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11. Perceived Anxiety, Coping, and Autonomic Function in Takotsubo Syndrome Long after the Acute Event

Author

Lazzeroni, Davide, primary, Ciraci, Chiara, additional, Sommaruga, Marinella, additional, Oggioni, Carlotta, additional, Saccò, Melissa, additional, Ziveri, Valentina, additional, Paglialonga, Letizia, additional, Bini, Matteo, additional, Moderato, Luca, additional, Brambilla, Lorenzo, additional, Coruzzi, Paolo, additional, Cruciani, Gianluca, additional, Lingiardi, Vittorio, additional, Tanzilli, Annalisa, additional, and Galli, Federica, additional

Published
2022
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13. Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure (CHF) patients undergoing cardiac rehabilitation.

Author

Granata, Nicolò, Torlaschi, Valeria, Zanatta, Francesco, Giardini, Anna, Maestri, Roberto, Pavesi, Claudia, Sommaruga, Marinella, Gazzi, Lidia, Bertolotti, Giorgio, Sarzi Braga, Simona, Monelli, Mauro, Zanelli, Emanuela, and Pierobon, Antonia

Subjects
POSITIVE psychology, MEDICAL rehabilitation, AFFECT (Psychology), PSYCHOLOGY of cardiac patients, SELF-evaluation, PATIENTS, COGNITION, CARDIAC rehabilitation, RESEARCH funding, DESCRIPTIVE statistics, MENTAL depression, PATIENT compliance, ANXIETY, HEART failure, OLD age
Abstract

In Chronic Heart Failure (CHF) patients, psychological and cognitive variables and their association with treatment adherence have been extensively reported in the literature, but few are the investigations in older people. The present study aimed to evaluate the psychological, cognitive, and adherence to treatment profile of older (>65 years) CHF patients, the interrelation between these variables, and identify possible independent predictors of self-reported treatment adherence. CHF inpatients undergoing cardiac rehabilitation were assessed for: anxiety, depression, cognitive impairment, positive and negative affect, and self-reported adherence (adherence antecedents, pharmacological adherence, and non-pharmacological adherence). 100 CHF inpatients (mean age: 74.9 ± 7.1 years) were recruited. 16% of patients showed anxiety and 24.5% depressive symptoms; 4% presented cognitive decline. Cognitive functioning negatively correlated to depression, anxiety, and negative affect (p < 0.01). The adherence antecedents (disease acceptance, adaptation, knowledge, and socio-familiar support) negatively correlated to anxiety (p < 0.05), depression (p < 0.001), and negative affect (p < 0.05), while they positively correlated to positive affect (p < 0.01). Pharmacological adherence negatively correlated to anxiety and negative affect (p < 0.05). Conversely, non-pharmacological adherence and positive affect positively correlated (p < 0.05). Furthermore, depression and anxiety negatively predicted adherence antecedents (β = −0.162, p = 0.037) and pharmacological adherence (β = −0.171, p = 0.036), respectively. Finally, positive affect was found as an independent predictor of non-pharmacological adherence (β = 0.133, p = 0.004). In cardiac rehabilitation, a specific psychological assessment focused on anxiety, depression, and affect can provide useful information to manage CHF older patients' care related to treatment adherence. In particular, positive affect should be targeted in future interventions to foster patients' non-pharmacological adherence. [ABSTRACT FROM AUTHOR]

Published
2023
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14. Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure (CHF) patients undergoing cardiac rehabilitation

Author

Granata, Nicolò, primary, Torlaschi, Valeria, additional, Zanatta, Francesco, additional, Giardini, Anna, additional, Maestri, Roberto, additional, Pavesi, Claudia, additional, Sommaruga, Marinella, additional, Gazzi, Lidia, additional, Bertolotti, Giorgio, additional, Sarzi Braga, Simona, additional, Monelli, Mauro, additional, Zanelli, Emanuela, additional, and Pierobon, Antonia, additional

Published
2022
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15. Post-traumatic stress disorder, depression and anxiety symptoms in COVID-19 outpatients with different levels of respiratory and ventilatory support in the acute phase undergoing three months follow up

