[show abstract][hide abstract] ABSTRACT: Atrial fibrillation, the most common sustained cardiac arrhythmia, is associated with significant morbidity and mortality. Chronic exercise training is a recognized form of treatment for those with many forms of heart disease. There might also be a role for exercise in the management of permanent atrial fibrillation; few studies have explored the effects of chronic exercise training in persons with this condition. The purpose of this study was to systematically evaluate and summarize the evidence surrounding the effects of chronic exercise training in persons with permanent atrial fibrillation.
A systematic and comprehensive literature review was undertaken of all English language literature. A total of 6 studies, 3 randomized controlled trials with a total of 118 participants, and 3 observational studies with a total of 93 participants, were identified.
The literature suggests that short-term chronic exercise training of low, moderate, or vigorous intensity in adults with permanent atrial fibrillation significantly improved rate control, functional capacity, muscular strength and power, activities of daily living, and quality of life. The effect of short-term chronic exercise training on aerobic capacity in adults with permanent atrial fibrillation is conflicting.
Chronic exercise training appears to play a promising role in the management of permanent atrial fibrillation. Future studies examining the effect of various forms of exercise training interventions in improving clinical outcomes and exercise tolerance in those with permanent atrial fibrillation are needed.
The Canadian journal of cardiology 12/2013; 29(12):1721-1728. · 3.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND:Family members of patients with coronary artery disease (CAD) have higher risk of vascular events. We conducted a trial to determine if a family heart-health intervention could reduce their risk of CAD. METHODS:We assessed coronary risk factors and randomized 426 family members of patients with CAD to a family heart-health intervention (n = 211) or control (n = 215). The intervention included feedback about risk factors, assistance with goal setting and counselling from health educators for 12 months. Reports were sent to the primary care physicians of patients whose lipid levels and blood pressure exceeded threshold values. All participants received printed materials about smoking cessation, healthy eating, weight management and physical activity; the control group received only these materials. The main outcomes (ratio of total cholesterol to high-density lipoprotein [HDL] cholesterol; physical activity; fruit and vegetable consumption) were assessed at 3 and 12 months. We examined group and time effects using mixed models analyses with the baseline values as covariates. The secondary outcomes were plasma lipid levels (total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol and triglycerides); glucose level; blood pressure; smoking status; waist circumference; body mass index; and the use of blood pressure, lipid-lowering and smoking cessation medications. RESULTS:We found no effect of the intervention on the ratio of total cholesterol to HDL cholesterol. However, participants in the intervention group reported consuming more fruit and vegetables (1.2 servings per day more after 3 mo and 0.8 servings at 12 mo; p < 0.001). There was a significant group by time interaction for physical activity (p = 0.03). At 3months, those in the intervention group reported 65.8 more minutes of physical activity per week (95% confidence interval [CI] 47.0-84.7min). At 12 months, participants in the intervention group reported 23.9 more minutes each week (95% CI 3.9-44.0 min). INTERPRETATION:A health educator-led heart-health intervention did not improve the ratio of total cholesterol to HDL cholesterol but did increase reported physical activity and fruit and vegetable consumption among family members of patients with CAD. Hospitalization of a spouse, sibling or parent is an opportunity to improve cardiovascular health among other family members. Trial registration: clinicaltrials.gov, no NCT00552591.
