Lifestyle after Cardiac Rehabilitation: Did the Message Come across, and Was It Feasible? An Analysis of Patients’ Narratives

Lifestyle following heart disease is considered important to prevent and reduce cardiovascular risk factors. Thus, cardiac rehabilitation is focused on potential lifestyle changes. Further insight into patients’ perspective on lifestyle after cardiac rehabilitation is needed as changing habits following heart disease is a complex matter. The objective of this study was to explore the characteristics of lifestyle after cardiac rehabilitation. A phenomenological-hermeneutic approach with qualitative interviews was performed in 20 patients six months after completing a hospital-based cardiac rehabilitation programme in 2012 at Aarhus University Hospital, Denmark. The patients were diagnosed with ischemic heart disease, heart failure or left heart valve disease. The interviews were analysed using the interpretation theory by Ricoeur. The variation in reactions to cardiac rehabilitation were: 1) considering prior lifestyle to be appropriate, maybe with minor adjustments;2) acknowledging the need for incorporating lifestyle changes;and 3) reconciling or feeling guilt when being unable to manage changes. Participation in the cardiac rehabilitation programme was a positive experience, but it had minor influence on long-term adherence to recommended lifestyle. The important thing in establishing new routines was whether they aroused interest, and whether the experience of changes was perceived as necessary and manageable. In future cardiac rehabilitation, focusing on patients’ interests and supporting them in incorporating recommendations into their everyday life might be essential following heart disease, also after ending cardiac rehabilitation.

Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation: An extended feasibility study

OBJECTIVES To assess the extended feasibility of a telerehabilitation program and its effects on physical performance in older adults who have recently undergone transcatheter aortic valve implantation(TAVI).METHODS In this single-center feasibility study, patients underwent an eight-week telerehabilitation program, involving webbased home exercise training twice weekly, an activity tracker, access to an informative website, and one online session with a nurse, starting one-week postoperative. Data collection was performed before surgery and three months postoperative. The feasibility of the intervention was based on recruitment and adherence to the program. As a secondary outcome, we evaluated the change in six-minute walk distance from before surgery to three months postoperative.RESULTS Forty-one patients scheduled for TAVI were assessed for eligibility;15 patients(37%) were enrolled. Of these, eight were excluded after surgery due to tiredness(n = 2), non-cardiac related hospital readmission(n = 2), fluctuating health(n = 1),death during hospital stay(n = 1), and reduced cognition(n = 2). Seven patients completed the eight-week web-based intervention and were evaluated three months postoperative. Their median(IQR) age was 83 [81, 87] years, and the sample comprised three men and four women. Their walked distance improved from median(IQR) 262 [199, 463] before surgery, to 381 [267, 521]meters three months postoperative. No adverse events were reported.CONCLUSION Web-based telerehabilitation, including supervised exercise training, in older adults who have recently undergone TAVI was feasible for a small number of patients who completed the eight-week intervention. This was reflected in an improvement in their walked distance three months after the surgery. However, the low recruitment and retention rates do question the overall feasibility of this intervention in a frail, older population of post-TAVI patients.