Author

FERRARIS, Marta, primary, MAFFONI, Marina, additional, DE MARZO, Vincenzo, additional, PIEROBON, Antonia, additional, SOMMARUGA, Marinella, additional, BARBARA, Cristina, additional, PORCILE, Annalisa, additional, RUSSO, Carmelo, additional, GHIO, Lucio, additional, CLAVARIO, Piero, additional, and PORTO, Italo, additional

Published
2022
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20. Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial

Author

Grünig, Ekkehard, primary, MacKenzie, Alison, additional, Peacock, Andrew J, additional, Eichstaedt, Christina A, additional, Benjamin, Nicola, additional, Nechwatal, Robert, additional, Ulrich, Silvia, additional, Saxer, Stéphanie, additional, Bussotti, Maurizio, additional, Sommaruga, Marinella, additional, Ghio, Stefano, additional, Gumbiene, Lina, additional, Palevičiūtė, Eglė, additional, Jurevičienė, Elena, additional, Cittadini, Antonio, additional, Stanziola, Anna A, additional, Marra, Alberto M, additional, Kovacs, Gabor, additional, Olschewski, Horst, additional, Barberà, Joan-Albert, additional, Blanco, Isabel, additional, Spruit, Martijn A, additional, Franssen, Frits M E, additional, Vonk Noordegraaf, Anton, additional, Reis, Abílio, additional, Santos, Mário, additional, Viamonte, Sofia Gonçalves, additional, Demeyer, Heleen, additional, Delcroix, Marion, additional, Bossone, Eduardo, additional, and Johnson, Martin, additional

Published
2020
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21. Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era

Author

Ambrosetti, Marco, primary, Abreu, Ana, additional, Cornelissen, Veronique, additional, Hansen, Dominique, additional, Iliou, Marie Christine, additional, Kemps, Hareld, additional, Pedretti, Roberto Franco Enrico, additional, Voller, Heinz, additional, Wilhelm, Mathias, additional, Piepoli, Massimo Francesco, additional, Beccaluva, Chiara Giuseppina, additional, Beckers, Paul, additional, Berger, Thomas, additional, Davos, Costantinos H, additional, Dendale, Paul, additional, Doehner, Wolfram, additional, Frederix, Ines, additional, Gaita, Dan, additional, Gevaert, Andreas, additional, Kouidi, Evangelia, additional, Kraenkel, Nicolle, additional, Laukkanen, Jari, additional, Maranta, Francesco, additional, Mazza, Antonio, additional, Mendes, Miguel, additional, Neunhaeuserer, Daniel, additional, Niebauer, Josef, additional, Pavy, Bruno, additional, Gil, Carlos Peña, additional, Rauch, Bernhard, additional, Sarzi Braga, Simona, additional, Simonenko, Maria, additional, Cohen-Solal, Alain, additional, Sommaruga, Marinella, additional, Venturini, Elio, additional, and Vigorito, Carlo, additional

Published
2020
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22. Psychosocial Cardiological Schedule-Revised (PCS-R) in a Cardiac Rehabilitation Unit: Reflections Upon Data Collection (2010–2017) and New Challenges

Author

Granata, Nicolò, primary, Nissanova, Ekaterina, additional, Torlaschi, Valeria, additional, Ferrari, Marina, additional, Vigorè, Martina, additional, Sommaruga, Marinella, additional, Angelino, Elisabetta, additional, Rizza, Claudia, additional, Caprino, Alessandra, additional, and Pierobon, Antonia, additional

Published
2020
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23. Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation

Author

Pierobon, Antonia, primary, Granata, Nicolò, additional, Torlaschi, Valeria, additional, Vailati, Chiara, additional, Radici, Alice, additional, Maestri, Roberto, additional, Pavesi, Claudia, additional, Sommaruga, Marinella, additional, Gazzi, Lidia, additional, Bertolotti, Giorgio, additional, Sarzi Braga, Simona, additional, Monelli, Mauro, additional, Zanelli, Emanuela, additional, and Giardini, Anna, additional

Published
2020
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24. Psychosocial Cardiological Schedule--Revised

Author

Granata, Nicolò, primary, Nissanova, Ekaterina, additional, Torlaschi, Valeria, additional, Ferrari, Marina, additional, Vigorè, Martina, additional, Sommaruga, Marinella, additional, Angelino, Elisabetta, additional, Rizza, Claudia, additional, Caprino, Alessandra, additional, and Pierobon, Antonia, additional

Published
2020
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25. Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial.