Canadian Medical Association Journal 11/2013; · 6.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: To develop and evaluate the validity and reliability of a questionnaire to measure intentions and beliefs about healthy eating in individuals at risk for coronary heart disease. Method: The Healthy Eating Opinion Survey was developed using the theory of planned behavior. An open-ended elicitation questionnaire was administered to 21 participants, and a 46-item questionnaire was developed for further testing. Test-retest reliability of each question on the survey was assessed by calculating the correlation coefficients between the responses over a 2- week period in 17 participants. Internal consistency was assessed using Cronbach's alpha, and factor analysis was used to assess the construct validity of the questionnaire in a sample of 388 participants. Results: The responses to the elicitation questions were used to develop behavioral beliefs, normative beliefs, and control beliefs questions for the final questionnaire. Test-retest reliability ranged from 0.22-0.90, with the majority (89%) of correlations being moderate to strong. Internal consistency was good, with Cronbach's alpha ranging from 0.74-0.92. All intentions questions loaded onto a single factor; attitude questions loaded onto two factors; subjective norm questions loaded onto two factors; perceived behavioral control questions loaded onto one factor; behavioral beliefs questions loaded onto one factor; normative beliefs questions loaded onto one factor; and control beliefs questions loaded onto one factor. Conclusion: The questionnaire was found to be a reliable, valid questionnaire to assess beliefs and intentions toward eating a healthy diet in individuals at risk for coronary heart disease. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Patients with heart failure are a growing population within cardiac rehabilitation. The purpose of this study was to compare, through a single-centre, parallel-group, randomized controlled trial, the effects of Nordic walking and standard cardiac rehabilitation care on functional capacity and other outcomes in patients with moderate to severe heart failure. METHODS: Between 2008 and 2009, 54 patients (aged 62.4 ± 11.4 years) with heart failure (mean ejection fraction = 26.9% ± 5.0%) were randomly assigned to standard cardiac rehabilitation care (n = 27) or Nordic walking (n = 27); both groups performed 200 to 400 minutes of exercise per week for 12 weeks. The primary outcome, measured after 12 weeks, was functional capacity assessed by a 6-minute walk test (6MWT). RESULTS: Compared with standard care, Nordic walking led to higher functional capacity (Δ 125.6 ± 59.4 m vs Δ 57.0 ± 71.3 m travelled during 6MWT; P = 0.001), greater self-reported physical activity (Δ 158.5 ± 118.5 minutes vs Δ 155.5 ± 125.6 minutes; P = 0.049), increased right grip strength (Δ 2.3 ± 3.5 kg vs Δ 0.3 ± 3.1 kg; P = 0.026), and fewer depressive symptoms (Hospital Anxiety and Depression Scale score = Δ -1.7 ± 2.4 vs Δ -0.8 ± 3.1; P = 0.014). No significant differences were found for peak aerobic capacity, left-hand grip strength, body weight, waist circumference, or symptoms of anxiety. CONCLUSIONS: Nordic walking was superior to standard cardiac rehabilitation care in improving functional capacity and other important outcomes in patients with heart failure. This exercise modality is a promising alternative for this population.
The Canadian journal of cardiology 06/2013; · 3.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To determine whether telephone-based smoking cessation follow-up counseling (FC), when delivered as part of a multi-component intervention program is associated with increased rates of follow-up support and smoking abstinence. METHODS: A cluster randomized controlled-trial was conducted within family medicine practices in Ontario, Canada. Consecutive adult patients who smoked were enrolled at two time points, the baseline period (2009) and the post-intervention period (2009-2011). Smoking abstinence was determined by telephone interview 4months following enrollment. Both groups implemented a multi-component intervention program. Practices randomized to the FC group could also refer patients to a follow-up support program which involved 5 telephone contacts over a 2-month period. RESULTS: Eight practices, 130 providers, and 928 eligible patients participated in the study. No statistically significant difference in 7-day point-prevalence abstinence was observed between intervention groups. There was a significant increase in referral to follow-up in both intervention groups. Significantly higher rates of smoking abstinence [25.7% vs. 11.3%; adjusted OR 3.1 (95% CI: 1.1, 8.6), p<0.05] were documented among the twenty-nine percent of FC participants who were referred to the follow-up support program compared to the MC group. CONCLUSION: Access to external follow-up support did not increase rates at which follow-up support was delivered.
[show abstract][hide abstract] ABSTRACT: PURPOSE:: Despite well-documented positive benefits, cardiac rehabilitation (CR) is an underutilized resource for patients following a cardiac event or intervention. Bias in the CR referral process has led to programs designed to ensure that all eligible patients receive a referral. The purpose of the current investigation was to describe the implementation of a nurse-delivered automatic bedside referral process and to examine the effectiveness on referral and intake rates for CR. METHODS:: In 2007, an automatic CR referral system was implemented at the University of Ottawa Heart Institute. A nurse-delivered automatic bedside referral process was implemented in 2008. A CR nurse screened all inpatient charts, discussed CR benefits and program options with patients, triaged the patient to the appropriate program, and facilitated booking of the CR intake appointment. Data were analyzed to determine the effectiveness of this approach. RESULTS:: Only 15.5% to 19.7% of eligible patients participated in CR program prior to 2006. Implementation of an automatic referral process increased participation to 26.7%. The nurse-delivered bedside automatic referral process increased participation to 32.6%. The proportion of patients receiving CR referrals almost tripled following the implementation of the nurse-delivered referral process from 26.7% in 2003 to 79.0% in 2008. CONCLUSIONS:: A nurse-delivered automatic bedside referral process had a positive impact on both referral and intake to CR. Future challenges for CR programs will be to ensure optimal participation in programs, while managing the growth associated with increased rates of involvement.
Journal of cardiopulmonary rehabilitation and prevention 02/2013; · 1.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction
La fibrillation auriculaire, qui est l’arythmie cardiaque soutenue la plus fréquente, est associée à une morbidité et une mortalité significatives. L’entraînement physique régulier est un type de traitement reconnu pour ceux ayant diverses formes de cardiopathie. L’exercice pourrait également jouer un rôle dans la prise en charge de la fibrillation auriculaire permanente. Quelques études ont exploré les effets de l’entraînement physique régulier chez les personnes ayant cette maladie. Le but de cette étude était d’évaluer et de résumer systématiquement les données scientifiques entourant les effets de l’entraînement physique régulier chez les personnes ayant une fibrillation auriculaire permanente.
Une revue systématique et globale de toute la littérature de langue anglaise a été entreprise. Un total de 6 études, dont 3 essais cliniques aléatoires comprenant un total de 118 participants et 3 études observationnelles comprenant un total de 93 participants, ont été sélectionnées.
La littérature suggère que l’entraînement physique régulier à court terme d’intensité faible, modérée ou vigoureuse chez les adultes ayant une fibrillation auriculaire permanente améliorait significativement la maîtrise de la fréquence, la capacité fonctionnelle, la force et la puissance musculaires, les activités de la vie quotidienne et la qualité de vie. L’effet de l’entraînement physique régulier à court terme sur la capacité aérobique chez les adultes ayant une fibrillation auriculaire permanente est contradictoire.
L’entraînement physique régulier semble jouer un rôle prometteur dans la prise en charge de la fibrillation auriculaire permanente. Des études ultérieures examinant l’effet des diverses formes d’interventions en entraînement physique en vue d’améliorer les résultats cliniques et la tolérance à l’exercice chez ceux ayant une fibrillation auriculaire permanente sont nécessaires.
The Canadian journal of cardiology 01/2013; 29(12):1721–1728. · 3.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: The CardioFit internet-based expert system was designed to promote physical activity in patients with coronary heart disease (CHD) who were not participating in cardiac rehabilitation. Design: This randomized controlled trial compared CardioFit to usual care to assess its effects on physical activity following hospitalization for acute coronary syndromes. Methods: A total of 223 participants were recruited at the University of Ottawa Heart Institute or London Health Sciences Centre and randomly assigned to either CardioFit (n = 115) or usual care (n = 108). The CardioFit group received a personally tailored physical-activity plan upon discharge from the hospital and access to a secure website for activity planning and tracking. They completed five online tutorials over a 6-month period and were in email contact with an exercise specialist. Usual care consisted of physical activity guidance from an attending cardiologist. Physical activity was measured by pedometer and self-reported over a 7-day period, 6 and 12 months after randomization. Results: The CardioFit internet-based physical activity expert system significantly increased objectively measured (p = 0.023) and self-reported physical activity (p = 0.047) compared to usual care. Emotional (p = 0.038) and physical (p = 0.031) dimensions of heart disease health-related quality of life were also higher with CardioFit compared to usual care. Conclusions: Patients with CHD using an internet-based activity prescription with online coaching were more physically active at follow up than those receiving usual care. Use of the CardioFit program could extend the reach of rehabilitation and secondary-prevention services.
European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 09/2011; · 2.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: Constituents of tobacco smoke are prothrombotic and atherogenic and causative factors in the development of coronary heart disease (CHD). Smoking cessation is the single most important intervention to reduce morbidity and mortality in smokers with CHD. This review presents contemporary information regarding treatments for smoking cessation in the setting of CHD.
The beneficial effects of smoking cessation may be mediated by improvements in endothelial function. Failure to quit smoking in those with CHD is a typical consequence of nicotine addiction. Practical counseling and pharmacotherapy [nicotine replacement therapy (NRT), bupropion, and varenicline] are well tolerated and effective treatments for CHD patients attempting to quit smoking. Treatments initiated in hospital following a CHD-related event or procedure are more effective than those initiated outside the hospital setting. Extending medication use beyond the initial treatment phase is the most promising means of preventing relapse. Financial coverage for smoking cessation pharmacotherapy improves quit rates. The routine provision of pharmacotherapy and practical counseling in the CHD setting can be assured by implementing proven, systematic approaches to smoking cessation treatment.
