SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
VOLUME 11 NUMBER 3 • SEPTEMBER 2014
113
living with a spouse or a partner, English-speaking, retired and
had multiple cardiac risk factors. Of the eligible patients, 2 121
(60%) attended the cardiac rehabilitation intake appointment. Of
the patients who attended intake, 1 463 (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%), nutritional counselling (
n
= 571; 39.0%), nursing
care (
n
= 546; 37.3%) and psychological intervention (
n
= 223;
15.2%).
The study concluded that an institutionalised, physician-endorsed
system of automatic referral to cardiac rehabilitation resulted in
higher rates of cardiac rehabilitation intake and enrolment following
CABG surgery than previously reported and should be adopted for
all cardiac populations.
Occupational therapy
In an article relating to occupational therapy and cardiac
rehabilitation, Torres asserted that occupational therapy in cardiac
rehabilitation is aimed at enabling the patient to return to work.
15
Ergonomics in relation to ‘dangerous tasks’ are taught to the patient
so that work may be done without risk. This is necessary because
there are differences between the work done in the effort tests and
the work done in an occupation- or work-related setting.
Therefore cardiac rehabilitation provides an efficient share in
coronary patient treatment and occupational therapy is a significant
complementary procedure. This indicates that occupational
therapists fulfil a role as part of the multidisciplinary team in a
cardiac rehabilitation programme.
Dietetics
A study by Holmes
et al.
16
was conducted in America to examine
the effectiveness of the registered dietician and education and
counselling on diet-related patient outcomes with general
education provided by the cardiac rehabilitation staff. The study also
evaluated the effectiveness of meat, eggs, dairy, fried foods, baked
goods, convenience foods, table fats and snacks. The MEDFICTS
dietary assessment questionnaire was used as an outcome measure
in cardiac rehabilitation.
Observational study data from 426 cardiac rehabilitation
patients discharged between January 1996 and February 2004
were examined. Groups were formed based on educational source:
(1) registered dietician, and (2) general education from cardiac
rehabilitation staff.
Baseline characteristics were compared between groups and
pre/post diet-related outcomes (lipid levels, waist circumference,
body mass index, MEDFICTS score) were compared within groups.
Controlling for baseline measures and lipid-lowering medication,
associations were examined between (1) registered dietician
education and diet-related outcomes, and (2) ending MEDFICTS
score and diet-related outcomes.
Mean age was 62 ± 11 years, 30% of patients were female, and
28% were non-white. At baseline, the registered dietician group
(
n
= 359) had more dyslipidaemia (88 vs 76%), more obesity (47
vs 27%), a larger waist (40 ± 6 vs 37 ± 5 inches), a higher body
mass index (30 ± 6 vs 27 ± 5 kg/m
2
), a higher diet score (32 ± 28
vs 19 ± 19), and lower self-reported physical activity (7 ± 12 vs 13
± 18 metabolic equivalent hours) (all
p
< 0.05) than the general
education group (
n
= 67).
Registered dietician education was associated with improved
levels of low-density lipoprotein (
i
= 0.13;
p
= 0.04) and triglycerides
(
i
= 0.48;
p
= 0.01), and MEDFICTS score (
i
= 0.18;
p
= 0.01).
Improvements in MEDFICTS scores were correlated with improved
total cholesterol and triglyceride levels, and waist measurements
(all
i
= 0.19;
p
= 0.04).
The study concluded that dietary education by a registered
dietician is associated with improved diet-related outcomes and
that the MEDFICTS score is a suitable outcome measure in cardiac
rehabilitation. This study affirms the role of the dietician as part of
the multidisciplinary team in cardiac rehabilitation.
Psychology
In a study by Yoshida in Sendai, Japan, physical and psychological
improvements were reported after phase II cardiac rehabilitation in
patients with myocardial infarction.
17
A new four-week hospitalised
phase II cardiac rehabilitation programme was designed.
Twenty-nine patients (27 males, 2 females) with acute myocardial
infarction who enrolled in the programme were assessed. All
patients enrolled in this study had received coronary interventions.
The rehabilitation consisted of exercise training, education and
counselling. The physical and psychological status of the patients
before and just after the programme and at a six-month follow up
was evaluated.
The physical status was assessed by exercise tolerance measured
by the peak oxygen consumption and anaerobic threshold, frequency
of exercise, and serum concentrations of triglycerides, total
cholesterol, high-density lipoprotein cholesterol, and low-density
lipoprotein cholesterol. The psychological status was assessed by
the Spielberger state-trait anxiety inventory questionnaire (STA) and
the self-rating questionnaire for depression (SRQ-D). Thirty-four
patients (27 men, 7 women) with MI who did not participate in the
rehabilitation programme served as a control group.
After participation in the rehabilitation programme, exercise
tolerance and serum lipid profiles of the patients were improved
compared to six months after rehabilitation. The STA anxiety score
was improved significantly and the SRQ-D depression score tended
to be improved just after the rehabilitation programme. Regular
physical activity was continued even six months after the completion
of the programme.
The hospitalised phase II cardiac rehabilitation programme
improved the management of cardiac risk factors and the
psychological status in patients with MI. This comprehensive
programme may contribute to the secondary prevention of MI
as well as the recovery of physical and psychological activities.
Psychologists therefore form an integral component of the
multidisciplinary cardiac rehabilitation team. The articles cited
above describe the benefits of a multidiscipliary approach to a
cardiac rehabilitation.
An article by Yohannes
et al
.
18
describes the benefits following
an investigation into the long-term benefits of a six-week
comprehensive cardiac rehabilitation programme on physical
activity, psychological well-being and quality of life in patients with
coronary heart disease. The researchers asserted that CR in the
short term improves exercise capacity and quality of life in patients
with cardiac disease. However, the long-term benefits of CR were
inconclusive.
A prospective CR programme with repeated-measures follow up
over 12 months was the design. A six-week out-patient cardiac
rehabilitation programme was conducted including 147 patients
