The Use of Health Related Quality of Life Measurement in Cardiovascular and Pulmonary Physical Therapy Practice: An Exploratory Study

Background: The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends health related quality of life (HRQL) measurement with all cardiovascular and pulmonary patients. The current pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists is unknown. Objective: The purpose of this study was to evaluate the pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists. Design: The study used a semi-structured interview format within the context of 3 focus groups. Methods: Eleven physical therapists participated in this study and all were members of the Cardiovascular and Pulmonary Section of the American Physical Therapy Association (APTA). Participants participated in a conference call and were provided a question tree to guide discussion. Results: Several primary themes emerged, including decreased knowledge, barriers, and poor indicators of patient status. In addition, several subthemes developed including lack of familiarity, lack of use, administrative and cost limitations, inappropriateness of tool for patient population, correlation between function and quality of life, and suggestions for future outcome measures. Conclusions: A lack of familiarity and use of HRQL measurement and barriers to their use were established. In addition, ideas for future research on HRQL measurements with specific patient populations in physical therapy practice were defined.Key Words: health related quality of life, outcomes measurement     

Association of leisure time and occupational physical activity with obesity and cardiovascular risk factors in Chile

ABSTRACT

The aim of this study was to investigate the association between physical activity (PA), both occupational (OPA) and during leisure time (LTPA), with obesity and cardiovascular risk factors in Chilean adults. 5,157 participants from the Chilean National Health Survey 2009–2010 were included in this study. OPA and LTPA levels were assessed using the Global Physical Activity Questionnaire. The association between both PA with obesity and cardiovascular risk factors was determined using logistic regression. Our findings showed a significant trend between higher LTPA and lower odds for obesity (OR 0.64 [95% CI: 0.53; 0.76], central obesity 0.52 [0.44; 0.61]) and other cardiovascular risk factors including diabetes (OR: 0.72 [0.55; 0.94]), hypertension (OR: 0.59 [0.50; 0.71]) and metabolic syndrome (OR: 0.62 [0.50; 0.78]). In contrast, OPA was only associated with lower odds of diabetes (OR: 0.79 [0.65; 0.98]) and hypertension (0.85 [0.74; 0.98]). In conclusion, LTPA was associated with a lower risk of all major cardiovascular risk factors, whereas OPA was only associated with a lower risk of diabetes and hypertension.     

The BASES expert statement on exercise therapy for people with chronic kidney disease

Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease, which is the leading cause of morbidity and mortality in this patient population. Physical inactivity has emerged as a significant and independent risk factor for accelerated deterioration of kidney function, physical function, cardiovascular function and quality of life in people in all stages of CKD. CKD specific research evidence, combined with the strong evidence on the multiple health benefits of regular and adequate amounts of PA in other cardiometabolic conditions, has resulted in physical inactivity being identified by national and international CKD clinical practice guidelines as one of the multiple risk factors that require simultaneous and early intervention for optimum prevention/management of CKD. Despite this realisation, physical inactivity is not systematically addressed by renal care teams. The purpose of this expert statement is therefore to inform exercise and renal care specialists about the clinical value of exercise therapy in CKD, as well as to provide some practical recommendations on how to more effectively translate the existing evidence into effective clinical practice.     

Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention

Purpose

The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention.

Methods

A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed.

Results

Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health.

Conclusions

Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors.Key Words: cardiovascular disease, primary disease prevention, secondary disease prevention     

Cardiovascular Regulation after Stroke: Evidence of Impairment,Trainability, and Implications for Rehabilitation

