Exercise Parameters and Outcome Measures Used in Cardiac Rehabilitation Programs Following Median Sternotomy in the Elderly: A Systematic Review and Meta-Analysis
- Authors: Pengelly, Jacqueline , Pengelly, Michael , Lin, Kuan-Yin , Royse, Colin , Karri, Roshan
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Heart Lung and Circulation Vol. 28, no. 10 (2019), p. 1560-1570
- Full Text: false
- Reviewed:
- Description: Objective: The aim of this systematic review was to identify exercise parameters and outcome measures used in cardiac rehabilitation programs following median sternotomy, in the elderly cardiac population. Data Sources: Five (5) electronic databases were searched for relevant studies published in English after 1997. Study Selection: The screening process was completed by two independent researchers, with a third independent reviewer for overall agreement. Studies were selected if they included only cardiac patients aged ≥65 years who had undergone valve surgery and/or coronary artery bypass grafting via median sternotomy, and who had undertaken a postoperative cardiac rehabilitation exercise intervention assessing physical function and/or cognitive recovery as outcomes. Data Extraction: Two researchers independently completed the data extraction and quality assessment. Quality was assessed using a modified Downs and Black tool. Data Synthesis: In total, 11 articles were included for appraisal with respect to the quality of the study. Only two randomised controlled trials were suitable for meta-analysis. A higher volume of exercise was shown to have a positive effect on functional recovery, assessed using the 6-minute walk test (6MWT) (mean difference = 26.97 m; 95% confidence interval [CI], 6.96–46.97; p = 0.008; I2 = 0%). No significant improvement was shown between additional exercise compared to standard care in improving VO2peak, maximal power output or quality of life. No studies evaluated the effect of exercise on cognitive recovery. Conclusions: Exercise significantly improves functional recovery in the post-surgical elderly cardiac population, however uncertainty still exists with regard to which modes of exercise and their specific parameters are most effective in improving cognitive recovery. © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Jacquelijne Pengelly” is provided in this record**
Resistance training following median sternotomy : a systematic review and meta-analysis
- Authors: Pengelly, Jacqueline , Pengelly, Michael , Lin,Kuan , Royse, Colin , Royse, Alistair , Bryant, Adam , Williams, Gavin , El-Ansary, Doa
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Heart Lung and Circulation Vol. 28, no. 10 (2019), p. 1549-1559
- Full Text: false
- Reviewed:
- Description: Objective: Despite no evidence to support weight limitations following median sternotomy, sternal precautions continue to be routinely prescribed. Moreover, international cardiac rehabilitation guidelines lack sufficient detail for the implementation of resistance training. This systematic review and meta-analysis aimed to determine what the literature defines as resistance training; how resistance training is applied, progressed and evaluated; and, whether resistance training improves physical and functional recovery postoperatively in the cardiac surgical population. Data Sources: Five (5) electronic databases were searched from inception to 28 September 2018 for studies published in English that investigated the effects of a resistance training intervention on physical and functional recovery following median sternotomy. Results: Eighteen (18) trials (n = 3,462) met eligibility criteria and were included in the analysis. Seven (7) randomised controlled trials shared common outcome measures, allowing meta-analysis. The performance of resistance training appears to be safe and feasible, and resulted in similar improvements in both cardiopulmonary capacity and anthropometry, when compared to aerobic training alone. However, the definition and application of resistance training is frequently a lower intensity and volume than recommended by the American College of Sports Medicine. Furthermore, sternal precautions are not reflective of the kinematics and weights used when performing many activities of daily living. For this reason, resistance training needs to be task-specific, reflecting functional tasks to promote recovery. Conclusion: Resistance training, in isolation or when combined with aerobic training, may lead to greater improvements in physical and functional recovery following cardiac surgery via median sternotomy; however, further research is required to inform clinical guidelines. © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)