Implementing a Community-Based Model of Exercise Training Following Cardiac, Pulmonary, and Heart Failure Rehabilitation (original) (raw)
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International Journal of Chronic Obstructive Pulmonary Disease, 2016
Background: Poor uptake and adherence are problematic for hospital-based pulmonary and heart failure rehabilitation programs, often because of access difficulties. The aims of this mixed-methods study were to determine the feasibility of a supervised exercise training program in a community gymnasium in people with chronic respiratory and chronic cardiac disease, to explore the experiences of participants and physiotherapists and to determine if a community venue improved access and adherence to rehabilitation. Methods: Adults with chronic respiratory and/or chronic cardiac disease referred to a hospitalbased pulmonary and heart failure rehabilitation program were screened to determine their suitability to exercise in a community venue. Eligible patients were offered the opportunity to attend supervised exercise training for 8 weeks in a community gymnasium. Semi-structured interviews were conducted with participants and physiotherapists at the completion of the program. Results: Thirty-one people with chronic respiratory and chronic cardiac disease (34% males, mean [standard deviation] age 72 [10] years) commenced the community-based exercise training program. Twenty-two (71%) completed the program. All participants who completed the program, and the physiotherapists delivering the program, were highly satisfied, with reports of the community venue being well-equipped, convenient, and easily accessible. Using a community gymnasium promoted a sense of normality and instilled confidence in some to continue exercising at a similar venue post rehabilitation. However, factors such as cost and lack of motivation continue to be barriers. Conclusion: The convenience and accessibility of a community venue for rehabilitation contributed to high levels of satisfaction and a positive experience for people with chronic respiratory and chronic cardiac disease and physiotherapists.
Community-Based Cardiac Rehabilitation Maintenance Programs: Use and Effects
Participants (n=[ 6 _ T D $ D I F F ] 101, 55.4% Secondary Prevention) attended 37.4AE27.9% of sessions annually. Participants were predominately New Zealand-European (93.5%), retired (80.2%), married (68.3%) elderly individuals, with musculoskeletal problems (60.0%), who lived proximate to the clubs. In Secondary but not Primary Prevention participants, first-year attendance was strongly correlated with attendance in subsequent years (p<0.001). In all participants, greater attendance in the previous 12 months was significantly associated with lower waist circumference, and greater shuttle walk test duration, chair stands and balance (p<.05). Session attendance was positively correlated to peak oxygen consumption (p=0.041) in Secondary Prevention participants only.
Heart, Lung and Circulation, 2017
Background The benefits of exercise rehabilitation for people with heart failure (HF) are well established. In Australia, little is known about how the guidelines around exercise rehabilitation for people with HF are being implemented in clinical practice. Furthermore, it is unknown what organisational barriers are faced in providing exercise rehabilitation programs for this population. The aim of this study is to provide an updated review of exercise rehabilitation services for people with HF in Australia and to identify perceived organisational barriers to providing these services. Methods A cross-sectional survey of cardiac rehabilitation centres in Australia, investigating the number and characteristics of services providing exercise rehabilitation for people with HF. Results A total of 334 of 457 identified services responded to the survey. Of these, 251 reported providing a supervised group-based exercise rehabilitation program for people with HF. These services were mapped, showing their distribution across Australia. Services which were unable to provide group-based exercise training for HF patients reported organisational barriers including insufficient funding (60%), staffing (56%) and clinical resources (53%). Of the 78 services that reported patients in their local area were unable to access appropriate exercise guidance, 81% were located in regional or remote areas. We found that reported exercise practices align with current best-practice guidelines with 99% of group based exercise programs reportedly including endurance training and 89% including resistance training. Conclusions In Australia, exercise practices for people with HF align with current best-practice guidelines for this condition. Limited resources, funding and geographic isolation are reported as the major organisational barriers to providing these programs. Future endeavours should include the development of alternative and flexible delivery models such as telerehabilitation and other home-based therapies to improve access for these individuals to such services.
Promoting participation in cardiac rehabilitation: patient choices and experiences
Journal of Advanced Nursing, 2004
Promoting participation in cardiac rehabilitation: patient choices and experiences Background. Cardiac rehabilitation can be an effective means for the secondary prevention of coronary heart disease, but a majority of eligible individuals fail to attend or drop out prematurely. Little research has examined patients' decisions about attendance. Aims. This paper reports a study examining patients' beliefs and decision-making about cardiac rehabilitation attendance. Methods. A purposive sample of patients from a mixed urban-rural region of Scotland was studied in 2001 using focus groups. Those who were eligible for a standardized 12-week cardiac rehabilitation programme were compared, with separate focus groups held for individuals with high attendance (>60% attendance; n ¼ 27), high rates of attrition (<60% attendance; n ¼ 9) and non-attendance (0% attendance; n ¼ 8). A total of 44 patients (33 men; 11 women) took part in eight focus groups. Results. Participants from all groups held sophisticated and cohesive frameworks of beliefs that influenced their attendance decisions. These beliefs related to the self, coronary heart disease, cardiac rehabilitation, other attending patients, and health professionals' knowledge base. An enduring embarrassment about group or public exercise also influenced attendance. Those who attended reported increased faith in their bodies, a heightened sense of fitness and a willingness to support new patients who attended. Conclusions. Reassurance to ease exercise embarrassment should be given before and during the early stages of programmes, and this could be provided by existing patients. Strategies to promote inclusion should address the inhibiting factors identified in the study, and should present cardiac rehabilitation as a comprehensive programme of activities likely to be of benefit to the individual irrespective of personal characteristics, such as age, sex or exercise capacity.