Purpose: To discuss the role of the vascular system and regulation of blood flow delivery in individuals with chronic stroke. This paper will discuss mechanisms of blood flow, vascular remodeling in chronic stroke, exercise as an intervention to improve blood flow delivery, and the role of physical therapy practice in promoting exercise. Key Points: Evidence suggests that people with chronic stroke may experience reduced blood flow and decreased arterial diameter in the hemiparetic limb. These arterial changes may influence exercise performance and functional ambulation. However, exercise training can be an effective intervention for improving blood flow delivery in the hemiparetic limb. Statement of Recommendations: Physical therapists working with people post-stroke should routinely prescribe aerobic exercise training within the plan of care during stroke rehabilitation. This may minimize declines in the cardiorespiratory and vascular systems and provide greater functional capacity to perform functional activities during and after discharge from physical therapy services.Key Words: blood flow, stroke, cardiovascular, exercise     

Improving the Validity and Reliability of a Health Promotion Survey for Physical Therapists

Purpose

Physical therapists (PTs) have a unique opportunity to intervene in the area of health promotion. However, no instrument has been validated to measure PTs’ views on health promotion in physical therapy practice. The purpose of this study was to evaluate the content validity and test-retest reliability of a health promotion survey designed for PTs.

Methods

An expert panel of PTs assessed the content validity of “The Role of Health Promotion in Physical Therapy Survey” and provided suggestions for revision. Item content validity was assessed using the content validity ratio (CVR) as well as the modified kappa statistic. Therapists then participated in the test-retest reliability assessment of the revised health promotion survey, which was assessed using a weighted kappa statistic.

Results

Based on feedback from the expert panelists, significant revisions were made to the original survey. The expert panel reached at least a majority consensus agreement for all items in the revised survey and the survey-CVR improved from 0.44 to 0.66. Only one item on the revised survey had substantial test-retest agreement, with 55% of the items having moderate agreement and 43% poor agreement.

Conclusions

All items on the revised health promotion survey demonstrated at least fair validity, but few items had reasonable test-retest reliability. Further modifications should be made to strengthen the validity and improve the reliability of this survey.Key Words: health promotion, physical therapy, validity, reliability     

北京上海沈阳深圳最大型企业员工健康状况与体育锻炼的社会研究(一)

调查的四个最大型企业,在我国国民经济建设中的重要力量,而员工们由于生活方式的不尽合理,则以心血管系统疾病为主,从而制约了劳动生产率的提高.四家集团公司的工会组织,积极开展文体活动,以最大限度地“活跃“员工们的文化生活.与之同时,由于知识更新不够,人们对体育的保健价值尚不能提高到“一级预防“的水平上来,体育活动在以上四公司中,无法充分实现其“预防医学“的“促进健康“价值.     

运用激励机制消除体育教师职业倦怠的研究

职业倦怠是影响体育教师职业素质、心理健康的不利因素，其身体的衰竭、认知的扭曲和行为的异常，影响着体育教师素质的全面提高。其成因来自于社会因素，职业因素和个人因素，运用激励机制，寻找键全体育教师心理健康、消除职业倦怠的对策。以全面提高体育教师素质。     

基于耦合视角下大学体育课程改革对学生体质健康促进影响的研究

为了更好发挥大学体育课程改革对大学生体质健康促进的作用,采用文献调研、数理统计以及逻辑分析等方法,以大学体育课程改革与学生体质健康促进的关系为研究对象,分析福建师范大学新旧课改对学生体质健康促进的积极和消极影响,总结出大学体育课程改革项目与学生体质健康状况的紧密联系,从而进一步推进大学体育课程的创新与发展,促进两者间的有序耦合与协调发展,为促进学生体质健康提供参考意见。     

Physical activity estimated by the bone-specific physical activity questionnaire is also associated with cardiovascular risk

