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EN
Endothelial dysfunction means any disturbance in the vascular endothelial function. There are many data indicating that endothelial dysfunction is a source of numerous vascular diseases. Cardiac rehabilitation, especially connected with increasing physical activity, plays an important role in the prophylaxis of vascular diseases complications in patients. Physical activity causes favorable changes in the circulatory system and improves psychophysical status. It is the base of healthy life style and fundamental element of primary and secondary prevention of cardiovascular diseases. Cardiac rehabilitation after acute coronary incidents reduces total mortality and decreases the risk of next cardiac intervention. Similar beneficial effects may be observed in chronic heart failure. Some reports attempt to explain mechanisms responsible for favorable effect of rehabilitation in primary and secondary prevention of cardiovascular disease. Many authors suggest, that cardiac training improves disturbed function of endothelium in cardiac diseases (hypertension, ischemic heart disease, chronic heart failure). Improved prognosis in patients with cardiovascular diseases after cardiac rehabilitation seems to be dependent on improvement in endothelial function.
PL
Dysfunkcja śródbłonka oznacza ubytek jakiejkolwiek z jego funkcji. Istnieje wiele danych upatrujących źródła chorób sercowo-naczyniowych w upośledzonej funkcji śródbłonka. Wśród działań mających na celu zapobieganie następstwom chorób układu krążenia istotną rolę przypisuje się rehabilitacji kardiologicznej, a zwłaszcza zwiększeniu aktywności fizycznej pacjentów. Aktywność fizyczna, wywołując korzystne zmiany fizjologiczne w czynności układu krążenia, redukując czynniki ryzyka chorób serca, poprawiając stan psychofizyczny pacjentów stała się podstawą zdrowego stylu życia oraz fundamentalnym elementem prewencji pierwotnej i wtórnej chorób układu krążenia. Zastosowanie rehabilitacji kardiologicznej u chorych po przebyciu ostrych incydentów wieńcowych redukuje śmiertelność całkowitą oraz zmniejsza ryzyko kolejnych interwencji kardiologicznych. Podobnie korzystne efekty widoczne są w przewlekłej niewydolności serca. W ostatnich latach pojawiło się szereg doniesień próbujących wytłumaczyć mechanizmy odpowiedzialne za pozytywny efekt rehabilitacji pacjentów z chorobami sercowo-naczyniowymi. Wielu autorów potwierdza, że kompleksowa rehabilitacja kardiologiczna, trening fizyczny przywraca zaburzoną funkcję śródbłonka w chorobach układu krążenia. Efekt ten jest widoczny w nadciśnieniu tętniczym, chorobie niedokrwiennej serca, przewlekłej niewydolności serca. Wydaje się, że poprawa rokowania zauważalna po zastosowaniu rehabilitacji kardiologicznej może być zależna od poprawy funkcji śródbłonka.
EN
Introduction Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR). Material and methods The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected. Results After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction. Conclusions These findings recommend an early assessment of patients’ psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.
EN
Monitoring of cardiovascular hemodynamic changes requires a very expensive and highly specialized equipment and skilled medical personnel. Up to the present time, an inexpensive, non-invasive and easy-to-use method which, like Doppler echocardiography, magnetic resonance angiography or radionuclide imaging, would assess hemodynamics of the cardiovascular system was not available. A method known as impedance cardiography (ICG) or thoracic electrical bioimpedance cardiography (TEBC) meets those criteria. It is non-invasive, which is of a particular advantage over the conventional methods that require catheterization. As a result, the patient is not at risk of possible complications and the procedure is less expensive and easier. Impedance cardiography, despite its non-invasive character, has not been so far extensively used for monitoring of hemodynamic parameters in hospitalized patients. Various authors report that attempts have been continued to compare the results from ICG and those obtained by other diagnostic methods. This paper presents the use of impedance cardiography in diagnosis of hypertension, cardiac insufficiency, differentiating the causes of acute dyspnea, as well as in assessing the effects of cardiac rehabilitation in patients with heart failure.