Increasing Use of Cardiac and Pulmonary Rehabilitation in Traditional and Community Settings
Journal of Cardiopulmonary Rehabilitation and Prevention, 2020
Although both cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) are recommended by clinical practice guidelines and covered by most insurers, they remain severely underutilized. To address this problem, the National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the National Institute on Aging (NIA), developed Funding Opportunity Announcements (FOAs) in late 2017 to support Phase II clinical trials to increase the uptake of CR and PR in traditional and community settings. The objectives of these FOAs were to 1) test strategies that will lead to increased use of CR and PR in the U.S. population who are eligible based on clinical guidelines; 2) test strategies to reduce disparities in the use of CR and PR based on age, gender, race/ethnicity, and socioeconomic status; and 3) test whether increased use of CR and PR, whether by traditional center-based or new models, is accompanied by improvements in relevant clinical and patient-centered outcomes, including exercise capacity, cardiovascular and pulmonary risk factors, and quality of life. Five NHLBI grants and a single NIA grant were funded in the summer
Progress in Cardiovascular Nursing, 2002
Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs. Some consistent factors found to be associated with participation in CR programs include lack of referral by physicians, associated illness, specific cardiac diagnoses, reimbursement, self-efficacy, perceived benefits of CR, distance and transportation, self-concept, self-motivation, family composition, social support, self-esteem, and occupation. Factors associated with non-adherence include being older, female gender, having fewer years of formal education, perceiving the benefits of CR, having angina, and being less physically active during leisure time. However, many of the studies have methodologic flaws, with very few controlled, randomized studies, making the findings tentative. Problems in objectively measuring adherence to unstructured, non-hospital-based programs, which are an increasingly popular alternative to traditional programs, are discussed. Suggestions for reducing barriers to participation and adherence to CR programs, as well as for future research aimed at clearly identifying these barriers, are discussed.
Improving uptake of cardiac rehabilitation: Using theoretical modelling to design an intervention
Background: Attendance rates at cardiac rehabilitation remain low with typically fewer than 35% of eligible patients attending. Much of the poor attendance stems from invited patients failing to attend. Aim: To design a theoretically based intervention to improve attendance at cardiac rehabilitation. Methods: Our methods followed recommendations that have been developed from the Medical Research Council (MRC) framework for the design of complex interventions. We conducted three processes that progressed simultaneously: 1) literature review for evidence on epidemiology, behavioural theory, and efficacy of interventions; 2) expert meetings on behavioural theory and to select target points for intervention; and 3) development and theoretical modelling of the intervention. Result: Our final interventions were a theoretically worded invitation letter and leaflet based on the Theory of Planned Behaviour and the Common Sense Model of Illness, designed to: a) motivate patients through professional recommendation; b) provide simple information on the contents of cardiac rehabilitation emphasising ease for participants; c) reassure participants that the programme is tailored to their personal needs in a safe supervised environment; and d) reinforce the benefits of attending cardiac rehabilitation. Conclusion: A theoretically worded letter and leaflet could be an inexpensive intervention to improve attendance at cardiac rehabilitation. The letters and leaflets will now be evaluated in a randomised trial.
Cardiac rehabilitation II: referral and participation
General Hospital Psychiatry
Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. Substantial health risks continue following ischemic coronary events (ICEs), but secondary prevention efforts, including cardiac rehabilitation (CR), have beneficial effects on both early and late mortality and morbidity. This prospective study examined the relationship among psychosocial factors and CR referral and participation patterns in 906 (586 men, 320 women) patients from the coronary intensive care unit (CICU) over the course of six months. Only 30% of participants were referred to CR programs, with significantly fewer women being referred. A logistic regression analysis was used to determine whether depression, anxiety, self-efficacy, or social support predicted CR participation six months following an ICE, while controlling for sociodemographic factors. Results show that higher family income, greater anxiety symptomatology, and higher self-efficacy were significantly predictive of CR participation at six months. Implications for women's recovery from an ICE are discussed.