Lifestyle changes in coronary heart disease—Effects of cardiac rehabilitation programs with focus on intensity, duration and content—A systematic review

Abstract

Background: Although coronary heart disease (CHD) is the most common cause of death worldwide the literature shows a wide variation in the arrangement of cardiac rehabilitation and achieved lifestyle changes. Aim: The purpose of this study was to evaluate the effects of intensity (number of patient follow-ups), duration (length of intervention) and content in cardiac rehabilitation programs (CRP) regarding lifestyle changes in patients with CHD. Method: A systematic literature review of articles published in the databases PubMed and CINAHL between 1990 and 2007 was conducted. This resulted in 1120 hits of which 25 articles finally met the set criteria for inclusion. Results: The majority of significant positive results on lifestyle factors were shown among the studies describing high intensity and long duration. Included studies showed a wide variation in content, but four different interventions (informative content, educational content, practical content, behavioral and self care-oriented content) emerged. The group of studies which contained all four interventions focused on most lifestyle factors and achieved the most significant positive results. Conclusion: This systematic literature review shows that CRP should include high intensity, long duration and an intervention content covering information, knowledge, practical training, self care-activity and behavior changes in order to achieve effect on all four lifestyle factors of diet, physical activity and exercise, smoking and stress. Lifestyle changes can be reached in less lifestyle factors, with a longer duration and a variation of intensity of contacts but in combining with an informative and educational content with an additional content of a practical nature or self activity.

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Strid, C. , Lingfors, H. , Fridlund, B. and Mårtensson, J. (2012) Lifestyle changes in coronary heart disease—Effects of cardiac rehabilitation programs with focus on intensity, duration and content—A systematic review. Open Journal of Nursing, 2, 420-430. doi: 10.4236/ojn.2012.24060.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] WHO (2004) The global burden of disease. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html
[2] The National Board of Health and Welfare (2004) The National Board of Health and Welfare guidelines for cardiac care 2004. Socialstyrelsen, Stockholm.
[3] Wallentin, L., Stenestrand, U., Lindahl, B., Tydén, P., Hambreus, K., James, S. and Lagerqvist, B. (2007) Annual report RIKS-HIA, SEPHIA, SCAAR. The National Board of Health and Welfare, Stockholm.
[4] Graham, I., Atar, D., Borch-Johnsen, K., Boysen, G., Burell, G., Cifkova, R., et al. (2007) European society of cardiology. European guidelines on cardiovascular disease prevention in clinical practice: Executive summary. European Journal of Cardiovascular Prevention and Rehabilitation, 14, 1-40. doi:10.1097/01.hjr.0000277983.23934.c9
[5] Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., et al. (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet, 364, 937-952. doi:10.1016/S0140-6736(04)17018-9
[6] Clark, A.M., Hartling, L., Vandermeer, B. and McAlister, F. (2005) Meta-analysis: Secondary prevention programs for patients with coronary artery disease. Annals of Internal Medicine, 143, 659-672.
[7] De Backar, G., Ambosioni, E., Borch-Johnsen, K., Brotons C., Cifkova R., Dallongeville J., et al. (2003) European guidelines on cardiovascular diseases prevention in clinical practice. Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice. European Heart Journal, 24, 1601-1610. doi:10.1016/S0195-668X(03)00347-6
[8] Ornish, D., Brown, S., Scherwitz, L., Billings, J., Armstrong, W., Ports, T., et al. (1990) Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet, 336, 129-133. doi:10.1016/0140-6736(90)91656-U
[9] Shephard, R.J. and Balady, G.J. (1999) Exercise as cardiovascular therapy. Circulation, 99, 963-972. doi:10.1161/01.CIR.99.7.963
[10] The National Board of Health and Welfare (2008) Coronary heart disease—scientific basis for national Guidelines for cardiac care. Socialstyrelsen, Stockholm.
[11] Ornish, D., Scherwitz, L.W., Billings, J.H., Gould, L., Merritt, T., Sparler, S., et al. (1998) Intensive lifestyle changes for reversal of coronary heart disease. JAM: The Journal of the American Medical Association, 280, 2001-2008.
[12] Kotseva, K., Wood, D., De Backer, G., De Bacquer, D., Pyorala, K. and Keil, K. (2009) Eurospire III: A survey on the lifestyle, riskfactors and use of cardioprotective drug therapies in coronary patients from 22 European countries. European Journal of Cardiovascular Prevention and Rehabilitation, 16, 121-137. doi:10.1097/HJR.0b013e3283294b1d
[13] Wood, D., De Backer, G., Faegerman, O., Kjekshus, J., Wedel, H., Berg, K., et al. (1998) Members of task force. Prevention of coronary heart disease in clinical practice. Recommendation of the second joint task force of European and other societies on coronary prevention. European Heart Journal, 19, 1434-1503. doi:10.1053/euhj.1998.1243
[14] Linden, W., Stossel, C. and Maurice, J. (1996) Psychosocial interventions for patients with coronary artery disease: A meta-analysis. Archives of Internal Medicine, 156, 745-752. doi:10.1001/archinte.1996.00440070065008
[15] De Lorgerli, M., Salen, P., Martini, J.L., Monjaud, I., Delay, J. and Mamelle, N. (1999) Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon diet heart study. Circulation, 99, 779-785. doi:10.1161/01.CIR.99.6.779
[16] Stead, L.F. and Lancaster, T. (2005) Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews, 149, 656-672.
