REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
114
VOLUME 11 NUMBER 3 • SEPTEMBER 2014
with coronary heart disease. Patients completed the Physical
activity energy expenditure (seven-day recall activity), MacNew
heart disease health-related quality of life (MacNew) and Hospital
anxiety and depression scale (HADs) questionnaires at baseline, six
weeks, six months and 12 months.
One hundred and five (71%) patients (76 male) with a mean
age of 61.8 years (SD = 9.7) completed the four measurement
points. Analysis of variance revealed that total energy expenditure
[
F
(2.231) = 131,
p
< 0.001], HADs [
F
(2.237) = 19.3,
p
< 0.001],
depression score [
F
(2.235) = 21.06,
p
< 0.001], anxiety score
[
F
(2.237) = 17.02,
p
< 0.001) and MacNew [
F
(2.197) = 77.02,
p
< 0.001] were all statistically significant over time. Bonferroni
pairwise follow up confirmed significant positive differences (
p
< 0.05) between baseline values and all subsequent measures
over time. Depression was independently explained in 22% of
the variance in quality of life at six or 12 months. The energy
expenditure was significantly higher for men compared to women
[
F
(1.103) = 31,
p
< 0.001].
The researchers concluded that a six-week cardiac rehabilitation
programme is beneficial in improving quality of life, physical
activity status, and anxiety and depression levels. These benefits
were maintained at 12 months. Elevated levels of depression were
associated with impaired quality of life.
Yohannes
et al
.
18
assert that all relevant healthcare staff should be
made aware of the benefits of cardiac rehabilitation and routinely
refer and encourage patients with cardiac disease to attend a cardiac
rehabilitation programme. The researchers indicate that depression
and anxiety intervention strategies should be incorporated into
cardiac rehabilitation programmes.
Conclusion
The AHA/AACVPR statement presents specific information
regarding evaluation, intervention and expected outcomes in
each of the core components of cardiac rehabilitation/secondary
prevention programmes. The outcomes of such programmes affirm
a multidisciplinary approach.
Trainingof all healthcareworkers involvedwith cardiac patients and
the establishment of treatment protocols within a multidisciplinary
framework is imperative for the development of integrated, holistic
cardiac rehabilitation interventions in South Africa. Following
multidisciplinary liaison, the establishment of cardiac rehabilitation
protocols and the acquisition of human and equipment resources,
the implementation of cardiac rehabilitation programmes would
gain momentum.
References
1. Mathes P.
Cardiovascular Prevention and Rehabilitation
. London: Springer, 2007.
2. Heran BS,
et al.
Exercise based cardiac rehabilitation for coronary heart disease.
Cochrane Syst Rev
2011; 7. Art No CD 001800.DOI:10.1002/14651858.
CD00180.pub2.tinyurl.com/CR-heart-disease.
3. Lam G,
et al
. The effect of a comprehensive cardiac rehabilitation programme
on 60-day hospital readmissions after an acute myocardial infarction.
J Am Coll
Cardiol
2011;
57
: E597–E597.
4. Davies EJ,
et al.
Exercise based rehabilitation for heart failure.
Cochrane Syst Rev
2010; 4. Art No CD 003331.tinyurl.com/exercise-CR.
5. Balady GJ, Williams MA, Ades PA, Bittner V, Comross P, Foofy JM,
et al
. Core
components of cardiac rehabilitation/secondary prevention programmes – A
scientific statement from the American Heart Association exercise, cardiac
rehabilitation, and prevention committee, the Council on Clinical Cardiology; the
councils on cardiovascular nursing, epidemiology and prevention, and nutrition,
physical activity, and metabolism; and the American Association of Cardiovascular
and Pulmonary Rehabilitation.
Circulation
2007;
115
: 2675–2682.
6. Kellerman JJ. Long-term comprehensive cardiac care – the perspectives and tasks
of cardiac rehabilitation.
Eur Heart J
1993;
14
: 1441–1444.
7. Piotrowicz R, Wolszakiewicz J. Cardiac rehabilitation following myocardial
infarction.
Cardiol J
2008;
15
: 481–487.
8. Martin AC. Current physiotherapy practice for post-operative cardiac patients.
J
Assoc Chart Physiother Resp Care
2007;
39
: 27–312.
9. Tucker B, Jenkins S, Davies K, McGram R, Waddel J, King R,
et al
. The physiotherapy
management of patients undergoing coronary artery surgery: A questionnaire
survey.
Australian J Physiother
1996;
42
(2): 129–137.
10. Roos R, van Aswegen H. Physiotherapy management of patients with coronary
artery disease: a report on current practice in South Africa.
S Afr J Physiother
2011;
67
(1) : 4–8.
11. Taylor RS,
et al.
Exercise-based rehabilitation for patients with coronary heart
disease: systematic review and meta-analysis of randomized controlled trials.
Am
J Med
2004;
116
: 682–692.
12. Lawler PR,
et al.
Efficacy of exercise-based cardiac rehabilitation post-myocardial
infarction: a systematic review and meta-analysis of randomized controlled trials.
Am Heart J
2011;
162
(4): 571–584.
13. Jiang X, Sit JW, Wong TK. A nurse-led cardiac rehabilitation programme improves
health behaviours and cardiac physiological risk parameters: evidence from
Chengdu, China.
J Clin Nurs
2007;
16
(10): 1886–1897.
14. Smith KM, Harkness K, Arthur HM. Predicting cardiac rehabilitation enrolment:
the role of automatic physician referral.
Eur J Cardiovasc Prevent Rehab
2006;
13
(1): 60–66.
15. Torres (Pastor) L, Sainz Hidalgo I, Guijarro Salcedo MC, Rena Sanchez M.
Occupational therapy in cardiac rehabilitation.
Revista Espanola de cardiologica
,
1995;
48
(Suppl 1): 28–32.
16. Holmes AL, Sanderson B, Maisiak R, Brown A, Bittner V. Dietician services
are associated with improved patient outcomes and the MEDFICTS dietary
assessment questionnaire is a suitable outcome measure in cardiac rehabilitation.
J Am Dietetic Assoc
2005;
105
(10): 1533–1540.
17. Yoshida T, Kohzuki M, Yoshida K, Hiwatari M, Kamimoto M, Yamamoto C,
et al
.
Physical and psychological improvements after phase II cardiac rehabilitation in
patients with myocardial infarction.
Nurs Health Sci
1999;
1
(3): 163–170.
18. Yohannes AM,
et al
. The long term benefits of cardiac rehabilitation on depression,
anxiety, physical activity and quality of life.
J Clin Nurs
2010;
19
(19–20): 2806–
2813.
