P. Messner Pellenc, C. Robert

Transcription

1 P. Messner Pellenc, C. Robert

2 Déclaration de Relations Professionnelles Disclosure Statement of Financial Interest J'ai actuellement, ou j'ai eu au cours des deux dernières années, une affiliation ou des intérêts financiers ou intérêts de tout ordre avec une société commerciale ou je reçois une rémunération ou des redevances ou des octrois de recherche d'une société commerciale : I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : Affiliation/Financial Relationship Company none none

3 Exercise capacity after C.rehabilitation The strongest predictor of mortality compared with the other risk factors Relation between physical activity and mortality of patients Myers et al, N England J Med 2002;346: OVERALL CV Wen et al, Lancet 2011; 378:

4 Exercised-based CR programs Improve physical activity Only mean 22% post MI pts Vona et al, Circulation 2009, 119:1601-8

5 Is physical activity maintained after CRP? Exercising at levels consistent with recommended guidelines: 10 h of moderate intensity exercise a month or 2h30 a week Circulation 2003; 107: OASIS study, pts, at 6 months => 40 % Circulation 2010; 121: Delonsky et al, at 1 year => 37 % Res Gerontol Nurs 2010; 3:30-8

6 How to maintain physical activity and exercise capacity after CRP? Determinants questionnaires Goals in physical activity Past physical activity Risk perception and outcome expectancies Motivational interventions Coping and action planning Self-efficiency recovery Family members and social support Ahabad et al, Global J Health Science 2014; 6: Methods: new modalities Telephonic coaching Web-based and mobile applications Hand held computer Wearable activity- tracking devices (pedometers, accelerometers ) Healthy life- style interventions No group sessions as «Club cœur et Santé» evoked! Lavie et al, JACC 2016; 67:13-5

7 GOSPEL study, 3241 pts, 3-Years following standard CRP. Interventional group compared with usual care group Comprehensive CRP sessions and individually tailored programs: Monthly (1 to 6 first m), then every 6 months for 3 years 30 min supervised aerobic E; 1 h 30 of lifestyle, risk factor counseling and preventive interventions A booklet explaining how to deal with exercise, diet, smoking cessation, stress, treatments Physical activity up to at least 3h/week Questionnaires with one specifically on physical activity Mutual support of family members encouraged Arch Intern Med 2008; 168:

8 GOSPEL: exercise capacity at the 3- year follow up 23.8% 18.8% With improvements in lifestyle habits, CV risk factors, taken pharmacological treatments

9 GOSPEL study: main results

10 CHANGE study, 250 pts, 1 year interventional in comparison with usual care groups 5 CR Sessions of which two at 1 and 2 months after CRP: Small groups ( 6-8 pts) By an experienced cardiac nurse Addressing exercise maintenance problems Self- efficacy enhancement Problem solving skills Physical activity relapse prevention With teaching materials Using portable wristwatch heart rate monitors worn during exercise Moore et al, Annals of Behavioral Medicine 2006;31:53-62

11 CHANGE study: exercise maintenance at 1 year follow-up after CRP Limit: means levels of exercise amount in recommended guidelines were not met even by interventional group.

12 ELMI study: extensive lifestyle management intervention during 4 years after CRP pts 1st year: 6 CR sessions with home based exercise program 6 telephone follow-ups 3 lifestyle and risk factor counseling sessions At 2,3 and 4 years: Exercise capacity assessed by questionnaire 4 telephone follow-ups and 2 lifestyle and risk factor CS Results: FRA score linked to TC, LDL-C, BP Exercise capacity similar to usual control group Lear and al, Am Heart J 2006; 152: 333-9

13 An internet and mobile based tailored intervention to maintenance of physical activity after CRP Antypas et al, J Med Internet Res 2014;16:e77 69 pts; interventional and C. Self reported physical activity Questionnaires evaluation Website and mobile text tailored messages To set realistic goals Motivational approach Physical A. at baseline, discharge, 1 m and 3 m post CRP

14 Increasing benefits of CRP by physical activity telemonitoring: Frederix et al, Eur J Prev. Cardiol 2013;19: pts during 18 weeks Controls: unreadable motion sensor for 7 days Interventional: motion sensor continuously worn unless asleep or bathing Triaxial accelerometer and personal computer All modalities of training A weekly 10% step count goal Peak VO2 (ml/min/kg) Interv. Group B Interv. Group 18w ** Control G 18w *

15 Original maintenance of physical activity after CRP in France: «Clubs Cœur et Santé» of the French Federation of Cardiology

16 «Clubs Cœur et Santé» of the FFC 217 Clubs in 2015 instead of 171 in with phase 3 R patients or relatives. décembre

17

18

19

20 How to maintain physical activity after cardiac rehabilitation: ccl Only in 40% of pts at 1 year maintain is observed Most effective interventions seem to be: Tailored CR sessions (1h30) in small groups With booklet and teaching materials Motivational and support family interventions Using portable wristwatch or telemonitoring devices, mobile and internet facilities rather than questionnaires Ideal: Clubs Coeur et Santé of FFC? Small groups; tailored and various physical activities Easy to add new technological modalities Ongoing study in Ile de France on attended benefits French national study?