Ji Hee Kim

Background/Objectives: Musculoskeletal pain and balance impairments are common in patients referred for cardiac rehabilitation (CR), but their influence on early exercise participation and aerobic capacity remains unclear. This study examined whether pain and muscle mass are associated with initial exercise tolerance test (ETT) participation and VO₂ peak. Methods: This retrospective, single-center cohort included 162 of 189 patients referred to CR after percutaneous coronary intervention for acute myocardial infarction; 105 who completed a symptom-limited cardiopulmonary exercise test were analyzed for VO₂ peak. Pain intensity was assessed using a visual analog scale (VAS 0–10), and the skeletal muscle index (SMI) was measured using a bioelectrical impedance analysis. Determinants of ETT participation and VO₂ peak were evaluated using multivariable logistic and linear regressions, respectively, with pain analyzed as a binary, three-category, and continuous variable. Results: More than half the patients reported musculoskeletal pain during physical activity, and 24.7% had balance problems. Patients with pain (VAS 1–10) had lower appendicular skeletal muscle mass and poorer functional status than pain-free patients. Among the 105 who completed the ETT, the pain group showed significantly lower workload-estimated metabolic equivalents [METs (Q)], respiratory exchange ratios, and peak minute ventilation and a shorter exercise time, but VO₂ peak did not differ between the groups. ETT participation rates were similar across pain categories (63.4%, 67.2%, and 63.0% for VAS 0, 1–5, and 6–10, respectively). In the multivariable logistic regression, older age, hypertension, and low SMI scores were independently associated with reduced ETT participation. In the linear regression, age was the only significant predictor of VO₂ peak; the SMI score showed a borderline association (p = 0.065), but pain intensity was not independently associated with VO₂ peak. Conclusions: Musculoskeletal pain is prevalent among patients entering CR after myocardial infarction, and it is accompanied by low muscle mass and functional limitations. However, after adjustment, pain itself was not an independent determinant of ETT participation or VO₂ peak. Low SMI scores were independently associated with reduced test participation and showed only a borderline association with aerobic capacity. These cross-sectional findings should be regarded as hypothesis-generating.

Globally, 25% of individuals aged ≥25 years will experience a stroke during their lifetime, and more than 100 million people are currently living with the sequelae of a prior stroke.1 Among the het...

Purpose: This study aimed to compare the effects of a cardiac rehabilitation (CR) exercise program on skeletal muscle index (SMI) and cardiorespiratory fitness (CRF) in patients aged ≥ 65 years. Patients and Methods: From January 2012 to December 2021, patients living in rural regions aged ≥ 65 who underwent percutaneous coronary intervention for acute myocardial infarction (AMI) and at least one CR exercise session were enrolled. We retrospectively reviewed the medical records of the patients who underwent an exercise tolerance test (ETT) at initial and 3-month follow-ups. A total of 36 patients were enrolled who underwent a mean of 6.56 exercise sessions and were divided into groups based on the number of center-based CR (CBCR) sessions: 14 in Group A (≥ 7 sessions) and 22 in Group B (< 7 sessions). In CBCR session, we comprehensively counseled them about their nutrition, smoking cessation et al. Both groups underwent an ETT after 12 weeks. The outcomes were CRF parameters examined by a cardiorespiratory exercise test and the SMI examined by bioimpedance analysis (BIA). Results: The number of exercise sessions was significantly correlated with the rate of SMI change. Group A showed significant increases in metabolic equivalent of task (MET), maximal oxygen uptake (VO2max), and SMI after 3 months. There were significant differences in the rates of change in MET, VO2max, and SMI between the two groups. Conclusion: CRF significantly improved in Group A in a short period. Further studies are required to increase long-term CBCR adherence in elderly patients with AMI in rural regions.

Background: Cardiac rehabilitation (CR) is an essential component in secondary prevention of cardiovascular diseases. Current guidelines recommend that the program should be comprehensive including multidisciplinary behavioral intervention, not only exercise training. While the utilization of CR is gradually increasing, the comprehensiveness of the program has not been systemically evaluated in Korea. Methods: During the year 2020, nation-wide survey was done to evaluate the current status of CR in Korea. Survey was done by web-based structured questionnaire. Survey was requested to 164 hospitals performing percutaneous coronary intervention. Results: Among 164 hospitals, 47 (28.7%) hospitals had CR programs. In hospitals with CR, multidisciplinary intervention other than exercise-based program was provided only partially: nutritional counseling (63%), vocational counseling for return to work (39%), stress management (31%), psychological evaluation (18%). Personnel for CR was commonly not dedicated to the program or even absent: (percentage of dedicated, concurrent with other work, absent) physical therapist (59, 41, 0%), nurse (31, 69, 0%), dietician (6, 65, 29%), clinical psychologist (0, 37, 63%). Conclusion: Comprehensiveness of CR in Korea is suboptimal and human resource for it is poorly disposed. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved.