EN
Background Comprehensive cardiac rehabilitation aims to restore pathophysiological and psychosocial consequences of myocardial infarction (MI). The aim of the study was to assess how exercise-only-based cardiac rehabilitation (ECR) influences the attitude to the therapy (ATT), to the aims in life and professional work (AAL) amongst men and women after MI. Material and Methods The study comprised 44 post-MI patients: 28 men and 16 women, mean age 58±10 years old, referred to ECR. Patients underwent 24 interval cycle ergometer trainings 3 times a week. At the beginning and after the training program (TP) each patient underwent exercise stress test (EST) and was scored to ATT and ALL based on the Psychological Effects of Rehabilitation Score Scale (PERSS) according to Tylka and Makowska. The analysis covered: 1) EST findings: maximal workload and test duration (min), 2) ATT and AAL based on PERSS, 3) resuming professional work. Results Exercise capacity improved significantly after TP. Attitude to the aims in life and professional work significantly increased in the whole group (4.4±2.8 vs. 5.1±2.4, p < 0.01) and separately in men (4.5±2.9 vs. 5.1±2.5, p < 0.05) and women (4.3±2.6 vs. 5.0±2.0, p < 0.05). Attitude to the therapy did not change significantly in the whole group (5.6±2.8 vs. 6.0±2.8) and in men (5.9±2.9 vs. 6.0±2.9), but increased significantly in women (5.0±2.5 vs. 6.1±2.7, p < 0.05). Professional work was resumed, averagely by 86.4% of all patients (85.7% men and 87.5% women). Conclusions Physical training beneficially influenced post-MI men’s and women’s attitude to the aims in life, professional work and attitude to the therapy in women. Med Pr. 2019;70(1):1–7
EN
Objectives Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation – hybrid cardiac rehabilitation (HCR) seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD) as a form of pension prevention paid by the Social Insurance Institution (SII). The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR. Material and Methods One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males), aged 57.31±5.61 years, were divided into 2 subgroups: W) white-collar employees (N = 22) and B) blue-collar employees (N = 130). To evaluate functional capacity, an exercise test on a treadmill was used. Results The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation – B: 1.09±3.10 days, W: 1.95±3.64 days). There were significant improvements (p < 0.05) in measured variables after HCR in both (W and B) groups (max workload: 8.21±2.88 METs (measured in metabolic equivalents) vs. 9.6±2.49 METs, 7.76±2.51 METs vs. 8.73±2.7 METs, resting heart rate (RHR): 77±16.22 bpm vs. 69.94±12.93 bpm, 79.59±14 bpm vs. 75.24±11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest) 10 815.22±2968.24 vs. 9242.94±1923.08, 10 927.62±2508.47 vs. 9929.7±2304.94). In group B, a decrease in systolic blood pressure (BP syst. – 137.03±17.14 mm Hg vs. 131.82±21.13 mm Hg), heart rate recovery in the 1st minute after the end of peak exercise (HRR1) (99.38±19.25 vs. 93.9±19.48) and New York Heart Association (NYHA) class (1.22±0.53 vs. 1.11±0.36) was observed. In group W, a decrease in diastolic blood pressure (BP diast.) at rest was observed (88.28±9.79 mm Hg vs. 83.39±8.95 mm Hg). The decrease in resting HR was significantly greater in group W (69.94±12.93 vs. 75.24±11.87, p = 0.034). Conclusions Hybrid cardiac rehabilitation is feasible and safe with high adherence to the program regardless of the patient’s professional status. Professional status did not influence the beneficial effect of HCR on exercise tolerance.
EN
Objectives To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Material and Methods During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of quality of life after myocardial infarction were obtained after follow-up (mean: 836±242 days). Results Average sick leave was 126±125 days. Following myocardial infarction, 3.4% of patients were discharged from their jobs while 31.7% retired. Lower salary was reported in 17.9% patients, major life events in 9.7%, while 40.7% estimated quality of life as worse following the event. Longer hospitalization was reported in patients transferred from surrounding counties, those with inferior myocardial wall and right coronary artery affected. Age, hyperlipoproteinemia and lower education degree were connected to permanent working cessation. Significant salary decrease was observed in male patients. Employer type was related to sick leave duration. Impaired quality of life was observed in patients who underwent in-hospital rehabilitation and those from surrounding counties. Longer sick leave was observed in patients with lower income before and after myocardial infarction. These patients reported lower quality of life after myocardial infarction. Conclusions Inadequate health policy and delayed cardiac rehabilitation after myocardial infarction may lead to prolonged hospitalization and sick leave as well as lower quality of life after the event, regardless of optimal treatment in acute phase of disease.
PL
Wstęp: Choroba niedokrwienna serca jest jedną z najczęstszych przyczyn inwalidztwa i umieralności. W celu zmniejszenia ryzyka wystąpienia ostrego zespołu wieńcowego duża grupa chorych kierowana jest na leczenie kardiochirurgiczne polegające na wykonaniu zabiegu pomostowania tętnic wieńcowych. Po przeprowadzonym zabiegu, pacjenci powinni zostać objęci następowym postępowaniem rehabilitacyjnym, które przynosi korzyści, m.in. w postaci poprawy jakości życia pacjenta. Celem pracy była ocena zamiany tolerancji wysiłku oraz subiektywnej oceny zmęczenia pacjentów po pomostowaniu tętnic wieńcowych poddanych rehabilitacji. Materiał i metoda: Badaniu zostało poddanych 158 pacjentów, leczonych w okresie od lutego do lipca 2011 roku. Pacjentów podzielono na trzy grupy wiekowe. Porównywano stan przy przyjęciu na leczenie i po zakończeniu rehabilitacji ogółem – jak również oddzielnie wśród kobiet i mężczyzn. Na podstawie wskaźnika BMI badanych podzielono również na osoby otyłe, osoby z nadwagą oraz osoby o prawidłowej masie ciała. Do określenia tolerancji zmęczenia zastosowano Test Marszu 6-minutowego, natomiast do subiektywnej oceny zmęczenia – skalę Borga. Wyniki: Analiza wyników badań wskazała, że badani pacjenci uzyskali poprawę wyników w zakresie tolerancji wysiłku oraz subiektywnej oceny zmęczenia po zakończonej rehabilitacji. Poprawę wyników zaobserwowano we wszystkich analizowanych grupach wiekowych. Nie odnotowano znaczących różnic w uzyskanych wynikach w przypadku podziału pacjentów ze względu na płeć oraz wskaźnik BMI. Wnioski: 1. W wyniku przeprowadzonej rehabilitacji kardiologicznej uzyskano istotną statystycznie poprawę tolerancji wysiłku, wyrażoną w przyroście dystansu w teście 6MWT oraz zmniejszeniem średniej liczby punktów w skali Borga. 2. Wiek, płeć oraz wskaźnik BMI nie są czynnikami wpływającymi istotnie na zmianę tolerancji wysiłku, jak również subiektywną ocenę zmęczenia pacjentów.
EN
Introduction: Coronary heart disease is one of the most common causes of disability and mortality. In order to reduce the risk of acute coronary syndrome, a large group of patients is referred to the cardiac surgery involving coronary artery bypass grafting. The patients after the procedure should be covered by rehabilitation program which has beneficial effects e.g. improving the quality of life of a patient. The aim of the study was to evaluate the conversion in tolerance of exercise and subjective fatigue assessment of patients after coronary artery bypass undergoing rehabilitation. Material and Methods: The subjects of the study were 158 patients treated in the period from February to July 2011. The patients were divided into three age groups. The condition on the admission to treatment and after rehabilitation was assessed in total as well as separately for women and men. On the basis of BMI, the subjects were divided into obese, overweight people and those with normal weight. 6-minute walking test was used for the assessment of fatigue tolerance and the Borg scale was applied to determine the subjective fatigue assessment. Results: The analysis of the results indicated improvement in the exercise tolerance and the subjective assessment of fatigue after the tested patients completed rehabilitation. Improvement was observed in all the analyzed age groups. There were no significant differences in the results obtained between the groups of patients by gender and BMI. Conclusions: 1. As a result of cardiac rehabilitation, statistically significant improvement in exercise tolerance was observed expressed in the increase in 6MWT distance and a decrease in the average number of points in the Borg scale. 2. Age, sex, and BMI were not significant factors influencing the change in the exercise tolerance as well as the subjective evaluation of fatigue in the patients.
EN
Background. Knowledge of obstacles in physical activity might be helpful in the treatment and prevention of recurrence of the cardiac diseases. The aim of this study was to compare the level of kinesiophobia and sociodemographic determinants in patients with cardiovascular diseases living in two different regions of Poland. Material and methods. The study involved 48 patients (mean age 64.58 ± 11.32 years) divided into two subgroups: 22 patients living in the province of Warmia and Mazury (I) and 26 patients living in the province of Silesia (II). The level of kinesiophobia was assessed using a Polish version of Kinesiophobia Causes Scale [KCS] questionnaire and sociodemographic factors were measured using the questionnaire developed by authors. Results. The mean values of kinesiophobia was: in group I: 38.11 ± 11.68, in group II: 48.62 ± 9.85. In group I there was a positive correlation between age and individual need of stimulation, and between male sex and power of biological drive. In group II there was a strong negative correlation between age and psychological domain, [KCS] and power of biological drive, and also between female sex and energy resources. Conclusions. Patients living in the different demographical regions of Poland are highly differentiated in terms of kinesiophobia risk factors and their sociodemographic determinants.
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