Publications by authors named "Jason Rengo"

14 Publications

  • Page 1 of 1

Benchmarking Depressive Symptoms in Cardiac Rehabilitation.

J Cardiopulm Rehabil Prev 2021 Nov 24. Epub 2021 Nov 24.

Vermont Center on Behavior and Health, Burlington (Mr Middleton and Drs Ades and Gaalema); Departments of Psychiatry (Dr Gaalema) and Psychology (Mr Middleton and Dr Gaalema), University of Vermont, Burlington; and Division of Cardiology, University of Vermont College of Medicine, Burlington (Messrs Savage and Rengo and Drs Khadanga and Ades).

Purpose: Depression affects cardiac health and is important to track within cardiac rehabilitation (CR). Using two depression screeners within one sample, we calculated prevalence of baseline depressive symptomology, improvements during CR, and predictors of both.

Methods: Data were drawn from the University of Vermont Medical Center CR program prospectively collected database. A total of 1781 patients who attended between January 2011 and July 2019 were included. Two depression screeners (Geriatric Depression Scale-Short Form [GDS-SF] and Patient Health Questionnaire-9 [PHQ-9]) were compared on proportion of the sample categorized with ≥ mild or moderate levels of depressive symptoms (PHQ-9 ≥5, ≥10; GDS-SF ≥6, ≥10). Changes in depressive symptoms by screener were examined within patients who had completed ≥9 sessions of CR. Patient characteristics associated with depressive symptoms at entry, and changes in symptoms were identified.

Results: Within those who completed ≥9 sessions of CR with exit scores on both screeners (n = 1201), entrance prevalence of ≥ mild and ≥ moderate depressive symptoms differed by screener (32% and 9% PHQ-9; 12% and 3% GDS-SF; both P < .001). Patients who were younger, female, with lower cardiorespiratory fitness (CRF) scores were more likely to have ≥ mild depressive symptoms at entry. Most patients with ≥ mild symptoms decreased severity by ≥1 category by exit (PHQ-9 = 73%; GDS-SF = 77%). Nonsurgical diagnosis and lower CRF were associated with less improvement in symptoms on the PHQ-9 (both P < .05).

Conclusion: Our results provide initial benchmarks of depressive symptoms in CR. They identify younger patients, women, patients with lower CRF, and those with nonsurgical diagnosis as higher risk groups for having depressive symptoms or lack of improvement in symptoms.
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http://dx.doi.org/10.1097/HCR.0000000000000657DOI Listing
November 2021

Optimizing Training Response for Women in Cardiac Rehabilitation: A Randomized Clinical Trial.

JAMA Cardiol 2021 Nov 24. Epub 2021 Nov 24.

Division of Cardiology, Department of Medicine, University of Vermont, Burlington.

Importance: Despite lower baseline fitness levels, women in cardiac rehabilitation (CR) do not typically improve peak aerobic exercise capacity (defined as peak oxygen uptake [peak Vo2]) compared with men in CR.

Objective: To evaluate the effect of high-intensity interval training (HIIT) and intensive lower extremity resistance training (RT) compared with standard moderate intensity continuous training (MCT) on peak Vo2 among women in CR.

Design, Setting, And Participants: This randomized clinical trial conducted from July 2017 to February 2020 included women from a community-based cardiac rehabilitation program affiliated with a university hospital in Vermont. A total of 56 women (mean [SD] age, 65 [11] years; range 43-98 years) participating in CR enrolled in the study.

Interventions: MCT (70% to 85% of peak heart rate [HR]) with moderate intensive RT or HIIT (90% to 95% of peak HR) along with higher-intensity lower extremity RT 3 times per week over 12 weeks.

Main Outcomes And Measures: The primary outcome was the between-group difference in change in peak Vo2 (L/min) from baseline to 12 weeks.

Results: Peak Vo2 increased to a greater degree in the HIIT group (+23%) than in the control group (+7%) (mean [SD] increase, 0.3 [0.2] L/min vs 0.1 [0.2] L/min; P = .03). Similarly, the change in leg strength was greater in the HIIT-RT group compared with the control group (mean [SD] increase, 15.3 [0.3] kg vs 6.4 [1.1] kg; P = .004).

Conclusions And Relevance: An exercise protocol combining HIIT and intensive lower extremity RT enhanced exercise training response for women in CR compared with standard CR exercise training. Women randomized to HIIT experienced significantly greater improvements in both peak Vo2 and leg strength during CR.

Trial Registration: ClinicalTrials.gov Identifier: NCT03438968.
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http://dx.doi.org/10.1001/jamacardio.2021.4822DOI Listing
November 2021

Assessment of the Early Disabling Effects of Coronary Artery Bypass Graft Surgery Using Direct Measures of Physical Function.

J Cardiopulm Rehabil Prev 2021 Mar 26. Epub 2021 Mar 26.

Division of Cardiology, Department of Medicine (Mr Rengo, Mr Savage, and Drs Ades and Toth) and Division of Cardiothoracic Surgery, Department of Surgery (Drs Hirashima and Leavitt), College of Medicine, The University of Vermont, Burlington.

Purpose: Coronary artery bypass graft (CABG) surgery is an important treatment option in patients with coronary artery disease. Despite its beneficial effects, CABG surgery and its subsequent hospitalization may reduce physical functional capacity in patients, contributing to physical disability. Our objective was to assess the early disabling effects of CABG surgery and its subsequent hospitalization using direct measurements of physical function.

Methods: Patients (n = 44) were assessed pre-surgery and at hospital discharge for physical function using the Short Physical Performance Battery (SPPB) and self-reported physical and mental health by questionnaire.

Results: The total SPPB score (P < .001) and all of its components (P < .01-.001) decreased markedly following CABG surgery and hospitalization, with greater reductions in total SPPB score (P < .05) and gait speed (P < .01) in patients with higher body mass index. While CABG surgery and hospitalization reduced patient-reported physical function, changes in these indices largely did not correlate with changes in SPPB outcomes.

Conclusion: Our results show the early disabling effects of CABG surgery and hospitalization on directly measured physical function, and that patients with higher body mass index had greater reductions. In addition, our results underscore the need to perform direct measurements of physical function to describe reductions in physiological functional capacity. These findings suggest the need for inpatient rehabilitation or early mobility programs to address this decline in physical function.

Abstract For Toc: This is the first study to evaluate the early disabling effects of coronary artery bypass graft surgery and hospitalization using direct measures of physical function. Although self-reported physical function also decreased, these changes largely did not correlate with direct measures of physical function.
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http://dx.doi.org/10.1097/HCR.0000000000000587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464611PMC
March 2021

Improvement in Physical Function After Coronary Artery Bypass Graft Surgery Using a Novel Rehabilitation Intervention: A RANDOMIZED CONTROLLED TRIAL.

J Cardiopulm Rehabil Prev 2021 Nov;41(6):413-418

Division of Cardiology, Department of Medicine (Messrs Rengo and Savage Drs Ades and Toth) and Division of Cardiothoracic Surgery, Department of Surgery (Drs Hirashima and Leavitt), College of Medicine, The University of Vermont, Burlington.

Purpose: Cardiorespiratory and skeletal muscle deconditioning occurs following coronary artery bypass graft surgery and hospitalization. Outpatient, phase 2 cardiac rehabilitation (CR) is designed to remediate this deconditioning but typically does not begin until several weeks following hospital discharge. Although an exercise program between discharge and the start of CR could improve functional recovery, implementation of exercise at this time is complicated by postoperative physical limitations and restrictions. Our objective was to assess the utility of neuromuscular electrical stimulation (NMES) as an adjunct to current rehabilitative care following postsurgical discharge and prior to entry into CR on indices of physical function in patients undergoing coronary artery bypass graft surgery.

Methods: Patients were randomized to 4 wk of bilateral, NMES (5 d/wk) to their quadriceps muscles or no intervention (control). Physical function testing was performed at hospital discharge and 4 wk post-discharge using the Short Physical Performance Battery and the 6-min walk tests. Data from 37 patients (19 control/18 NMES) who completed the trial were analyzed. The trial was registered at ClinicalTrials.gov (NCT03892460).

Results: Physical function measures improved from discharge to 4 wk post-surgery across our entire cohort (P < .001). Patients randomized to NMES, however, showed greater improvements in 6-min walk test distance and power output compared with controls (P < .01).

Conclusion: Our results provide evidence supporting the utility of NMES to accelerate recovery of physical function after coronary artery bypass graft surgery.
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http://dx.doi.org/10.1097/HCR.0000000000000576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310525PMC
November 2021

Response to Exercise Training During Cardiac Rehabilitation Differs by Sex.

J Cardiopulm Rehabil Prev 2020 09;40(5):319-324

Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, Burlington (Messrs Rengo and Savage and Drs Khadanga and Ades); and University of Vermont College of Medicine, Burlington (Drs Khadanga and Ades).

Purpose: Directly measured peak aerobic capacity or oxygen uptake is a powerful predictor of prognosis in individuals with cardiovascular disease. Women enter phase 2 cardiac rehabilitation (CR) with lower and their response to training, compared with men, is equivocal. We analyzed at entry and exit in patients participating in CR and improvements by diagnosis to assess training response. We also identified sex differences that may influence change in .

Methods: The cohort included consecutive patients enrolled in CR between January 1996 and December 2015 who performed entry exercise tolerance tests. Data collected included demographics, index diagnosis, , and exercise training response.

Results: The cohort consisted of 3925 patients (24% female). There was a significant interaction between baseline and diagnosis (P < .001), with percutaneous coronary intervention and myocardial infarction greater than other diagnoses. Surgical patients demonstrated greater improvement in than nonsurgical diagnoses (n = 1789; P < .001). Women had lower than men for all diagnoses (P < .02) and demonstrated less improvement (13 vs 17%, P < .001). Percent improvement using estimated metabolic equivalents of task (METs) were similar for women and men (33 vs 31%, P = NS). Despite overall increases in , 18% of patients (24% women, 16% men) failed to demonstrate any improvement (exit ≤ entry ).

Conclusions: While there were no differences in training effect estimated by METs, directly measured showed a significantly lower training response for women despite adjusting for covariates. In addition, 18% of patients did not see any improvement in . Alternatives to traditional CR exercise programming need to be considered.
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http://dx.doi.org/10.1097/HCR.0000000000000536DOI Listing
September 2020

Financial Incentives to Increase Cardiac Rehabilitation Participation Among Low-Socioeconomic Status Patients: A Randomized Clinical Trial.

JACC Heart Fail 2019 07 8;7(7):537-546. Epub 2019 May 8.

Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont.

Objectives: This study sought to examine the efficacy of financial incentives to increase Medicaid patient participation in and completion of cardiac rehabilitation (CR).

Background: Participation in CR reduces morbidity, mortality, and hospitalizations while improving quality of life. Lower-socioeconomic status (SES) patients are much less likely to attend and complete CR, despite being at increased risk for recurrent cardiovascular events.

Methods: A total of 130 individuals enrolled in Medicaid with a CR-qualifying cardiac event were randomized 1:1 to receive financial incentives on an escalating schedule ($4 to $50) for completing CR sessions or to receive usual care. Primary outcomes were CR participation (number of sessions completed) and completion (≥30 sessions completed). Secondary outcomes included changes in sociocognitive measurements (depressive/anxious symptoms, executive function), body composition (waist circumference, body mass index), fitness (peak VO) over 4 months, and combined number of hospitalizations and emergency department (ED) contacts over 1 year.

Results: Patients randomized to the incentive condition completed more sessions (22.4 vs. 14.7, respectively; p = 0.013) and were almost twice as likely to complete CR (55.4% vs. 29.2%, respectively; p = 0.002) as controls. Incentivized patients were also more likely to experience improvements in executive function (p < 0.001), although there were no significant effects on other secondary outcomes. Patients who completed ≥30 sessions had 47% fewer combined hospitalizations and ED visits (p = 0.014), as reflected by a nonsignificant trend by study condition with 39% fewer hospital contacts in the incentive condition group (p = 0.079).

Conclusions: Financial incentives improve CR participation among lower-SES patients following a cardiac event. Increasing participation among lower-SES patients in CR is critical for positive longer-term health outcomes. (Increasing Cardiac Rehabilitation Participation Among Medicaid Enrollees; NCT02172820).
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http://dx.doi.org/10.1016/j.jchf.2018.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599560PMC
July 2019

Clinical and Demographic Trends in Cardiac Rehabilitation: 1996-2015.

J Cardiopulm Rehabil Prev 2019 07;39(4):266-273

University of Vermont College of Medicine, Burlington (Drs Gaalema, Naud, Priest, and Ades); and University of Vermont Medical Center, Burlington (Messrs Savage and Rengo and Drs Leadholm and Ades).

Purpose: Clinical interventions in programs such as cardiac rehabilitation (CR) are guided by clinical characteristics of participating patients. This study describes changes in CR participant characteristics over 20 yr.

Methods: To examine changes in patient characteristics over time, we analyzed data from 1996 to 2015 (n = 5396) garnered from a systematically and prospectively gathered database. Linear, logistic, multinomial logistic or negative binomial regression was used, as appropriate. Effects of sex and index diagnosis were considered both as interactions and as additive effects.

Results: Analyses revealed that mean age increased (from 60.7 to 64.2 yr), enrollment of women increased (from 26.8% to 29.6%), and index diagnosis has shifted; coronary artery bypass surgery decreased (from 37.2% to 21.6%), whereas heart valve repair/replacement increased (from 0% to 10.6%). Risk factors also shifted with increases in body mass index (28.7 vs 29.6 kg/m), obesity (from 33.2% to 39.6%), hypertension (from 51% to 62.5%), type 2 diabetes mellitus (from 17.3% to 21.7%), and those reporting current smoking (from 6.6% to 8.4%). Directly measured peak aerobic capacity remained relatively stable throughout. The proportion of patients on statin therapy increased from 63.6% to 98.9%, coinciding with significant improvements in lipid levels.

Conclusions: Compared with 1996, participants entering CR in 2015 were older, more overweight, and had a higher prevalence of coronary risk factors. Lipid values improved substantially concurrent with increased statin use. While the percentage of female participants increased, they continue to be underrepresented. Patients with heart valve repair/replacement now constitute 10.6% of the patients enrolled. Clinical programs need to recognize changing characteristics of attendees to best tailor interventions.
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http://dx.doi.org/10.1097/HCR.0000000000000390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594875PMC
July 2019

Cardiac Rehabilitation Participation Rates and Outcomes for Patients With Heart Failure.

J Cardiopulm Rehabil Prev 2018 01;38(1):38-42

Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, Burlington (Messrs Rengo and Savage and Dr Ades); and University of Vermont College of Medicine, Burlington (Drs Barrett and Ades).

Purpose: Exercise training has been shown to reduce combined cardiovascular mortality and hospitalizations in patients with chronic heart failure (CHF) with reduced ejection fraction (HFrEF). Whereas there are extensive data on exercise training for individuals with HFrEF in a research setting, the experience of delivering cardiac rehabilitation (CR) services in the clinical setting has not been well described. With little knowledge regarding the number of qualifying patients with HFrEF in the United States, we described our 18-month experience recruiting hospitalized inpatients and stable outpatients into phase 2 CR.

Methods: Patients hospitalized with CHF HFrEF were tracked for enrollment in CR. Exercise training response was described for patients identified as inpatients and for stable HFrEF outpatients referred from cardiology clinic or heart failure clinic.

Results: The cohort included 83 patients hospitalized with CHF and 36 outpatients. Only 17% (14/83) of eligible HFrEF inpatients enrolled in CR following CHF hospitalization compared with 97% (35/36) outpatient referrals. Improvements in aerobic capacity for the total cohort were observed whether expressed as estimated metabolic equivalents (n = 19, 4.6 ± 1.6 to 6.2 ± 2.4, P < .0001) or (Equation is included in full-text article.)O2peak (n = 14, 14.4 ± 3.5 to 16.4 ± 4.6 mL/kg/min, P = .02) for those who completed CR.

Conclusion: Significant barriers to recruiting and enrolling patients with HFrEF were observed and only 17% of inpatients attended CR. Systematic in-hospital referral with close followup in the outpatient setting has the potential to capture more eligible patients. The participation of referred stable outpatients with HFrEF was much higher. Regardless of the referral source, patients with HFrEF completing CR can expect improvements in aerobic capacity, muscle strength, and depressive symptoms.
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http://dx.doi.org/10.1097/HCR.0000000000000252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741463PMC
January 2018

Directly Measured Physical Function in Cardiac Rehabilitation.

J Cardiopulm Rehabil Prev 2017 May;37(3):175-181

Division of Cardiology, Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, Burlington (Messrs Rengo and Savage, Ms Shaw, and Dr Ades); and University of Vermont College of Medicine, Burlington (Dr Ades).

Purpose: The Short Physical Performance Battery (SPPB) is a strong predictor for risk of physical disability in older adults. Roughly half of individuals participating in phase II cardiac rehabilitation (CR) are 65 years or older, many presenting with low aerobic capacities and may be at increased risk for physical disability.

