Research with clinical populations: Cardiac rehabilitation Shawn N Fraser University of Alberta

Research program-CR The enduring impact of social influences on exercise tolerance Determinants of self-efficacy to overcome barriers to exercise in cardiac rehabilitation Determinants of CVR to stress among post-MI patients

Research program-CR Health care costs of those who have and have not attended CR Changes in QOL among men and women who have attended CR Social support and coping Social psychological influences of behavior and outcomes of CR patients

Introduction CVDs leading causes of death in Canada and in the industrialized world 1/3 of deaths globally (WHO, 2002) 80,000 Canadians Roughly equal numbers of men and women Men higher incidence but survive more

Introduction Heart disease, stroke Much due to lifestyle factors Smoking, diet, exercise

Cardiac rehabilitation Secondary and tertiary prevention of CVDs Intervene early or treatment efforts Exercise based rehabilitation Demonstrated efficacy Increased survival Reduced recurrent events Psychological benefits

Cardiac rehabilitation Exercise based rehabilitation improves: Survival Prognosis Functional outcomes Risk profiles (cholesterol, etc.) Psychological outcomes

Cardiac rehabilitation Cardiac rehabilitation offers: Nutritional counseling Stress management Aerobic exercise Resistance training Other educational classes

CR-concerns Most people ‘qualify’ for CR CABG, MI, Angioplasty About 20-30% of eligible are referred Of those attending ½ will stop exercising within 6 mos.

CR-concerns Those referred are typically: Men Younger Healthier Those with most to gain?

CR-Research challenges Research team Cardiologist Exercise technologist Exercise specialist Nurses Researcher Patient

CR-Research Outcomes Death Recurrent events Prognostic factors Functional factors: QOL, etc. Behavior: smoking, exercise, etc.

CR-Research Prognostic factors Cholesterol levels Weight Depression Exercise tolerance Mental stress tolerance Other physiological markers Other behavioral factors

Exercise tolerance Diagnostic tool determines patient’s capacity for exercise Diagnose CAD Provide exercise prescription Useful prognostic indicator And indicator of progress

Exercise tolerance Exercise stress test Exercise (walk, cycle) until: Patient cannot continue BP, HR too high Silent ischemia

CR-Research challenges Adherence Many stop exercising Most were not referred Effects?

CR-Research challenges Problem Within the last month you’ve had a heart attack, bypass, and/or angioplasty Efficacy to exercise? Mental stress (fear) of test? Accurate exercise tolerance? Effort, stress response Interpretation of test cessation?