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Research with clinical populations: Cardiac rehabilitation

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Research with clinical populations: Cardiac rehabilitation Shawn N Fraser University of Alberta Research program-CR The enduring impact of social influences on ... – PowerPoint PPT presentation

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Title: Research with clinical populations: Cardiac rehabilitation


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 patients 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 youve 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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