대한심장호흡재활의학회지(Annals of CardioPulmonary Rehabilitation)

The prevalence of acute coronary syndrome in Korea has steadily increased, however, the understanding of and participation rate in cardiac rehabilitation (CR) is very low. There are few studies have been conducted in myocardial infarction (MI) patients with reduced heart function, a so-called high-risk group. Therefore, it is necessary to compare the effects of CR on the degree of improvement in cardiopulmonary fitness (CPF), whether MI patients participate or not, especially in the patients that are at a high risk of MI. Three hundred and ninety-four patients that were commissioned for CR between January 2016 and December 2020 were screened for risk stratification based on the American Association of Cardiovascular and Pulmonary Rehabilitation guidelines, and 115 were classified as high-risk patients. We retrospectively reviewed the patients who underwent both an exercise tolerance test (ETT) during the initial visit and 3 months after the onset of the study. During this period, 42 subjects were included, of which, 26 underwent at least one CR session and 16 did not. The baseline characteristics of the patients showed no significant differences. The results of the CPF improvement were measured as peak oxygen consumption (VO_{2 peak}) and metabolic equivalent of tasks (METs) values which were derived through the ETT. Prior to the ETT, all of the demographic features, including ejection fraction, showed that there were no significant differences between the two groups. The initial CPF values were the same. However, after three months, the VO_{2 peak} and METs values showed that there were significant differences between the two groups (p < 0.01). Additionally, the exercise time differed significantly between the two groups. The CPF values and exercise time showed a significant increase after 3 months in the CR participants. Therefore, it is necessary to initiate cardiac rehabilitation especially in high-risk patients as soon as the patient’s vital signs are stable to improve their cardiopulmonary function.

BackgroundTo compare the effects of cardiac rehabilitation on the degree of improvement in cardiopulmonary fitness (CPF) in patients at high risk of myocardial infarction (MI).MethodsPatients commissioned for cardiac rehabilitation between January 2016 and December 2020 were screened for risk stratification based on the American Association of Cardiovascular and Pulmonary Rehabilitation guidelines. We retrospectively reviewed patients who underwent both an initial and 3 months after the onset exercise tolerance test (ETT). During this period, 42 subjects were included of which 26 underwent at least one CR program and 16 did not. The results of CPF improvement were measured as VO₂ peak, VE_peak, and METs values derived through ETT.ResultsPrior to ETT, all demographic features, including ejection fraction, showed no significant differences between the two groups. The initial CPF values were the same. However, after three months, the VO₂ peak and MET values showed significant differences between the two groups. Contrary to our expectations, the VE_peak did not show the same results; however, when compared within each group, the CR participants showed a significant change, whereas the CR non-participants did not, suggesting that CR affects VE peak enhancement. Additionally, exercise time differed significantly between the two groups.ConclusionsCPF values and exercise time increased significantly after 3 months in CR participants. Although the VE_peak showed no significant change between the two groups, the CR participants showed a significant increase after three months, whereas the CR non-participants did not.

The percentage of patients undergoing cardiac rehabilitation programs (CRP) is very low (30–40%), and hospitals providing CRP are either insufficient or lacking, even in countries with advanced medical care; therefore, this study aims to investigate the barriers, as well as compare the differences between hospitals, with or without CRP. We conducted a survey, in which the questionnaire was distributed through post or email to 607 specialists who work at 164 hospitals performing percutaneous coronary interventions (PCI). The results were as follows: (1) of the 164 hospitals, 132 responded (response rate: 80.5%). While all 47 hospitals with CRP responded (100%), from among the 117 hospitals without CRP, 85 responded (72.7%). (2) Of the 607 specialists, 227 responded (response rate: 36.9%). The response rates according to specialties were as follows: cardiologists (28.9%), cardiac surgeons (24.5%), and physiatrists (64.1%). (3) While the specialists at hospitals with CRP identified patient referral, transportation, and cost as the major barriers, for those at hospitals without CRP, all items were considered barriers, especially the items related to equipment, space, workforce, and budget as being more serious barriers. Therefore, in order to actively promote CRP, it is suggested that governments consider the customized support system according to the performance of CRPs.

Kim C, et al. J Korean Med Sci. 2022 Apr;37(14):e109. https://doi.org/10.3346/jkms.2022.37.e109

Regional Cardiocerebrovascular Centers (RCCs)—a Korean government initiative—seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50–500) and density (0.42–7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study’s results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs.