A Home-based Maintenance Exercise Program After Center-based Cardiac Rehabilitation: Effects on Blood Lipids, Body Composition, and Functional Capacity

Ph, Brubaker; Wj, Rejeski; Mj, Smith; Kh, Sevensky; Ka, Lamb; Wm, Sotile; Hs, Miller

doi:10.1097/00008483-200001000-00009

Cited by 61 publications

(82 citation statements)

References 18 publications

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“…In cardiac patients, homebased maintenance programs after centerbased cardiac rehabilitation have been shown effective in improving or maintaining functional capacity, blood lipid profiles, and body weight (6). Additionally, studies in older adults have reported that home-based resistance training can be an effective way to elicit strength gains, although the effect on metabolic risk markers such as glycemic control, lipids, and blood pressure is unknown (7,8).…”

Section: Diabetes Care 28:3-9 2005mentioning

confidence: 99%

Home-Based Resistance Training Is Not Sufficient to Maintain Improved Glycemic Control Following Supervised Training in Older Individuals With Type 2 Diabetes

et al. 2005

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OBJECTIVE -To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training.RESEARCH DESIGN AND METHODS -We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60 -80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA 1c ), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months.RESULTS -Compared with the WL group, HbA 1c decreased significantly more in the RT&WL group (Ϫ0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P Ͻ 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P ϭ 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P Ͻ 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months.CONCLUSIONS -In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control. Diabetes Care 28:3-9, 2005P hysical activity recommendations for older patients with type 2 diabetes have traditionally focused on aerobic-based activities such as walking programs. However, resistance or strength training has been considered a viable alternative to aerobic exercise because of its effectiveness in improving muscular strength and its role in the prevention of age-related sarcopenia (1). Recently, we have reported improved HbA 1c in sedentary, overweight, older men and women (60 -80 years of age) with type 2 diabetes after 6 months of supervised progressive resistance training (2). Other controlled trials have also demonstrated improved glycemic control in patients with type 2 diabetes after supervised resistance training for 2-4 months (3,4).Although these findings support the use of resistance training for the management of glycemic control in older adults with type 2 diabetes, it is unclear whether improved glycemic control can be maintained after supervised exercise is withdrawn. Most trials have used supervised exercise sessions in laborator...

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Section: Diabetes Care 28:3-9 2005mentioning

confidence: 99%

Home-Based Resistance Training Is Not Sufficient to Maintain Improved Glycemic Control Following Supervised Training in Older Individuals With Type 2 Diabetes

et al. 2005

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“…This hypotensive effect may continue with the repetition of exercise sessions over time [3,47]. However, these beneficial effects of exercises are restricted to supervised physical training programs or cardiovascular rehabilitation programs in patients already affected by cardiac events [12,32]. Therefore, little is known on the impact of a nonsupervised physical training program on blood pressure.…”

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Hypertension in aging: physical activity as primary prevention

Ben‐Sira

Oliveira

2007

Eur Rev Aging Phys Act

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In most physiologic systems, there is considerable evidence that the normal aging processes do not result in significant impairment or dysfunction in the absence of pathology and under resting conditions. However, in response to a stress, the age-related reduction in physiologic reserves causes a loss of regulatory or homeostatic balance. This happens before an individual notices that something is wrong. An additional consequence of age-related changes is an increased perception of effort associated with submaximal work. Thus, a vicious cycle is set up, leading to decreasing exercise capacity, resulting in an elevated perception of effort, subsequently causing avoidance of activity, and finally feeding back to exacerbation of the agerelated declines secondary to disuse. Sedentary behavior is an important risk factor for chronic disease morbidity and mortality in aging. However, there is a limited amount of information on the type and amount of activity needed to promote optimal health and function in older people [19]. The purpose of this review is to discuss the important role of exercise training as a primary prevention tool to hypertension. In addition, this review will address the topic of the recommended amount of physical activity required for health promotion along with the current exercise guidelines.Keywords Work capacity . Aerobic exercise . Isometric exercise . Sympathetic nerve activity Exercise training and blood pressureBy the year 2030, the number of individuals 65 years and over will reach 70 million in the USA alone; persons 85 years and older will be the fastest growing segment of the population. As more individuals live longer, it is imperative to determine the extent and mechanisms by which exercise and physical activity can improve health, functional capacity, quality of life, and independence in this population. Aging is a complex process involving many variables (e.g., genetics, lifestyle factors, chronic diseases) that interact with one another, significantly influencing the manner in which we age [1].Many studies provide evidence that in developed nations such as the USA, a sedentary lifestyle contributes significantly to development of the major risk factors for age-related disease, prominent among them being obesity, diabetes, and hypertension [44]. Conversely, there is increasing evidence that a high level of activity during old age and consequently an influence on the aging process can be achieved by regular training initiated as early as young adulthood. The focus of this training process should be on improving muscle strength, general flexibility, and cardiovascular exercise. Thus, it is appropriate to perceive physical activity as a medical prescription for the aging population [4,34].The high prevalence of hypertension in modern industrialized societies imposes a considerable public health problem [35], and therefore, prevention of hypertension is a major public health objective. Hypertension is a serious health problem that increases the risk of coronary heart disease, ...

