Cardiac rehabilitation in patients with type 2 diabetes mellitus and coronary disease: A comparative study | Revista Portuguesa de Cardiologia (English edition)

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do Porto, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Reabilitação cardíaca em doentes coronários com diabetes mellitus tipo 2: Estudo comparativo" ] ] "textoCompleto" => "IntroductionCardiac rehabilitation programs (CRPs) are multidisciplinary interventions that are designed to help cardiac patients achieve and maintain their maximum physical and psychosocial potential.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>CRPs are a valuable therapeutic option that provide multiple benefits by promoting healthy lifestyles and cardiovascular risk factor control, symptom relief and optimization of functional capacity, while reducing the incidence of new cardiovascular events, thus helping patients to return to a productive and satisfying life.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Studies have reported a 25% reduction in mortality following myocardial infarction (MI) in patients on CRPs compared to those not undergoing cardiac rehabilitation.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> However, CRPs continue to be underused in Portugal; according to Diagnosis Related Groups data from 2007 and the 2007 survey of the Portuguese Society of Cardiology's Study Group on Exercise Physiology and Cardiac Rehabilitation, only 3% of patients discharged from hospital after MI were admitted to a CRP, with even lower percentages for other cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In 2007, Portugal was second from last in Europe for cardiac rehabilitation, despite doubling patient numbers compared to 2004.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The clinical indications for a CRP include acute coronary syndrome (ACS), stable angina, revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting, valve surgery, compensated heart failure and heart transplantation, as well as for control of cardiovascular risk factors in patients at high risk of coronary artery disease (CAD).<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>CRPs consist of three or four phases, in accordance with the European<a class="elsevierStyleCrossRef" href="#bib0030">6</a> and American<a class="elsevierStyleCrossRef" href="#bib0035">7</a> guidelines, respectively, beginning with admission for a cardiovascular event and ending at the point when the individual patient takes full responsibility for maintaining the strategies learned.Patients with diabetes mellitus (DM) have a 2–4 times higher risk of cardiovascular disease, particularly CAD, than those without and DM doubles mortality due to a cardiovascular event, even after adjustment for other cardiovascular risk factors.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>The World Health Organization (WHO) has declared that DM is a major public health issue, and that it is essential to implement health education measures, given that there are predicted to be 366 million diabetic individuals worldwide by 2030.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> In Portugal, 11.7% of the population aged 20–79 years have diabetes.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Although mortality from coronary events has fallen in recent decades in the general population as a result of improved control of cardiovascular risk factors and more effective treatment of heart disease, this has not been the case for diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>The approach to reducing cardiovascular risk in diabetic patients includes diet modification, control of cardiovascular risk factors, regular exercise and drug therapy.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> These strategies lead to favorable metabolic and endocrine responses, which in the medium and long term will be reflected in reduced glycated hemoglobin (HbA1c), glucose intolerance and insulin resistance, increased muscle glucose uptake, reduced adipose tissue and increased exercise tolerance. Together, these benefits slow development of the micro- and macrovascular complications associated with DM, thus reducing cardiovascular risk and improving patients’ quality of life.<a class="elsevierStyleCrossRefs" href="#bib0035">7,13,14</a>Of patients referred for CRPs, 20–30% have DM,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> but few studies have assessed the efficacy of CRPs specifically in diabetic patients, even though such programs may be especially valuable in this patient population.The aim of the present study is to evaluate the effects of phase II of a CRP in patients with CAD and type 2 DM and to compare the results with regard to control of risk factors and improvement in functional capacity with coronary patients without diabetes.MethodsThis was a single-center, prospective, observational cohort study of 818 patients diagnosed with ischemic heart disease (IHD), consecutively referred for a CRP in the Cardiovascular Prevention and Rehabilitation Unit of Hospital de Santo António, Porto, between January 2009 and June 2013. Of the initial sample, 136 patients were excluded, of whom 91 quit the CRP, nine suffered clinical complications that prevented them from completing the minimum of eight sessions (due to rehospitalization for PCI in two, ACS in one, and musculoskeletal lesions in six), and 36 due to lack of data during follow-up, particularly laboratory test results or anthropometric data that were required for the statistical analysis. The study population thus consisted of 682 patients who began the CRP within three months of the event, irrespective of the admission diagnosis. The population was divided into two groups: the diabetic group, composed of patients with a history of type 2 DM (confirmed in their medical records) and those under antidiabetic therapy (oral antidiabetics or insulin therapy), and the non-diabetic group.The patients underwent two assessments, one at the beginning of the CRP and the second three months later. The first assessment consisted of clinical history, including sociodemographic