OBJECTIVE -The purpose of this study was to evaluate whether a combined resistance and aerobic training program would improve insulin sensitivity compared with aerobic training alone in postmenopausal women with type 2 diabetes. A second objective was to relate the improved insulin sensitivity to changes in abdominal adipose tissue (AT) and thigh muscle density. RESEARCH DESIGN AND METHODS-A total of 28 obese postmenopausal women with type 2 diabetes were randomly assigned to one of three 16-week treatments: control, aerobic only training (Ae only), or aerobic plus resistance training (AeϩRT). Pre-and posttreatment outcome measures included glucose disposal by hyperinsulinemic-euglycemic clamp and computed tomography scans of abdominal AT and mid-thigh skeletal muscle.RESULTS -Glucose infusion rates increased significantly (P Ͻ 0.05) in the AeϩRT group. Both exercise groups had reduced abdominal subcutaneous and visceral AT and increased muscle density. The AeϩRT training group exhibited a significantly greater increase in muscle density than the Ae only group. Improved glucose disposal was independently associated with changes in subcutaneous AT, visceral AT, and muscle density. Muscle density retained a relationship with glucose disposal after controlling for abdominal AT.CONCLUSIONS -Adding resistance training to aerobic training enhanced glucose disposal in postmenopausal women with type 2 diabetes. The improved insulin sensitivity is related to loss of abdominal subcutaneous and visceral AT and to increased muscle density.

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The structural and functional status of the vasculature are independent predictors of coronary events as shown by noninvasive measurement of endothelial function and carotid atheroma burden in patients with CAD. Preserved endothelial function attenuates the risk of future events associated with a high plaque burden.

Using the Morisky scale to identify patients who have been nonadherent with chronic cardiovascular medications may be reasonable in some settings; however, the threshold score would have to be chosen based on a trade-off between sensitivity and PPV. These results were likely influenced by the low rate of nonadherence in this cohort. Rewording the questions, increasing the number of questions, and the use of graded response options may improve consistency.

With an aging population in many Western countries and increases in risk factors such as obesity, the number of patients with cardiovascular diseases (CVDs) is increasing. 1 These patients are at greater risk of subsequent events, comorbidities, and premature mortality, therefore effective and ongoing management is needed to reduce this risk. Cardiac rehabilitation programs (CRPs) are effective at improving lifestyle behaviors and reducing risk factors in patients with CVD, as well as reducing CVD events and premature mortality, while being cost-effective.2-5 As a result, the American Heart Association, and others, have highlighted participation in CRP as an essential element of secondary prevention in patients with CVD. [6][7][8] Despite the known benefits of CRP, as little as 10% to 30% of eligible patients attend these programs. [9][10][11][12][13] The majority of these programs are limited to hospitals in large urban areas with geographical accessibility as one of the main barriers to attendance.14,15 Lack of access is more pronounced for patients in rural areas that do not have CRP, 16,17 although risk factors such as smoking and obesity are higher in rural populations 18 resulting in a greater rate of hospitalizations than urban populations.19 Home-based CRP have been developed to address the accessibility issue, and a review of these studies found no difference to hospital-based CRP with respect to improvements in CVD risk. 20 However, these programs generally consist of a mix of on-site exercise sessions, clinic or home visits, telephone calls from staff, and diaries, which still require patients to attend some sort of clinic and therefore do not accommodate patients in outlying areas.The proliferation of low-cost communications technology, such as the Internet, has opened up an array of opportunities for patient communication while bridging geographic distance. The Internet holds great promise in improving access to healthcare services as it is ubiquitous, requires little infrastructure and cost, and is readily scalable to large populations. Despite the enthusiasm for technology supported healthcare services, the evidence to support such use in cardiac rehabilitation is limited to pilot studies. [21][22][23][24] As a result, a recent American Heart Association Presidential Advisory has called for more robust research to test the feasibility and effectiveness of Internet-based CRP. 25 Our goal therefore, was to test the clinical effectiveness of a virtual CRP (vCRP) delivered exclusively using Internet-based technology. Local Challenges in ImplementationA common challenge to the implementation of CRP is the cost of their implementation despite having been demonstrated to be cost-effective.5 This challenge also holds true for technology-based solutions. Although several communication technology mediums exist (telephone, video-conferencing, and telemonitoring), we chose to use a web-based program delivered through the Internet as it is (1) commonly available in people's homes, (2) requires less capital exp...

AimsHeart failure (HF) results in characteristic signs and symptoms including oedema and breathing difficulties. Heart failure is particularly suited to telemonitoring, because patients' signs and symptoms can be assessed remotely by healthcare providers, and deterioration can be quickly detected and addressed. In this paper, we review studies conducted in HF telemonitoring, to describe the nature of the modality, the methods, and the results. Methods and resultsArticles were obtained through a MedLine search, utilizing the term heart failure in conjunction with the terms telehealth, telecare, telemonitoring, web, Internet, remote monitoring, and self-monitoring. Studies utilizing various modalities, including telephone touch pad, specialized hardware, and websites for participants to enter data were found, with various benefits being reported. Most studies demonstrated improvements in outcome measures, including improved quality of life and decreased hospitalizations. However, not all studies reported the same improvements and in several cases the sample sizes were relatively small. ConclusionTelemonitoring appears to be an acceptable method for monitoring of HF patients. Controlled, randomized studies directly comparing different modalities and evaluating their success and feasibility when used as part of routine clinical care, are now required.--

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