Methods: The cohort consisted of 196 consecutive patients (136 men), aged 65 years or older, entering CR who were prospectively evaluated by the SPPB. Data were also obtained for age, self-reported physical function (Medical Outcomes Study Short Form-36 questionnaire), and peak aerobic capacity. Measures were repeated upon completion of CR for those individuals who completed the program.

Results: The average age of patients was 74 ± 0.5 years. At baseline, total SPPB score was 9.7 ± 0.2 (out of 12). Followup data were obtained on 133 (68%) patients, with a mean improvement of 0.8 ± 0.1 (P < .0001), which was not clinically significant (≥1 point). Focusing on patients with a low baseline SPPB score, 72 subjects scored ≤9 (7.1 ± 0.2), with 45 completing exit measures. Improvements were found in gait speed (0.5 ± 0.1, P < .0001), chair-stand (1.0 ± 0.1, P < .0001), and total SPPB (1.6 ± 0.3, P < .0001) in this more disabled group. Measures of (Equation is included in full-text article.)O2peak were significantly reduced in the low SPPB group (13.5 ± 0.4 vs 17.5 ± 0.4 mL/kg/min, P < .0001). Measured (Equation is included in full-text article.)O2peak (R = 26%, P < .0001) and self-reported physical function score (R = 5%, P = .02) were the only multivariate predictors of baseline SPPB.

Conclusion: For patients who enter CR with low SPPB scores (37%), significant improvements in physical function were noted, largely explained by improved walking speed and leg strength (chair-stand).
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http://dx.doi.org/10.1097/HCR.0000000000000231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407931PMC
May 2017

Patient Characteristics Predictive of Cardiac Rehabilitation Adherence.

J Cardiopulm Rehabil Prev 2017 Mar;37(2):103-110

Vermont Center on Behavior and Health, Burlington (Drs Gaalema, Higgins, and Ades, Mr Cutler, and Ms Elliott); Departments of Psychiatry (Drs Gaalema and Higgins, Mr Cutler, and Ms Elliott), Psychology (Drs Gaalema and Higgins), and Medical Biostatistics (Mr Savage and Rengo and Dr Ades), University of Vermont, Burlington; and Department of Medicine, University of Vermont Medical Center, Burlington (Dr Priest).

Purpose: Cardiac rehabilitation (CR) is a program of structured exercise and interventions for coronary risk factor reduction that reduces morbidity and mortality rates following a major cardiac event. Although a dose-response relationship between the number of CR sessions completed and health outcomes has been demonstrated, adherence with CR is not high. In this study, we examined associations between the number of sessions completed within CR and patient demographics, clinical characteristics, smoking status, and socioeconomic status (SES).

Methods: Multiple logistic regression and classification and regression tree (CART) modeling were used to examine associations between participant characteristics measured at CR intake and the number of sessions completed in a prospectively collected CR clinical database (n = 1658).

Results: Current smoking, lower SES, nonsurgical diagnosis, exercise-limiting comorbidities, and lower age independently predicted fewer sessions completed. The CART analysis illustrates how combinations of these characteristics (ie, risk profiles) predict the number of sessions completed. Those with the highest-risk profile for nonadherence (<65 years old, current smoker, lower SES) completed on average 9 sessions while those with the lowest-risk profile (>72 years old, not current smoker, higher SES, surgical diagnosis) completed 27 sessions on average.

Conclusions: Younger individuals, as well as those who report smoking or economic challenges or have a nonsurgical diagnosis, may require additional support to maintain CR session attendance.
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http://dx.doi.org/10.1097/HCR.0000000000000225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322217PMC
March 2017

Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients.

Prev Med 2016 11 15;92:47-50. Epub 2016 Feb 15.

Vermont Center on Behavior and Health, University of Vermont, United States; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, United States.

Purpose: Cardiac rehabilitation (CR) improves medical outcomes after myocardial infarction or coronary revascularization. Lower socioeconomic status (SES) patients are less likely to participate in and complete CR. The aim of this study was to test whether financial incentives may increase participation and adherence to CR among lower-SES patients.

Methods: Patients eligible to participate in CR with Medicaid insurance coverage were approached for inclusion. Patients were placed on an escalating incentive schedule of financial incentives contingent upon CR attendance. CR participation was compared to a usual care group of 101 Medicaid patients eligible for CR in the 18months prior to the study. Attendance (participating in ≥one CR sessions) and adherence (sessions completed out of 36) were compared between groups. The study was conducted in Vermont, USA, 2013-2015.