Author

Grünig, Ekkehard, MacKenzie, Alison, Peacock, Andrew J, Eichstaedt, Christina A, Benjamin, Nicola, Nechwatal, Robert, Ulrich, Silvia, Saxer, Stéphanie, Bussotti, Maurizio, Sommaruga, Marinella, Ghio, Stefano, Gumbiene, Lina, Palevičiūtė, Eglė, Jurevičienė, Elena, Cittadini, Antonio, Stanziola, Anna A, Marra, Alberto M, Kovacs, Gabor, Olschewski, Horst, and Barberà, Joan-Albert

Subjects
LUNG disease treatment, LUNG diseases -- Immunological aspects, RANDOMIZED controlled trials, EXERCISE therapy, MEDICAL rehabilitation
Abstract

Aims This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n  = 98; CTEPH n  = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17–33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18–51 m; P  < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P  = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2 P  = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P  = 0.048) compared with the control group. Conclusion This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries. [ABSTRACT FROM AUTHOR]

Published
2021
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26. Anxiety and depression in patients with pulmonary hypertension: impact and management challenges

Author

Bussotti,Maurizio and Sommaruga,Marinella

Subjects
Vascular Health and Risk Management
Abstract

Maurizio Bussotti,1 Marinella Sommaruga2 1Cardiorespiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy; 2Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy Background: Anxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges. Methods: A literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004–2018]). Results: The prevalence of mental disorders in PAH patients lies between 7.5% and 53% for depression and 19% and 51% for anxiety and panic disorders. The latest guidelines of the European Society of Cardiology recommend a psychological support with a class of recommendation I and a level of evidence c. The analysis of psychological intervention shows that at present there is no evidence of specific psychological interventions in these patients. However, treatment approaches based on other chronic illnesses are suggested, especially based on relaxation training, slow breathing, and cognitive behavioral therapy. Finally, data concerning the use of antidepressant drugs are conflicting. Conclusion: Firstly, our data demonstrate a common underestimation of mental disorders by health professionals and secondly, the need of implementing appropriate methods of screening for mental disorders in PAH patients. However, the paucity of large observational studies in this area requires the attention of researchers. The evidence about optimal approaches for managing anxiety and depression in PAH also remains unclear and largely speculative. The challenge is the introduction of routine psychological intervention, as suggested by the European Society of Cardiology and already applied in other chronic disease. Keywords: pulmonary arterial hypertension, anxiety, depression, psychological distress, rehabilitation, psychological intervention

Published
2018

29. What constitutes the ‘Minimal Care’ interventions of the nurse, physiotherapist, dietician and psychologist in Cardiovascular Rehabilitation and secondary prevention: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology

Author

Fattirolli, Francesco, primary, Bettinardi, Ornella, additional, Angelino, Elisabetta, additional, da Vico, Letizia, additional, Ferrari, Marina, additional, Pierobon, Antonia, additional, Temporelli, Daniele, additional, Agostini, Susanna, additional, Ambrosetti, Marco, additional, Biffi, Barbara, additional, Borghi, Silvana, additional, Brazzo, Silvia, additional, Faggiano, Pompilio, additional, Iannucci, Manuela, additional, Maffezzoni, Barbara, additional, Masini, Maria Luisa, additional, Mazza, Antonio, additional, Pedretti, Roberto, additional, Sommaruga, Marinella, additional, Barro, Sabrina, additional, Griffo, Raffaele, additional, and Piepoli, Massimo, additional

Published
2018
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30. Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Author