[17] Taylor, R., Brown, A., Ebrahim, S., Jolliffe, J., Noorani, H., Rees, K., et al. (2004) Exercise-based rehabilitation for patients with coronary heart disease: Systematic review and meta analysis of randomised controlled trials. American Journal of Medicine, 116, 682-692. doi:10.1016/j.amjmed.2004.01.009
[18] Bellman, C., Hambreus, K., Lindback, J. and Lindahl, B. (2009) Achievement of secondary preventive goals after myocardial infarction: A comparison between participants and non-participants in a routine patient education programme in Sweden. European Journal of Cardiovascular Nursing, 24, 362-368.
[19] Willman, A., Stoltz, P. and Bahtsevani, C. (2006) Evidence-based nursing; a bridge between research and clinical practice. Studentlitteratur, Lund.
[20] Forsberg, C. and Wengstrom, Y. (2003) To conduct a systematic literature review. Natur och Kultur, Stockholm.
[21] Brüggemann, J., Poels, B., Oosterwijk, M., Van der Schans, C., Postema, K. and van Veldhuisen, D.Q. (2007) A randomised controlled trial of cardiac rehabilitation after revascularisation. International Journal of Cardiology, 19, 59-64. doi:10.1016/j.ijcard.2006.07.047
[22] Sundin,O., Lisspers, J., Hofman-Bang, C., Nygren, A., Rydén, L. and Ohman, A. (2003) Comparing multifactoral lifestyle interventions and stress management in coronary risk reduction. Internal Journal of Behavioural Medicine, 10, 191-204. doi:10.1207/S15327558IJBM1003_01
[23] Campell, N.C., Ritchie, L.D., Thain, J., Deans, H.G., Rawles, J.M. and Squair, J.L. (1998) Secondary prevention in coronary heart disease: A randomised trial of nurse led clinics in primary care. Heart, 80, 447-452.
[24] Alm-Roijer, C., Stagmo, M., Udén, G. and Erhardt, L. (2004) Better knowledge improves adherence to lifestyle changes and medication in patients with coronary heart disease. European Journal of Cardiovascular Nursing, 3, 321-330. doi:10.1016/j.ejcnurse.2004.05.002
[25] Fox, K.F., Nuttal, M., Wood, D.A., Wright, M., Arora, B., Dawson, E., et al. (2001) A cardiac prevention and rehabilitation programme for all patients at first presentation with coronary artery disease. Heart, 85, 533-538. doi:10.1136/heart.85.5.533
[26] Hansen, T., Nordrehaug, J., Eide, G. and Hanestad, B. (2007) Improving outcomes after myocardial infarction: A randomized controlled trial evaluating effects of a telephone follow-up intervention. European Journal of Cardiovascular Prevention and Rehabilitation, 14, 429-437. doi:10.1097/HJR.0b013e32801da123
[27] Lear, S., Ignaszewski, A., Linden, W., Brozic, A., Kiess, M., Spinelli, J., et al. (2003) The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial. European Heart Journal, 24, 1920-1927. doi:10.1016/j.ehj.2003.08.015
[28] Murchie, P., Campell, N., Ritchie, L., Simpson, J. and Thain, J. (2003) Secondary prevention clinics for coronary heart disease: Four-year follow-up of a randomised controlled trial in primary care. BMJ, 326, 84-89. doi:10.1136/bmj.326.7380.84
[29] Nordmann, A., Heilmbauer, I., Walker, T., Martina, B. and Battegay, E. (2001) A case-management program of medium intensity does not improve cardiovascular risk factor control in coronary artery disease patients: The heartcare I trial. American Journal of Medicine, 110, 543-550. doi:10.1016/S0002-9343(01)00682-9
[30] Mittag, O., China, C., Hoberg, E., Juers, E., Kolenda, K.D., Richard, G., et al. (2006) Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): Overall and gender-specific effects. International Journal of Rehabilitation Research, 29, 295-302. doi:10.1097/MRR.0b013e328010ba9a
[31] Oldenburg, B., Martin, A., Greenwood, J., Bernstein, L. and Allan, R. (1995) A controlled trial of behavioral and educational intervention following coronary artery bypass surgery. Journal of Cardiopulmonary Rehabilitation, 15, 39-46. doi:10.1097/00008483-199501000-00006
[32] Wallner, S., Watzinger, N., Lindschinger, M., Smolle, K.H., Toplak, H., Eber, B., et al. (1999) Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty. European Journal of Clinical Investigation, 29, 372-379. doi:10.1046/j.1365-2362.1999.00456.x
