Background and Objectives:Physical activity is one of the core components in cardiac rehabilitation and secondary prevention programs. This study investigated the effect of an intervention based on the health action process approach (HAPA) together with family support in the maintenance of physical activity and exercise capacity in coronary heart disease after discharge from rehabilitation.Method and Materials:In this randomized controlled trial, 96 patients with coronary heart disease were randomly assigned to control and intervention groups at the end of a rehabilitation program at Afshar Hospital, Yazd, Iran. HAPA Constructs and family support using a self-reported questionnaire and maximal oxygen uptake through a treadmill exercise test were measured prior to and 4 months after the intervention.Results:HAPA-based intervention together with family support increased scores of HAPA constructs and family support in the intervention group compared with the control group. The results showed that physical activity and exercise capacity in the intervention group was significantly higher than the control group after the intervention.Conclusion:HAPA-based intervention together with family support can be a useful tool for maintenance of physical activity and exercise capacity in coronary heart disease.

ObjectivesThis study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting.SettingAfshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran.DesignThis was a multimethod study, culminating in a cross-sectional survey.ParticipantsInpatient CR graduates who did not attend their initial outpatient CR appointment.MethodThe 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test–retest reliability of the scale (5% subsample) were evaluated using Cronbach’s α and intraclass correlation (ICC), respectively.ResultsFace, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett’s test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test–retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians.ConclusionThe four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.

Background Cardiovascular diseases are the most common causes of mortality in the world including Iran and are one of the main causes of disability. Cardiac Rehabilitation (CR) is a multidisciplinary program that helps CVD patients recover faster after a heart attack and avoid any subsequent incident . This report determined the current state of CR in Yazd, Iran. Characteristics of the program Hospital-based Afshar CR program in Yazd, Iran, is the only CR facility in Yazd province, which is located in the centre of Iran. Currently, the Afshar CR program has four phases including inpatient, sub-acute, outpatient and maintenance. The CR team includes cardiologists and heart surgeons as physicians, and physical medicine rehabilitation specialist, outpatient and inpatient resident medical officers, psychiatrists, nutritionists, psychologists, physiotherapists and social workers. Discussion Given the facilities and training programs mentioned above, the rate of patient referral to the center by the inpatient CR team during the short life of CR in this center was 60%, the patient participation rate was 6.9% and the enrollment rate was 55%. In addition, over the past three years, 57% of registered patients completed the program. Conclusion The Afshar CR is trying to get closer to the world standard setting. But it seems that it is necessary to develop the standard of CR in Iran based on the culture and socio-economic status of Iranian community.

Background:Cardiac rehabilitation is a combination of integrated programs aimed at improving outcomes in patients recovering from heart events.Objectives:The present study aimed to evaluate the early benefits of supervised exercise training on electrophysiological function of post-ischemic myocardium. In this regard, signal-averaged electrocardiogram (SAECG) was used.Patients and Methods:Between May and September 2012, all patients (n = 100) admitted to our center, with the diagnosis of acute Myocardial Infarction (MI), were enrolled in this study. Every other patient was assigned to two groups receiving either inpatient cardiac rehabilitation plus standard post-MI care (cases) or only standard post-MI care (controls). Electrophysiological function was assessed by SAECG in all the patients at baseline and on the day 5. The patients were considered as having late potential if they had abnormalities in at least two SAECG indices.Results:Cardiac rehabilitation led to significant improvements in QRS duration (P < 0.001), square root of amplitude in the last 40 ms (P < 0.001) and duration of terminal signal with low amplitude (P < 0.001). Cardiac rehabilitation also resulted in amelioration of SAECG parameters; frequency of patients with late potential significantly decreased from 64% to 20% after five days (P < 0.001).Conclusions:Supervised in-hospital exercise training was associated with improvements in SAECG-measured electrical activity post-MI.

Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively. Aim: This study investigated cardiac specialists’ perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral. Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group. Results: Four themes emerged: “physician factors,” “center factors,” “patient factors,” and “cultural factors.” Regarding “physician factors,” most participants mentioned shortage of time. Regarding “center factors,” most participants mentioned poor physician-patient-center coordination. In “patient factors,” the subcategories that arose were socioeconomic challenges and clinical condition of the patients. “Cultural factors” related to lack of belief in behavioral/preventive medicine. Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.

Background and Objective. Patients with cardiovascular problems experience sleep disorders. Due to the importance of adequate sleep and rest for the growth and repair of damaged cells, it is necessary to use appropriate interventions to improve it. This study determined the effect of sleep intervention programs during cardiac rehabilitation on patients’ sleep quality. Materials and Methods. In this quasi-experimental study with unequal control group design, 35 individuals participated in the cardiac rehabilitation program as the experimental group and 35 served as the control group. The program included 12 weeks of exercise, 3 sessions per week, 3 sessions of training programs each lasting for 45 minutes, and a special two-session sleep improvement program. Data were collected using the Pittsburgh Sleep Quality Index and analysed with descriptive and inferential statistical methods. Results. There were not any significant differences between the two groups in age, sex, marital status, smoking, and indication for cardiac rehabilitation ( P > 0.05 ). The scores of sleep quality of patients were 9.2 ± 1.58 before and 4.40 ± 1.14 after intervention in the experimental group and 9.02 ± 2.56 before and 7.48 ± 1.86 after intervention in the control group. There was no significant difference between the two groups before intervention ( P = 0.73 ). yet there was a significant difference after intervention ( P = 0.0001 ). In addition, scores of sleep quality of patients were significantly different in the experimental and control groups before and after intervention ( P = 0.0001 ). Conclusion. Findings indicated that the quality of sleep of cardiac patients improved after the sleep intervention program during the cardiac rehabilitation program. Therefore, it is suggested to implement sleep improvement programs for cardiac patient care as an effective, easy, and feasible technique. In addition, it is necessary to pay more attention to the sleep improvement program in cardiac rehabilitation. Trial Registration. The trial was retrospectively registered on https://en.irct.ir/trial/50799 on 14 September 2020 (14.09.2020) with registration number IRCT20140307016870N6.

Background Despite the benefits of cardiac rehabilitation (CR), it remains under-utilized, particularly by women. This study compared CR barriers between non-enrolling men and women in Iran, which has among the lowest gender equality globally. Methods In this cross-sectional study, CR barriers were assessed via phone interview in phase II non-attenders from March 2017 to February 2018 with the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P). T-tests were used to compare scores, with each of 18 barriers scored out of 5, between men and women. Results 357 (33.9%) of the sample of 1053 were women, and they were older, less educated and less often employed than men. Total mean CRBS scores were significantly greater in women (2.37 ± .37) than men (2.29 ± .35; p < .001). The top CR barriers among women were cost (3.35, P < 0.001), transportation problems (3.24, P < 0.001), distance (3.21, P < 0.001), comorbidities (2.97, P < 0.001), low energy (2.41, P < 0.001), finding exercise as tiring or painful (2.22, P = 0.018), and older age (2.27, P = 0.001). Men rated "already exercise at home or in community" (2.69, P = 0.001), time constraints (2.18, P < 0.001) and work responsibilities (2.24, P = 0.001) as greater CR barriers than women. Conclusion Women had greater barriers to CR participation than men. CR programs should be modified to address women’s needs. Home-based CR tailored to women’s exercise needs and preferences should be considered.

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