Sommaruga, Marinella, primary, Angelino, Elisabetta, additional, Della Porta, Paola, additional, Abatello, Mara, additional, Baiardo, Giacomo, additional, Balestroni, Gianluigi, additional, Bettinardi, Ornella, additional, Callus, Edward, additional, Ciracì, Chiara, additional, Omodeo, Ombretta, additional, Rizza, Claudia, additional, Michielin, Paolo, additional, Ambrosetti, Marco, additional, Griffo, Raffaele, additional, Pedretti, Roberto F.E., additional, and Pierobon, Antonia, additional

Published
2018
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31. Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era

Author

Ambrosetti, Marco, Abreu, Ana, Cornelissen, Veronique, Hansen, Dominique, Iliou, Marie Christine, Kemps, Hareld, Pedretti, Roberto Franco Enrico, Voller, Heinz, Wilhelm, Mathias, Piepoli, Massimo Francesco, Beccaluva, Chiara Giuseppina, Beckers, Paul, Berger, Thomas, Davos, Costantinos H, Dendale, Paul, Doehner, Wolfram, Frederix, Ines, Gaita, Dan, Gevaert, Andreas, Kouidi, Evangelia, Kraenkel, Nicolle, Laukkanen, Jari, Maranta, Francesco, Mazza, Antonio, Mendes, Miguel, Neunhaeuserer, Daniel, Niebauer, Josef, Pavy, Bruno, Gil, Carlos Peña, Rauch, Bernhard, Sarzi Braga, Simona, Simonenko, Maria, Cohen-Solal, Alain, Sommaruga, Marinella, Venturini, Elio, and Vigorito, Carlo

Abstract

This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from −5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 ‘for’ and 10 ‘against’ respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per sewhen the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.

Published
2021
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32. COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation

Author

Pierobon,Antonia, Sini Bottelli,Elisa, Ranzini,Laura, Bruschi,Claudio, Maestri,Roberto, Bertolotti,Giorgio, Sommaruga,Marinella, Torlaschi,Valeria, Callegari,Simona, Giardini,Anna, Pierobon,Antonia, Sini Bottelli,Elisa, Ranzini,Laura, Bruschi,Claudio, Maestri,Roberto, Bertolotti,Giorgio, Sommaruga,Marinella, Torlaschi,Valeria, Callegari,Simona, and Giardini,Anna

Abstract

Antonia Pierobon,1 Elisa Sini Bottelli,1 Laura Ranzini,1 Claudio Bruschi,2 Roberto Maestri,3 Giorgio Bertolotti,4 Marinella Sommaruga,5 Valeria Torlaschi,1 Simona Callegari,1 Anna Giardini1 1Psychology Unit, 2Department of Pulmonary Rehabilitation, 3Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, 4Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Tratate, 5Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Camaldoli, Italy Abstract: In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III–IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depressi

Published
2017

38. First definition of Minimal Care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology

Author

Bettinardi, Ornella, primary, Da Vico, Letizia, additional, Pierobon, Antonia, additional, Iannucci, Manuela, additional, Maffezzoni, Barbara, additional, Borghi, Silvana, additional, Ferrari, Marina, additional, Brazzo, Silvia, additional, Mazza, Antonio, additional, Sommaruga, Marinella, additional, Angelino, Elisabetta, additional, Biffi, Barbara, additional, Agostini, Susanna, additional, Masini, Maria Luisa, additional, Ambrosetti, Marco, additional, Faggiano, Pompilio, additional, and Griffo, Raffaele, additional

Published
2015
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44. ISYDE-Ψ* First step of the implementation of guidelines for psychology activities in cardiac rehabilitation and prevention *Italian SurveY on CarDiac REhabilitation – Psychology

Author

Sommaruga, Marinella, primary, Tramarin, Roberto, additional, Balestroni, Gianluigi, additional, Bettinardi, Ornella, additional, Cauteruccio, Maria Antonella, additional, Miglioretti, Massimo, additional, Monti, Marco, additional, Omodeo, Ombretta, additional, Pierobon, Antonia, additional, and Vaghi, Paola, additional

Published
2005
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45. Nursing Role in Cardiac Prevention

Author

Riccio, Carmine, primary, Sommaruga, Marinella, additional, Vaghi, Paola, additional, Cassella, Alfonso, additional, Celardo, Silvana, additional, Cocco, Emilia, additional, De Chiro, Vincenzo, additional, Marzaioli, Maria, additional, Ruotolo, Enza, additional, Zanni, Ornella, additional, Iacomino, Maria, additional, and Chieffo, Carmelo, additional

Published
2004
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48. 98Takotsubo syndrome in COVID-19 era: is psycological distress the key?