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“…Os programas de reabilitação não supervisionada têm-se mostrado eficientes para aumentar a potência aeróbica, a capacidade funcional e modificar os fatores de risco coronariano 4 . Em recente revisão da literatura, registraram-se, até presentemente, 22 relatos, abrangendo 1.895 pacientes 15 .…”

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“…verificaram elevações semelhantes da potência aeróbia e do HDL-colesterol em pacientes randomizados submetidos a reabilitação supervisionada e reabilitação não supervisionada durante 9 meses 4 . Entre nós, após programa de 19 a 79 meses (mediana de 31 meses), registrou-se aumento significativo na relação VO 2 pico / freqüência cardíaca, comparando-se o grupo treinado com grupo controle pareado 4 . Elevações significativas da fração de ejecão no pico do esforço após 8 meses de treinamento 24 , da sensibilidade ao baroreflexo e do RRSD (R-R interval standard deviation) em 15 dias de condicionamento físico também foram relatadas 16 .…”

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Reabilitação não supervisionada ou semi-supervisionada: uma alternativa prática

Filho¹,

Salvetti²

2004

Arq. Bras. Cardiol.

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Atualmente em países desenvolvidos, pouco menos de 25% dos pacientes elegíveis para reabilitação participam de programas de treinamento em centros especializados 1 . Após cirurgia de revascularização, esses valores atingem 25 a 50% dos casos 2 . Entre nós, a despeito da falta de estatísticas, as oportunidades são, reconhecidamente, muito menores. Entre os pacientes que participam de programas de reabilitação supervisionada, em países desenvolvidos, 25 a 50% desistem do treinamento em 6 meses e, cerca de mais de 90%, em um ano 1,3 . Entre nós, não existem dados estatísticos publicados sobre reabilitação supervisionada. Os protocolos pertinentes não se têm mostrado exeqüíveis, na prática diária, dadas as inúmeras dificuldades de ordem social e econômica: distância do centro de reabilitação, problemas de horário, custos, falta de cobertura por convênios 4 , além de ausência quase absoluta de apoio governamental. Assim, a reabilitação supervisionada não se torna uma solução prática e a reabilitação não supervisionada pode ser uma alternativa razoável para pacientes coronarianos considerados de baixo risco 5 . Após episódio de infarto do miocárdio, cerca de 55% dos sobreviventes apresentariam função ventricular preservada, ausência de isquemia miocárdica nos testes funcionais e mortalidade no 1º ano de 1 a 3% 6 , tornandose candidatos em potencial para reabilitação não supervisionada.A elegibilidade para reabilitação não supervisionada varia pouco de acordo com diferentes autores [7][8][9] . Segundo a Sociedade Brasileira de Cardiologia, não são elegíveis os pacientes com VO 2 pico ≤18ml/kg/min (5MET), aparecimento de angina ou outra manifestação clínica de isquemia do miocárdio em carga ≤18ml/kg/ min (5MET), infarto do miocárdio extenso com fração de ejeção ≤35% em repouso, teste ergométrico com redução de fração de ejeção de 10% ao esforço, queda da pressão arterial sistólica no teste ergométrico, arritmia ventricular complexa, intervalo QT corrigido ≥440 ms, antecedentes de parada cardíaca primária, inabilidade de automonitorização e aderência ao exercício, obesidade importante, hipertensão arterial refratária e diabetes mellitus descompensado. Na ausência de contra-indicações, são elegíveis os pacientes estáveis, após seis meses de treinamento, que apresentem conhecimento suficiente do treinamento aeróbio, temperamento e motivação capazes de total aderência ao treinamento 8 . A necessidade de treinamento prévio tem sido suprimida em inúmeros relatos, e substituída por consultas, demonstrações e palestras em grupos 2,10-14 . Nesses casos, a reabilitação não supervisionada se torna exeqüível apenas para pacientes com perfil psicológico e sociocultural adequado.Em nossa Instituição, fomos orientados pela Comissão de Éti-ca em Pesquisa a realizar a reabilitação não supervisionada mediante protocolo de pesquisa, tendo em vista aspectos médico-legais. Entretanto, tal exigência não se aplica a consultórios médicos, onde a relação adequada médico-paciente é sufuciente. Em se tratando de projeto inicial em nosso meio, tem...

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A Home-based Maintenance Exercise Program After Center-based Cardiac Rehabilitation: Effects on Blood Lipids, Body Composition, and Functional Capacity

Cited by 61 publications

References 18 publications

Home-Based Resistance Training Is Not Sufficient to Maintain Improved Glycemic Control Following Supervised Training in Older Individuals With Type 2 Diabetes

Home-Based Resistance Training Is Not Sufficient to Maintain Improved Glycemic Control Following Supervised Training in Older Individuals With Type 2 Diabetes

Hypertension in aging: physical activity as primary prevention

Reabilitação não supervisionada ou semi-supervisionada: uma alternativa prática

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