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Zusammenfassung
Hintergrund: Patienten mit koronarer Herzkrankheit verfugen uber eine altersentsprechend reduzierte korperliche Leistungsfahigkeit. Um in Abhangigkeit bestehender Patientencharakteristika ein zielgruppenspezifisches Training wahrend kardiologischer Rehabilitation zu ermoglichen, ist die Kenntnis von Einflussgro ss en auf die Steigerung der Leistungsfahigkeit wunschenswert.
Methodik: In einem bundesweiten Register (TROL) wurden 47286 Patienten (mittleres Alter: 6411,62 Jahre; 74,5% Manner) eingeschlossen. Alle Patienten absolvierten zu Beginn und zum Ende der Rehabilitation einen fahrradergometrischen Belastungstest. Als abhangige Variable fur die univariate Analyse und die multivariate logistische Regression galt die Steigerung der Belastbarkeit, die uber einen Cut-off-Wert von 15 Watt Leistungszuwachs definiert wurde. Als Einflussfaktoren gingen Komorbiditaten und eine vor dem Index-Ereignis bestehende korperliche Aktivitat von>90Min/Woche in die Analyse ein.
Ergebnisse: Die Leistungssteigerung aktiver im Vergleich zu inaktiven Patienten war signifikant hoher (21,84 Watt vs. 16,35 Watt; p<0,001). Korperliche Aktivitat vor dem Ereignis (Odds Ratio - OR 1,85 [95% Konfidenzintervall - CI: 1,75-1,97]) sowie mannliches Geschlecht (OR 1,62 [95% CI: 1,51-1,74]) konnten als positive, Komorbiditaten und Alter (OR 0,82 [95% CI: 0,74-0,90]) als negative Pradiktoren identifiziert werden.
Schlussfolgerung: Zukunftig sollten in kardiologischen Rehabilitationseinrichtungen zielgruppenspezifische Trainingsprogramme eingesetzt werden, die die eingeschrankte Leistungsfahigkeit alterer und durch Komorbiditat limitierter Patienten berucksichtigt.
Abstract
Objective Patients who suffered from an acute coronary syndrome (ACS) boast a low exercise capacity (EC). To enhance EC is a core component of cardiac rehabilitation (CR). The aim of the study was to investigate predictors of exercise capacity to optimize the rehabilitation process in untrained subgroups.
Method: 47286 patients (mean age 6411.62, 74.5% male) were enclosed in the TROL registry. All patients underwent a bicycle stress test at admission and discharge. The dependent variable for the univariate analysis and multivariate logistic regression was the increase of EC during CR, with a cutoff of 15 Watts (pre/post design). Furthermore comorbidities and physical activity before the index event were analyzed.
Results: Exercise capacity enhancement differs between active and inactive patients significantly (21.84 Watt vs. 16.35 Watt; p<0.001). While a male gender (OR 1.62 [95% CI: 1.51-1.74]) and physical activity before rehabilitation (OR 1.85 [95% CI: 1.75-1.97]) were positive, comorbidities and age (OR 0.82 [95% CI: 0.74-0.90]) were negative predictors.
Conclusion: In cardiac rehabilitation settings special exercise training programs for elderly and comorbid patients are needed, to enhance their exercise capacity sufficiently.
Methods: We approached a group of 61 male competitive bodybuilders and collected urine samples for biochemical testing. The pictorial doping Brief Implicit Association Test (BIAT) was used for attitude measurement. This test quantifies the difference in response latencies (in milliseconds) to stimuli representing related concepts (i.e. doping-dislike/like-[health food]).
BACKGROUND: The aim of occupational health care management programs (OHMP) is to improve the health status of employees, increase work ability and reduce absence time. This includes better coping abilities, work-related self-efficacy and self-management which are important abilities that should be trained within OHMPs.
OBJECTIVES: To study the effectiveness of an OHMP including special interventions to enhance self-efficacy and self-management.
PARTICIPANTS: Employees from the German Federal Pension Agency.
METHODS: Effects of an OHMP on sickness absence was studied by comparing an intervention group (N = 159) and two control groups (N = 450). A core feature of the OHMP were group sessions with all members of working teams, focussing on self-efficacy and self management of the individual participant as well as the team as a group (focus groups). Participants in the OHMP were asked for their subjective evaluation of the focus groups. Rates of sickness absence were taken from the routine data of the employer.
RESULTS: Participants of the OHMP indicated that they had learned better ways of coping and communication and that they had generated intentions to make changes in their working situation. The rate of sickness absence in the intervention group decreased from 9.26% in the year before the OHMP to 7.93% in the year after the program, while there was in the same time an increase of 7.9% and 10.7% in the two control groups.
CONCLUSIONS: The data suggest that OHMP with focus on self-efficacy and self management of individuals and teams are helpful in reducing work absenteeism.
Changes in performance parameters over four consecutive maximal incremental cycling tests were investigated to determine how many tests can be performed within one single day without negatively affecting performance. Sixteen male and female subjects (eight trained (T): 25 +/- 3 yr, BMI 22.6 +/- 2.5 kg center dot m(-2), maximal power output (P-max) 4.6 +/- 0.5 W center dot kg(-1); eight untrained (UT): 27 +/- 3 yr, BMI 22.3 +/- 1.2 kg center dot m(-2), P-max 2.9 +/- 0.3 W center dot kg(-1)) performed four successive maximal incremental cycling tests separated by 1.5 h of passive rest. Individual energy requirements were covered by standardised meals between trials. Maximal oxygen uptake (VO2max) remained unchanged over the four tests in both groups (P = 0.20 and P = 0.33, respectively). P-max did not change in the T group (P = 0.32), but decreased from the third test in the UT group (P < 0.01). Heart rate responses to submaximal exercise were elevated from the third test in the T group and from the second test in the UT group (P < 0.05). The increase in blood lactate shifted rightward over the four tests in both groups (P < 0.001 and P < 0.01, respectively). Exercise-induced net increases in epinephrine and norepinephrine were not different between the tests in either group (P 0.15). If VO2max is the main parameter of interest, trained and untrained individuals can perform at least four maximal incremental cycling tests per day. However, because other parameters changed after the first and second test, respectively, no more than one test per day should be performed if parameters other than VO2max are the prime focus.