Smoking cessation is a fundamental priority in smokers with CHD. Systematic approaches to ensure that cessation assistance is provided by clinicians and to improve cessation outcomes for smokers are effective and available.
Current opinion in cardiology 09/2011; 26(5):443-8. · 2.66 Impact Factor
[show abstract][hide abstract] ABSTRACT: A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care.
As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors.
The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services.
Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care.
Canadian family physician Medecin de famille canadien 06/2011; 57(6):e202-7. · 1.19 Impact Factor
[show abstract][hide abstract] ABSTRACT: Few studies have explored exercise and motivational patterns of cardiac rehabilitation patients in the long term.
We explored differential patterns of exercise and motivation in cardiac rehabilitation patients over a 24-month period and examined the relationship between these emerging patterns.
Participants (n = 251) completed an exercise, barrier self-efficacy, outcome expectations and self-determined motivation questionnaire. Latent class growth modelling was used to classify patients in different exercise and motivational patterns.
Three exercise patterns emerged: inactive, non-maintainers and maintainers (16%, 67% and 17% of sample per pattern, respectively). Multiple trajectories were found for barrier self-efficacy, outcome expectations and self-determined motivation (3, 5, and 4, respectively). Patients in high barrier self-efficacy, outcome expectation and self-determined groups had greater probability of being in the maintainer exercise group.
Identifying a patient's exercise and motivational profile could help cardiac rehabilitation programmes tailor their intervention to optimize the potential for continued exercise activity.
Annals of Behavioral Medicine 03/2011; 42(1):55-63. · 4.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: Many patients with coronary artery disease (CAD) fail to attend cardiac rehabilitation following acute coronary events because they lack motivation to exercise. Theory-based approaches to promote physical activity among non-participants in cardiac rehabilitation are required.
A randomized trial comparing physical activity levels at baseline, 6, and 12 months between a motivational counselling (MC) intervention group and a usual care (UC) control group.
One hundred and forty-one participants hospitalized with acute coronary syndromes not planning to attend cardiac rehabilitation were recruited at a single centre and randomized to either MC (n = 69) or UC (n = 72). The MC intervention, designed from an ecological perspective, included one face-to-face contact and eight telephone contacts with a trained physiotherapist over a 52-week period. The UC group received written information about starting a walking programme and brief physical activity advice from their attending cardiologist. Physical activity was measured by: 7-day physical activity recall interview; self-report questionnaire; and pedometer at baseline, 6, and 12 months after randomization.
Latent growth curve analyses, which combined all three outcome measures into a single latent construct, showed that physical activity increased more over time in the MC versus the UC group (µ(add) = 0.69, p < 0.05).
Patients with CAD not participating in cardiac rehabilitation receiving a theory-based motivational counselling intervention were more physically active at follow-up than those receiving usual care. This intervention may extend the reach of cardiac rehabilitation by increasing physical activity in those disinclined to participate in structured programmes.
European journal of preventive cardiology. 02/2011; 19(2):161-6.
[show abstract][hide abstract] ABSTRACT: Tobacco addiction is the leading cause of preventable disease, disability, and death in Canada and is the most significant of the modifiable cardiovascular risk factors. Tobacco addiction is a principal contributor to the development of coronary artery disease (CAD) and its consequences, including sudden cardiac death, acute myocardial infarction, and heart failure. Its prevention and treatment should be accorded high priority. In fact, 30% of all CAD deaths are attributable to smoking. The identification and documentation of the smoking status of all patients, and the provision of cessation assistance, should be a priority in every cardiovascular setting. Systematic approaches to the identification and treatment of smokers can dramatically enhance the likelihood of cessation-the most cost-effective of all the interventions to prevent the development or progression of CAD. It is the view of the Canadian Cardiovascular Society that all patients in every medical setting-private office, outpatient clinic, or hospital-should have their smoking status systematically identified and documented and be offered specific assistance in initiating a cessation attempt. The provision of unambiguous, nonjudgemental advice regarding the importance of cessation and assistance with the initiation of a smoking cessation attempt should be seen as a fundamental responsibility of any cardiovascular clinician who encounters smokers in any setting. All cardiovascular specialists should be familiar with the principles and practice of smoking cessation. It is important for cardiovascular specialists to be as familiar with the initiation of smoking-cessation pharmacotherapy as they are with the pharmacological management of hypertension and hyperlipidemia.