[33] The Vestfold Heartcare Study Group (2003) Influence on lifestyle measures and five-year coronary risk by comprehensive lifestyle intervention programme in patients with coronary heart disease. European Journal of Cardiovascular Prevention and Rehabilitation, 10, 429-437. doi:10.1097/01.hjr.0000107024.38316.6a
[34] Van Elderen, T. and Dusseldorp, E. (2001) Lifestyle effects of group health education for patients with coronary heart disease. Psychology and Health, 16, 327-341. doi:10.1080/08870440108405510
[35] Aldana, S.G., Whitmer, W.R., Greenlaw, R., Avins, A., Salberg, A., Barnhurst, M., et al. (2003) Cardiovascular risk reductions associated with aggressive lifestyle modification and cardiac rehabilitation. Heart & Lung, 32, 374-382. doi:10.1016/S0147-9563(03)00106-7
[36] Carlsson, R., Lindberg, G., Westin, L. and Israelsson, B. (1997) Influence of coronary nursing management follow up on lifestyle after acute myocardial infarction. Heart, 44, 256-259. doi:10.1136/hrt.77.3.256
[37] Gordon, N., English, C., Contractor, A., Salmon, R., Leighton, R., Franklin, B. and Haskell, W. (2002) Effectiveness of three models for comprehensive cardiovascular disease risk reduction. American Journal of Cardiology, 89, 1263-1268. doi:10.1016/S0002-9149(02)02323-8
[38] Hofman-Bang, C., Lisspers, J., Nordlander, R., Nygren, A., Sundin, O., Ohman, A., et al. (1999) Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneos transluminal coronary angioplasty. European Heart Journal, 20, 1465-1474. doi:10.1053/euhj.1999.1544
[39] Lear, S., Spinelli, J., Linden, W., Brozic, A., Kiess, M., Frohlich, J., et al. (2006) The Extensive Lifestyle Managemnet Intervention (ELMI) after cardiac rehabilitation: A 4-year randomized controlled trial. American Heart Journal, 152, 333-339. doi:10.1016/j.ahj.2005.12.023
[40] Lisspers, J., Hofman-Bang, C., Nordlander, R., Rydén, L., Sundin, O., Ohman, A., et al. (1998) Multifactorial evaluation of a program for lifestyle behavior change in rehabilitation and secondary prevention of coronary artery disease. Scandinavian Cardiovascular Journal, 33, 9-16.
[41] Lisspers, J., Sundin, O., Hofman-Bang, C., Nordlander, R., Nygren, A., Rydén, L., et al. (1999) Behavioral effects of a comprehensive multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: A prospective, randomized, controlled study. Journal of Psychosomatic Research, 46, 143-154. doi:10.1016/S0022-3999(98)00074-9
[42] Lisspers, J., Sundin, O., Ohman, A., Hofman-Bang, C., Rydén, L. and Nygren, A. (2005) Long-term effects of lifestyle behaviour change in coronary artery disease: Effects on recurrent coronary events after percutaneous coronary intervention. Health Psychology, 24, 41-48. doi:10.1037/0278-6133.24.1.41
[43] Reid, R.D., Dafoe, W.A., Morrin, L., Mayhew, A., Papadakis, S., Beaton, L., et al. (2005) Impact of program duration and contact frequency on efficacy and cost of cardiac rehabilitation: Results of a randomized trial. American Heart Journal, 149, 862-868. doi:10.1016/j.ahj.2004.09.029
[44] Cobb, S., Brown, D. and Davies, L. (2006) Effective interventions for lifestyle change after myocardial infarction or coronary artery revascularisation. Journal of the American Academy of Nurse Practitioners, 18, 31-39. doi:10.1111/j.1745-7599.2006.00096.x
[45] Orth-Gomér, K. (2007) Psychosocial and behavioural aspects of cardiovascular disease prevention in men and woman. Current Opinion in Psychiatry, 20, 147-151. doi:10.1097/YCO.0b013e32802b705e
[46] Orth-Gomér, K., Schneiderman, N., Wang, H., Walldin, C., Blom, M. and Jernberg, T. (2009) Stress reduction prolongs life in women with coronary disease: The Stockholm women’s intervention trial for coronary heart disease (SWITCHD). Circulation: Cardiovascular Quality and Outcomes, 2, 25-32. doi:10.1161/CIRCOUTCOMES.108.812859
[47] Cooper, A.F., Jackson, G., Weinman, J. and Horne, R. (2002) Factors associated with cardiac rehabilitation attendance: A systematic review of the literature. Clinical Rehabilitation, 16, 541-552. doi:10.1191/0269215502cr524oa
[48] Polit, D.F. and Hungler, B.F. (2004) Nursing research— Principles and methods. 7th Edition, J.B. Lippincott Company, Philadelphia.

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