Results: Of 13 patients approached to be in the study and receive incentives, 10 (77%) agreed to participate. All 10 patients completed at least one session of CR, significantly greater than the 25/101 (25%) in the control condition (p<0.001). Of patients in both groups who attended at least one session of CR, adherence was higher in the intervention group (average of 31.1 sessions completed vs. 13.6 in the control group, p<0.001). CR completion rates were also higher during the intervention with 8 of 10 (80%) intervention patients completing all 36 sessions compared to only 2 of 25 (8%) control patients (p<0.001).

Conclusions: Financial incentives may be an efficacious strategy for increasing CR participation and adherence among Medicaid patients.
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http://dx.doi.org/10.1016/j.ypmed.2015.11.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985497PMC
November 2016

Skeletal muscle ultrastructure and function in statin-tolerant individuals.

Muscle Nerve 2016 Feb 9;53(2):242-51. Epub 2015 Dec 9.

Department of Medicine, University of Vermont, College of Medicine, Burlington, Vermont, USA.

Introduction: Statins have well-known benefits on cardiovascular mortality, though up to 15% of patients experience side effects. With guidelines from the American Heart Association, American College of Cardiology, and American Diabetes Association expected to double the number of statin users, the overall incidence of myalgia and myopathy will increase.

Methods: We evaluated skeletal muscle structure and contractile function at the molecular, cellular, and whole tissue levels in 12 statin tolerant and 12 control subjects.

Results: Myosin isoform expression, fiber type distributions, single fiber maximal Ca(2+) -activated tension, and whole muscle contractile force were similar between groups. No differences were observed in myosin-actin cross-bridge kinetics in myosin heavy chain I or IIA fibers.

Conclusions: We found no evidence for statin-induced changes in muscle morphology at the molecular, cellular, or whole tissue levels. Collectively, our data show that chronic statin therapy in healthy asymptomatic individuals does not promote deleterious myofilament structural or functional adaptations.
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http://dx.doi.org/10.1002/mus.24722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673037PMC
February 2016

Cardiac Rehabilitation After Heart Valve Surgery: COMPARISON WITH CORONARY ARTERY BYPASS GRAFT PATIENTS.

J Cardiopulm Rehabil Prev 2015 Jul-Aug;35(4):231-7

Cardiac Rehabilitation and Prevention, Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont.

Purpose: Coronary artery bypass graft (CABG) surgery patients participating in cardiac rehabilitation (CR) experience improvements in aerobic fitness, but there has been little study of outcomes for heart valve (HV) surgical patients. The primary aims of this study were to evaluate baseline peak aerobic capacity for HV patients participating in CR and to compare outcomes between HV and CABG patients.

Methods: Five hundred seventy-six consecutive patients who underwent HV surgery (n = 125), HV plus CABG surgery (n = 57), or CABG surgery (n = 394), all with classic sternotomy and enrolled in CR, were prospectively studied. Changes in outcomes were assessed for individuals who completed CR (n = 313).

Results: HV patients were significantly older and had a greater percentage of females than the CABG-only group. Combining HV and HV + CABG groups, valvular disorders included 134 mitral, 39 aortic, and 8 combined abnormalities (mitral and aortic). For the entire cohort, the mean number of CR exercise sessions attended was 23.6 ± 11.7. Peak oxygen uptake ((Equation is included in full-text article.)) increased 19.5% from 17.4 ± 4.4 to 20.8 ± 5.5 mLO2·kg(-1)·min(-1) (P < .0001). Improvement in peak (Equation is included in full-text article.)with CR exercise training was similar between the 3 groups of patients. Within the group of patients who had HV surgery, percentage change in peak (Equation is included in full-text article.)was not significantly different between the 3 types of valvular abnormalities (ie, mitral [19.2%], aortic [24.4%], and mitral + aortic [21.9%]).

Conclusions: HV surgery patients achieve similar improvement in aerobic fitness from participating in CR exercise training as individuals who had CABG. The observed improvements in aerobic fitness are similar, regardless of the type of valve abnormality or whether CABG was performed concurrently.
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http://dx.doi.org/10.1097/HCR.0000000000000104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483139PMC
March 2016

Statin therapy does not attenuate exercise training response in cardiac rehabilitation.

J Am Coll Cardiol 2014 May 19;63(19):2050-1. Epub 2014 Mar 19.

University of Vermont College of Medicine, Burlington, Vermont. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2014.02.554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107451PMC
May 2014
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