The nature of physical activity that benefits bone is traditionally thought to differ from that benefiting cardiovascular health. Accordingly, exercise recommendations for improving bone health and cardiovascular health are largely incongruent. Our aim was to determine the associations between high-impact physical activity participation and both cardiovascular disease risk factors and bone mass. We recruited 94 men and women (age 34.0?±?13.3 years) to undergo measures of cardiovascular disease risk (BMI, total cholesterol, fasting blood glucose, waist-to-hip ratio, and mean arterial pressure) and dual-energy X-ray absorptiometry (DXA XR-800, Norland) measures of bone mass (femoral neck, lumbar spine, and whole body BMD) and body composition (whole body lean mass and fat mass). Physical activity participation was estimated using the bone-specific physical activity questionnaire (BPAQ). Those in the upper tertile for current BPAQ score exhibited lower total cholesterol, waist-to-hip ratio, and mean arterial pressure than those in the lower tertiles (P?r?=??0.49 to 0.29, P?P?=?0.008), with BPAQ score predicting 6% of the variance in BMD (P?=?0.02). We conclude that high-impact physical activity as captured by the BPAQ may be beneficial for both bone health and for attenuating cardiovascular disease risk.     

American adults' knowledge of exercise recommendations

Physical inactivity is a major risk factor for cardiovascular disease, stroke, hypertension, diabetes, obesity, osteoporosis, and some cancers. Approximately 950,000 Americans die annually from cardiovascular diseases. The purpose of this study was to determine whether American adults know which traditional and lifestyle physical activities affect health and how they should be physically active to achieve a health benefit. Secondary purposes were to determine whether this knowledge is a function of gender, ethnicity, education, or age and if those who are sufficiently active for a health benefit possess different knowledge levels than those not sufficiently active for a health benefit. Items based on the Centers for Disease Control and Prevention/American College of Sports Medicine principles included knowledge of exercise guidelines and traditional and lifestyle physical activities. This information was obtained from 20 questions that were part of a national random telephone survey of 2,002 American households in the 48 contiguous states and the District of Columbia. Respondents were most aware of traditional physical activities (M = 94%) that provide a health benefit and less aware of specific exercise guidelines (M = 68%) and lifestyle physical activities (M = 71%) that can result in a health benefit. Knowledge was not related to physical activity behavior sufficient for a health benefit and only slightly related to ethnicity, education, and age. These data suggest that physical activity knowledge alone is not sufficient to elicit a behavior; however, it provides educators with an understanding of the public's physical activity knowledge that could be helpful in developing health promotion and physical activity interventions.     

The epigenetic landscape of exercise in cardiac health and disease

With the rising incidence of cardiovascular diseases, the concomitant mortality and morbidity impose huge burdens on quality of life and societal costs. It is generally accepted that physical inactivity is one of the major risk factors for cardiac disease and that exercise benefits the heart in both physiological and pathologic conditions. However, the molecular mechanisms governing the cardioprotective effects exerted by exercise remain incompletely understood. Most recently, an increasing number of studies indicate the involvement of epigenetic modifications in the promotion of cardiac health and prevention of cardiac disease. Exercise and other lifestyle factors extensively induce epigenetic modifications, including DNA/RNA methylation, histone post-translational modifications, and non-coding RNAs in multiple tissues, which may contribute to their positive effects in human health and diseases. In addition, several studies have shown that maternal or paternal exercise prevents age-associated or high-fat diet-induced metabolic dysfunction in the offspring, reinforcing the importance of epigenetics in mediating the beneficial effects of exercise. It has been shown that exercise can directly modify cardiac epigenetics to promote cardiac health and protect the heart against various pathological processes, or it can modify epigenetics in other tissues, which reduces the risk of cardiac disease and affords cardioprotection through exerkines. An in-depth understanding of the epigenetic landscape of cardioprotective response to exercise will provide new therapeutic targets for cardiac diseases. This review, therefore, aimed to acquaint the cardiac community with the rapidly advancing and evolving field of exercise and epigenetics.     

我国体育健康促进研究述评

体育作为促进人类健康的一种方式已得到各界的广泛认同.体育健康促进已成为一个明确概念.我国学界对体育健康促进的研究主要集中在对体育健康促进概念,体育对体质健康、心理健康和社会适应效果的评价,实施体育健康促进的策略等方面.通过梳理我国体育健康促进的相关研究成果,分析现有研究成果的不足,为进一步推进体育健康促进研究提供参考借鉴.最后,提出要进一步加强实证研究方法运用,联合多学科领域学者合作,拓展体育健康促进的研究领域,以及进一步提升体育健康促进对策的适用性与针对性.     

