Tag Archives: exercise

Introduction Exercise is well recognised as a tool for assessment, prevention and management of cardiovascular disease.1 Cardiac patients are encouraged to attend cardiac rehabilitation programmes including elements of supervised exercise. Such programmes can reduce mortality and morbidity rates by up to 27%.2,3 Despite the benefits derived from participation in exercise-based cardiac rehabilitation, exercise itself may act as a trigger for myocardial ischaemia or cardiac arrest in patients with established coronary heart disease.4 During rehabilitation, cardiovascular event rates range from 12.3 to 37.4 per million patient hours of exercise.

Historically, CR programmes have been under funded and under resourced; this has resulted predominantly from the absence of a CR specific tariff resulting in the inclusion of the service into the broader cardiology tariff or service level agreements between commissioners and providers. This could be about to change with the proposed introduction of payment by results recognising CR programmes as cost-effective interventions that produce substantial health benefits.2 Resources Resources, at the most basic level, are defined as appropriately qualified staff to deliver exercise programmes within suitable venues. Current recommendations for exerc

Heart hotspots campaign The North/South divide in coronary heart disease (CHD) mortality remains significant despite improvements in cardiovascular disease (CVD) care, according to the ‘Heart Hotspots’ campaign launched at this year’s conference. The North West region has the highest mortality (93.72 per 100,000) versus South Central, which showed the lowest mortality (65.59 people per 100,000), according to NHS Information Centre data highlighted by the campaign (figure 1).1 CHD mortality in Tameside and Glossop, near Manchester, is almost four times as high as for those living in Kensington and Chelsea, London (140.84 vs. 36.91 people

To address the question of increasing engagement with CR programmes in target areas, in 2009, I chaired a Steering Committee convened by Abbott Healthcare Products Ltd. (formerly Solvay Healthcare) called ‘Setting the Standard for Cardiac Rehabilitation’ (START). The Steering Committee advised that the existing Cardiac Networks in each region would be the best forum for disseminating information about changes in CR funding and standards of care in this field. Abbott Healthcare Products Ltd. kindly agreed to organise a series of meetings in the UK, held during 2009 and early 2010, with the aim of raising awareness of the importance of CR a

WHO definition The World Health Organization (WHO) defined CR in 1993 in a timeless way that is inclusive and sensitive to the psychosocial, biomedical, professional expertise and service delivery mode and location elements required of a contemporary CR service. “The sum of activities required to influence favourably the underlying cause of the disease so that (people) may by their own efforts preserve, or resume when lost, as normal a place in the community… …it must be integrated within secondary prevention services of which it forms one facet”.3 BACR definition This article reflects on how this definition dovetails with the BACR St

In fact, fewer than half of networks have ever benefited from Patient Choice Revascularisation Pathway monies, which were originally intended to support CR also.2 The START meeting in Birmingham in December 2009 was an opportunity to celebrate the innovative approach undertaken by the West Midlands’ Regional NSF Implementation Group for Cardiac Rehabilitation and Secondary Prevention, describing local CR pathway service standards against which West Midlands’ CR programmes could be audited to inform commissioning. The subsequent proportional allocation of ‘Patient Choice’ rehabilitation funding across Birmingham and the Black Country w

The service at Charing Cross was used as the model for EUROACTION, a randomised, controlled trial of a preventive cardiology programme, conducted in eight European countries, including the UK. This nurse-led multidisciplinary programme significantly improved the management of lifestyle and medical risk factors for cardiovascular disease prevention in coronary patients and patients at high multifactorial risk for developing heart disease.1 The principles of the EUROACTION programme were used to found The MyAction community programme, commissioned in 2008 by NHS Westminster as a model for preventive cardiology care for its residents. The Imperi

What is beneficial exercise? A prime question needs to be considered before furthering this discussion: what is meant by beneficial exercise? The benefits of exercise impact on all aspects of health – physiological, psychological and social. A study by Fox (1999) found that short bouts of any activity, even low-intensity activity that may not bring about a significant physiological risk factor change, if it is performed regularly, will provide psychological benefits to self-esteem and self-efficacy, and reductions in anxiety and depression.2 Angina patients engaging in regular walking on a similar premise to that expressed by Fox show signi

North West London To try and identify local barriers and share good practice, we have been regularly reviewing our cardiac rehabilitation (CR) services in North West London. Through this process we hope to increase the average uptake in a step-wise fashion from 50–60% to the national target of 85%.1 Lack of appropriately funded services and low staffing levels are real problems across the sector, unfortunately. Nevertheless, some innovative approaches to CR are taking place. The uptake of CR services after primary percutaneous coronary intervention (PPCI) for myocardial infarction has increased from 26% to 84% at Imperial College Healthcare

JUPITER shows large cardiovascular risk reduction in primary prevention The eagerly awaited landmark JUPITER trial shows that the treatment of apparently healthy patients – who had low levels of low-density lipoprotein (LDL) cholesterol but elevated C-reactive-protein (CRP) levels – with rosuvastatin cuts their risk of cardiovascular disease morbidity and mortality by around 50%. The results were the first late-breaking trial data reported here at the AHA 2008 Scientific Sessions and were also published in the New England Journal of Medicine (N Engl J Med 2008; 359: 2195-207). JUPITER was designed as a four-year study but was stopped in