility. A relative absence of these behavioral features characterizes the converse, Type-B behaviour pattern. In 1981, a review panel assembled by NHLBI concluded that Type-A behaviour pattern is an independent risk factor for CHD in employed, middle-aged U.S. citizens.
Depression is reported to precede inyocardial infarction in 33-50 per cent of patients. Higher rates of myocardial infarction have been reported among depressed than non-depressed psychiatric patients. Examination of 283 hospitalized patients with myocardial infarction showed that 18 per cent had major depression and an additional 27 per cent had symptoms of depression.
Cardiac rehabilitation exercise training with and without other cardiac rehabilitation services generally results in improvement in measures of psychological status and functioning. Exercise training as a sole intervention does not consistently result in improvement in measures of anxiety and depression. Exercise training is recommended to enhance measures of psychological functioning, particularly as a component of multifactorial cardiac rehabilitation.
Cardiac rehabilitation exercise training, either alone or as a component of multifactorial rehabilitation, often results in improvement in various measures of psychological status and functioning. This evidence from the scientific literature is consistent with the widespread belief among cardiac rehabilitation professionals that cardiac rehabilitation exercise training improves the sense of well-being among participants. The evidence particularly supports improvement among individuals with high levels of distress at the time of entry into the study. The instruments used to measure psychological outcomes differed widely and are those often designed to measure abnormal responses and changes in patients with psychologist or psychiatric illness; even with use of these instruments, improvement in psychological status was documented in patients not specifically targeted because of psychological illness. Patients tended to perceive themselves as improving in a number of psychosocial domains, although these perceptions may not have been objectively documented. More sensitive tests may have to be developed to better ascertain changes in cardiac patients without specific psychiatric illness, and those data are very limited for elderly patients.