Risk predictors and frequency of cardiovascular symptoms occurring during cardiac rehabilitation programs in phase III-WHO

Abstract

Patients likely to experience cardiovascular symptoms in ambulatory rehabilitation can be identified by their medical history and perceived exertion.

Evidence-based risk assessment and recommendations for physical activity clearance: diabetes mellitus and related comorbidities1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process.

“…In contrast, 1 large scale epidemiological study of more than 674 000 patient exercise hours in a cardiac rehabilitation setting found that diabetes had no significant impact on cardiovascular symptoms or on events (Unverdorben et al 2007). This discrepancy in findings may be because the latter analysis was done on supervised exercise rehabilitation programs in patients who were medically cleared for exercise, while the former study was based on interviews of recent MI patients who were asked to report on the activities that they were doing in the hours before (or at the time of) the infarct.…”

“…Moreover, we found that a majority of exercise training sessions occurred under supervision with a carefully targeted exercise intensity that would likely place the participants at overall low risk for an adverse event (i.e., mild to moderate intensity). When more vigorous exercise was performed, adverse events appeared more frequently and were of more clinical concern in some (Mittleman et al 1993;Bernbaum et al 1989;Schneider et al 1984Schneider et al , 1992Unverdorben et al 2007;Inoguchi et al 2000) but not all (Balducci et al 2004;Maiorana et al 2002;Mourier et al 1997;Giannopoulou et al 2005;Loimaala et al 2003;Matteucci et al 2006) studies. Thus, it remains unclear if the low incidence of reported ad-verse events documented in this analysis reflects the true safety of PA, screening-out of higher risk subjects prior to enrollment in trials, or less than optimal documentation of adverse events in many research studies.…”

“…Overall, cardiovascular symptoms were rare during PA intervention studies. One epidemiological study from Germany (Unverdorben et al 2007), examining risk predictors and frequency of cardiovascular symptoms during cardiac rehabilitation programs, found high levels of mild to moderate cardiovascular symptoms in a mix of diabetic and nondiabetic patients (828 symptoms were reported by 538 patients in ∼674 000 patient exercise hours). However, in that study, previous MI and diabetes had no statistically significant impact on cardiovascular Note: 1RM, one-repetition maximum; BMI, body mass index; CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; DM, glucose tolerance; MI, mitochondrial infarction; NA, not applicable; NIDDM, non-insulin-dependent diabetes mellitus; PA, physical activity; PFA, partial foot sumption; _ V O 2 peak , peak oxygen consumption.…”

“…Those with greater amounts of weekly PA have a lower risk of total cardiovascular events (includes both exercise and nonexercise time) diabetes mellitus; ET, endurance training; GXT, graded exercise test; HR max , maximal heart rate; IDDM, insulin-dependent diabetes mellitus; IGT, impaired amputation; RCT, randomized control trial; RR, relative risk; SBP, systolic blood pressure; TTA, trans-tibial amputations; _ V O 2 max , maximal oxygen con-symptoms, whereas perceived overexertion, a low exercise capacity, and chronic heart failure all increased the relative risk for symptoms (Unverdorben et al 2007). …”

“…We found 21 RCTs that had some mention of adverse events (or lack thereof) associated with exercise in persons with diabetes who were largely free of CVD (i.e., subjects were prescreened). Moreover, the event rate (or subject withdrawal rate because of a cardiac condition) was often similar between subjects with diabetes and the controls (i.e., nondiabetic) (Unverdorben et al 2007;Banzer et al 2004). However, these studies were generally of relatively short duration (either graded exercise stress tests, or short duration prospective studies lasting weeks to months) and are likely underpowered to identify rare adverse events such as sudden cardiac death, MI, or stroke.…”