Author

Barbieri, Lucia, Galli, Federica, Conconi, Barbara, Gregorini, Teresa, Lucreziotti, Stefano, Mafrici, Antonio, Pravettoni, Gabriella, Sommaruga, Marinella, and Carugo, Stefano

Abstract

Covid-19 pandemic, starting from Wuhan, China has spread all over the word and Italy was one of the most affected countries, especially in Lombardy, where, on 20 February the first case was confirmed. Italian Government ordered a national lockdown on the 9 March 2020, forcing the population to severe restrictive isolation measures. The burden on mental health of the medical emergency related to COVID-19 is progressively been revealed. Takotsubo syndrome (TTS), is estimated to represent 1–3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. Comparing patients hospitalized from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients in 2020 vs. 3 in 2019), especially during the first period of lockdown. The only two males were patients with COVID-19 and were the only two who died in hospital. At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. Most patients were positive to the allostatic overload. Only one patient showed a clinical cut-off for HADS and no one for the fear COVID-19 scale. We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS.

Published
2021
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49. Standardised exercise training is feasible, safe and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension - results from a large European multicentre randomised controlled trial

Author

Andrew J. Peacock, Elena Jurevičienė, Gabor Kovacs, Sofia Viamonte, Alberto M. Marra, Antonio Cittadini, Heleen Demeyer, Christina A. Eichstaedt, Anna Agnese Stanziola, Ekkehard Grünig, Eglė Palevičiūtė, Frits M.E. Franssen, Robert Nechwatal, Maurizio Bussotti, Silvia Ulrich, Marinella Sommaruga, Mário Santos, Joan Albert Barberà, Isabel Blanco, Martin Johnson, Lina Gumbiene, Stefano Ghio, Stéphanie Saxer, Nicola Benjamin, Anton Vonk Noordegraaf, Abílio Reis, Eduardo Bossone, Martijn A. Spruit, Marion Delcroix, Horst Olschewski, Alison MacKenzie, Pulmonologie, RS: NUTRIM - R3 - Respiratory & Age-related Health, Grünig, Ekkehard, Mackenzie, Alison, Peacock, Andrew J, Eichstaedt, Christina A, Benjamin, Nicola, Nechwatal, Robert, Ulrich, Silvia, Saxer, Stéphanie, Bussotti, Maurizio, Sommaruga, Marinella, Ghio, Stefano, Gumbiene, Lina, Palevičiūtė, Eglė, Jurevičienė, Elena, Cittadini, Antonio, Stanziola, Anna A, Marra, Alberto M, Kovacs, Gabor, Olschewski, Horst, Barberà, Joan-Albert, Blanco, Isabel, Spruit, Martijn A, Franssen, Frits M E, Vonk Noordegraaf, Anton, Reis, Abílio, Santos, Mário, Viamonte, Sofia Gonçalve, Demeyer, Heleen, Delcroix, Marion, Bossone, Eduardo, Johnson, Martin, Pulmonary medicine, and ACS - Pulmonary hypertension & thrombosis

Subjects
Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, law.invention, 0302 clinical medicine, Randomized controlled trial, QUALITY-OF-LIFE, law, Exercise programme, Medicine and Health Sciences, Clinical endpoint, Prospective Studies, Exercise Tolerance, Rehabilitation, Middle Aged, Europe, medicine.anatomical_structure, Female, Chronic thromboembolic pulmonary hypertension, Cardiology and Cardiovascular Medicine, WALK TEST, Adult, medicine.medical_specialty, Hypertension, Pulmonary, END-POINT, Pulmonary arterial pressure, Pulmonary hypertension, CAPACITY, 03 medical and health sciences, Walking distance, Internal medicine, BENEFITS, medicine, Humans, Pulmonary rehabilitation, In patient, Exercise, Aged, Lung, Surrogate endpoint, business.industry, EFFICACY, medicine.disease, Confidence interval, 030228 respiratory system, Chronic Disease, Usual care, Quality of Life, Physical therapy, business
Abstract

Aims This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17–33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18–51 m; P Conclusion This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.