北京上海沈阳深圳最大型企业员工健康状况与体育锻炼的社会研究(四)

调查的4个最大型企业,是我国国民经济建设中的重要力量。员工们由于生活方式的不尽合理,出现以心血管系统疾病为主的多种疾病,从而制约了劳动生产率的提高。4家集团公司的工会组织,积极开展文体活动,最大限度地“活跃”员工们的文化生活。与之同时,由于知识更新不够,人们对体育的保健价值尚不能提高到“一级预防”的水平上来,体育活动在以上4公司中,无法充分实现其“预防医学”的“促进健康”价值。     

Fluid ingestion and exercise hyperthermia: implications for performance, thermoregulation, metabolism and the development of fatigue

The development of fatigue during exercise and the subsequent onset of exhaustion occur earlier in the heat than in cooler environments. The underlying mechanisms responsible for the premature development of fatigue in the heat have yet to be clearly identified. However, the proposed mechanisms include metabolic, cardiovascular and central nervous system perturbations, together with an elevated core temperature. Fluid ingestion is one of three strategies that have been shown to be successful in enhancing the performance of endurance exercise in the heat, with the other interventions being precooling and acclimatization. However, like the development of fatigue in the heat, the mechanisms by which fluid ingestion allows for improved exercise performance remain unclear. We propose that fluid ingestion enhances exercise performance in the heat by increasing the heat storage capacity of the body. We suggest that the thermoregulatory, metabolic and cardiovascular alterations that occur as a result of this increased heat storage capacity contribute to performance enhancement when fluid is ingested during exercise heat stress.     

Fluid ingestion and exercise hyperthermia: Implications for performance,thermoregulation, metabolism and the development of fatigue

The development of fatigue during exercise and the subsequent onset of exhaustion occur earlier in the heat than in cooler environments. The underlying mechanisms responsible for the premature development of fatigue in the heat have yet to be clearly identified. However, the proposed mechanisms include metabolic, cardiovascular and central nervous system perturbations, together with an elevated core temperature. Fluid ingestion is one of three strategies that have been shown to be successful in enhancing the performance of endurance exercise in the heat, with the other interventions being precooling and acclimatization. However, like the development of fatigue in the heat, the mechanisms by which fluid ingestion allows for improved exercise performance remain unclear. We propose that fluid ingestion enhances exercise performance in the heat by increasing the heat storage capacity of the body. We suggest that the thermoregulatory, metabolic and cardiovascular alterations that occur as a result of this increased heat storage capacity contribute to performance enhancement when fluid is ingested during exercise heat stress.     

北京上海沈阳深圳最大型企业员工健康状况与体育锻炼的社会研究(三)

调查的4个最大型企业,在我国国民经济建设中的重要力量,而员工们由于生活方式的不尽合理,则以心血管系统疾病为主,从而制约了劳动生产率的提高.4家集团公司的工会组织,积极开展文体活动,以最大限度地“活跃“员工们的文化生活.与之同时,由于知识更新不够,人们对体育的保健价值尚不能提高到“一级预防“的水平上来,体育活动在以上4公司中,无法充分实现其“预防医学“的“促进健康“价值.     

北京上海沈阳深圳最大型企业员工健康状况与体育锻炼的社会研究(二)

调查的4个最大型企业,是我国国民经济建设中的重要力量.员工们由于生活方式的不尽合理,出现以心血管系统疾病为主的多种疾病,从而制约了劳动生产率的提高.4家集团公司的工会组织,积极开展文体活动,最大限度地“活跃“员工们的文化生活.与之同时,由于知识更新不够,人们对体育的保健价值尚不能提高到“一级预防“的水平上来,体育活动在以上4公司中,无法充分实现其“预防医学“的“促进健康“价值.