The Canadian journal of cardiology 01/2011; 27(2):132-7. · 3.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background Tobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population. Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic. Trial design Cluster randomised controlled trial. Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation. Results Of 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20). Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial. Trial registration number http://ClinicalTrials.gov # UOHI2010-1.
BMJ Open 01/2011; 1(2):e000366. · 1.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: International travel is a frequent occurrence in the life of the elite athlete; such travel can pose challenges to the sport medicine practitioner. Travel is also the reality of many recreational level or sub-elite athletes as opportunities for international competition and training proliferate. An appreciation of the range of responsibilities associated with the preparation for and the strategies to facilitate such travel is essential for any physician charged with the care of athletes and teams. An appreciation of (1) the medical and public health challenges associated with competition in a particular setting; (2) the requirements for vaccination and immunization; (3) the strategies for the management of jet lag and climatic or environmental extremes; (4) the range of supplies and equipment necessary for travel to certain locales; (5) the need to ensure the availability of ample familiar and nutritious foods; (6) the potential need for specialty care in strange settings; (7) the management of common travel-associated illness; and (8) the challenges associated with the evacuation of an injured athlete are fundamental to the successful management of international travel involving athletes and teams. The adoption of a methodical approach to pre-trip planning can ensure an enhanced travel experience, illness-free training and competition, and facilitate optimal performance.
Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 01/2011; 21(1):62-6. · 1.50 Impact Factor
[show abstract][hide abstract] ABSTRACT: Parents have a fundamental role in promoting the healthy weight of their children.
To determine parental perceptions of their child's body weight, eating and physical activity (PA) behaviours, and to test a predictive model of parental perceptions regarding their child's PA and healthy eating behaviours.
A random-digit telephone survey was conducted among parents of children four to 12 years of age living in the Champlain region of Ontario. Descriptive statistics were used to summarize the responses. Path analysis was used to identify predictors of parental perceptions of PA and healthy eating.
The study sample consisted of 1940 parents/caregivers. Only 0.2% of parents reported their child as being obese; 8.6% reported their child as being overweight. Most parents perceived their child to be physically active and eating healthily. Approximately 25% of parents reported that their child spent 2 h/day or more in front of a screen, and that their child consumed less than three servings of fruits and vegetables daily, and regularly consumed fast food. Variables that correlated with PA perceptions included time spent reading/doing homework, interest in PA, perceived importance of PA, frequency of PA, level of parental PA, participation in organized sport, child weight and parental concern for weight. Variables that predicted perceptions regarding healthy eating were parental education, household income, preparation of home-cooked meals, fruit and vegetable intake, and concern for and influence on the child's weight.
Parents in the present study sample did not appear to understand, or had little knowledge of the recommendations for PA and healthy eating in children. Parents appeared to base their judgment of healthy levels of PA or healthy eating behaviours using minimal criteria; these criteria are inconsistent with those used by health professionals to define adequate PA and healthy eating. The present survey highlights an important knowledge gap between scientific opinion and parental perceptions of the criteria for healthy PA and eating behaviours.
Paediatrics & child health 11/2010; 15(9):e33-41. · 1.03 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of the present study was to examine if time varying, mediating effect of physical activity plays an important role in the gender-satisfaction with life relationship. Six hundred four male and 197 female patients were included. Principal outcomes of interest were self-report satisfaction with life and physical activity at baseline, 6, 12 and 24 months. The Krull and MacKinnon procedure for hierarchical linear modeling showed that the change in physical activity mediated the gender-satisfaction with life over a 2 year period. Results from the current study suggest that increased physical activity partially explains why males report having increased well-being than females after hospitalization. This suggests that future interventions need to focus on reducing the gender disparity in physical activity to improve differences noted in satisfaction with life. If higher physical activity levels impact satisfaction with life positively, the importance of physical activity for female patients is warranted.
Journal of Behavioral Medicine 10/2010; 34(3):192-200. · 3.10 Impact Factor