Published
2020

50. Effects of an outpatient service rehabilitation programme in patients affected by pulmonary arterial hypertension: an observational study

Author

Paolo Totaro, Roberto F E Pedretti, Marinella Sommaruga, Patrycja Kransinska, Maurizio Bussotti, Paola Gremigni, Paola Corbo, Giovanni Marchese, Silvia Di Marco, Bussotti, Maurizio, Gremigni, Paola, Pedretti, Roberto Fe, Kransinska, Patrycja, Di Marco, Silvia, Corbo, Paola, Marchese, Giovanni, Totaro, Paolo, and Sommaruga, Marinella

Subjects
Adult, Male, Spirometry, medicine.medical_specialty, Hypertension, Pulmonary, medicine.medical_treatment, Anxiety, 030204 cardiovascular system & hematology, Hospital Anxiety and Depression Scale, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Quality of life, Internal medicine, Ambulatory Care, medicine, Clinical endpoint, Humans, Adverse effect, Pharmacology, Rehabilitation, medicine.diagnostic_test, Depression, business.industry, Cardiorespiratory fitness, Hematology, General Medicine, Middle Aged, Brain natriuretic peptide, 030228 respiratory system, Pulmonary arterial hypertension , quality of life, psychological support, Exercise Test, Quality of Life, Physical therapy, Cardiology, Molecular Medicine, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Pulmonary arterial hypertension (PAH) is a rare disease characterised by a severe impairment of functional status and quality of life (QoL). Use of rehabilitative programmes may help to improve outcomes. The aim of this pre/post test case series was to evaluate the impact of a training program, including sessions of aerobic and resistance exercise, inspiratory muscle reinforcement, slow breathing, relaxation, and psychological support, on functional outcomes. Methods: Fifteen patients affected by PAH, in World Health Organization (WHO) Functional Class (FC) II or III and in stable clinical condition, were included in a 4-week cardiorespiratory training programme conducted in outpatient service. Patients were tested during a routine control visit (T0), one month later at the beginning of the training programme (T1), and at study end (T2). Between T0 and T1, patients continued their normal activities and therapies. At each step, patients underwent respiratory and functional evaluation by spirometry, 6-minute walk test (6-MWT), maximal cardiopulmonary exercise testing (CPET), echocardiography, and levels of brain natriuretic peptide (BNP). QoL was also assessed at T1 and T2 using the Hospital Anxiety and Depression Scale and the EuroQoL-5D questionnaire. The primary endpoint was the effect of training on peak oxygen consumption (peak VO2). Results: There were no significant differences in BNP levels, or in any of the respiratory or echocardiographic parameters measured, between T0 and T1. Between T1 and T2, significant improvements were recorded in QoL (HADS-Anxiety mean change 3.5 ± 3.3 and HADS-Depression mean change 1.6 ± 2.0, all p < 0.01). Significant improvements were also observed in functional capacity with distance walked at 6-MWT increasing from 455 ± 115 to 487 ± 120 (+8%, p < 0.01), workload (WR) of CPET was increased from 22% (from 73 ± 22 to 87 ± 21 watt, p < 0.001), peak VO2 increasing from 17.3 ± 4.2 to 19.9 ± 4.5 mL/kg/min (p < 0.001) and pulse O2 increasing from 7.8 ± 1.8 to 8.8 ± 2.4 mL/beat (p < 0.01). No adverse events or deterioration in clinical status were observed during the training sessions. Conclusion: Cardiorespiratory training in a outpatient service is a suitable option for patients with PAH in WHO FC II/III thanks to improved exercise capacity and QoL, which may allow them to achieve better outcomes.

Published
2017

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