data and personal and family history, and physical examination of the cardiovascular, musculoskeletal and neurological systems. At both assessments, data were collected on risk profile, including blood pressure (BP), body mass index (BMI) (in kg/m2) and waist circumference (WC), smoking, blood glucose and HbA1c, and lipid profile after 12 hours fasting, consisting of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG).The following were used as reference values: BP <130/80 mmHg in two consecutive measurements; BMI 18–24.9 kg/m2 (BMI 25–29.9 kg/m2 being classified as overweight and BMI ≥30 kg/m2 being classified as obese); WC <80 cm in women and <94 cm in men; fasting capillary glucose <110 mg/dl and HbA1c <6.5%; TC <190 mg/dl, LDL-C <100 mg/dl, HDL-C >45 mg/dl in men and >40 mg/dl in women, and TG <150 mg/dl.Patients’ level of physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), which has been validated for the Portuguese population<a class="elsevierStyleCrossRef" href="#bib0080">16</a>; this is designed to quantify (in metabolic equivalents [METs]/min/week) the amount of exercise taken in a week performing various activities (including household chores, employment, sport and recreation). The following categories were used in the analysis: sedentary lifestyle (<600 METs/min/week); moderate exercise (600–3000 METs/min/week); and vigorous exercise (>3000 METs/min/week).At each assessment, all patients underwent treadmill exercise testing (ET), under their usual medication, to determine parameters of chronotropic and hemodynamic response. Maximum functional capacity during ET was estimated in METs, based on the metabolic equations of the American College of Sports Medicine for treadmill exercise,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> and total ET time was also recorded.Cardiac rehabilitation programThe CRP includes individual counseling on strategies for control of cardiovascular risk factors, supervised exercise sessions and group health education sessions.Supervised exerciseAll patients took part in twice-weekly exercise sessions supervised by a cardiologist, a physiatrist and a physiotherapist. The CRP lasts for 8–12 weeks depending on cardiac risk stratification, absence of complications during the program and patients’ availability based on the distance from their place of residence and need to return to work.Each session lasts between 60 and 90 minutes; the exercise protocol includes a warm-up period, aerobic training (treadmill and arm and leg ergometers), resistance training (using elastic bands, dumbbells, exercise balls and other strength training equipment), a cool-down period and flexibility exercises. The intensity of aerobic exercise was determined for each individual patient, based on their exercise heart rate calculated by the Karvonen formula<a class="elsevierStyleCrossRef" href="#bib0085">17</a> using the data obtained from ET, and complemented by the patient's rating of perceived exertion on the Borg scale.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Prior to each exercise session, a brief clinical assessment was performed that included a questionnaire on relevant symptoms and compliance with drug therapy, and measurement of baseline heart rate and BP; capillary glucose was also assessed in diabetic patients. Heart rate was continuously monitored during each session by remote ECG monitoring or heart rate monitor, in accordance with international guidelines on the appropriate level of supervision and monitoring for each patient.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>In addition, patients were encouraged to exercise on the other days of the week in accordance with the guidelines on secondary prevention.<a class="elsevierStyleCrossRefs" href="#bib0035">7,17</a>Health educationPeriodic group sessions involving patients and their relatives were held on various subjects, including “Coronary Artery Disease”, “Nutrition”, “Stress” and “Exercise”.When clinically indicated, patients were referred for specialist consultations in the unit, for endocrinology, psychiatry, smoking cessation, urology or vascular surgery. All diabetic patients were assessed by a nutritionist and prescribed an individualized diet program.Statistical analysisStatistical analysis of the data was performed using Statistical Package for the Social Sciences (SPSS) version 17.0. Continuous variables are presented as means ± standard deviation (SD) for those with normal distribution and as medians and interquartile range (P25–P75) for those with non-normal distribution. Differences within each patient group were assessed by the Student's t test for paired samples for continuous variables with normal distribution and by the Wilcoxon test for those with non-normal distribution. Differences in CRP response between the groups were assessed by the Student's t test to compare means and by the Mann-Whitney test to compare medians. Categorical variables were compared using the McNemar test for differences within groups and the chi-square test for differences between groups.Values of p<0.05 were considered statistically significant.ResultsThe study population consisted of 682 patients (253 diabetic and 429 non-diabetic). Both groups had a higher proportion of males. The most common admission diagnosis in both groups was ACS. Full characterization of the study population on admission to the CRP is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Diabetic patients were significantly older (61.6±9.1 vs. 58.6±11.0 years, p<0.001) and presented worse cardiovascular risk profiles (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>): greater prevalence of overweight (80.6% vs. 60.1%, p<0.001) and significantly higher BMI and WC; greater prevalence of dyslipidemia (76.3% vs. 64.3%, p=0.004) and significantly higher TG and lower HDL-C; and greater prevalence of hypertension (70.4% vs. 52.4%, p<0.001) and sedentary lifestyle (61.3% vs. 49.7%, p=0.013). However, they had a lower prevalence of smoking (21.7% vs. 37.1%, p<0.001). Functional capacity was significantly lower in diabetic patients: 7.9±2.1 METs vs. 9.1±2.4 METs, p<0.001; ET duration: 6:51±2:08 min:s vs. 8:22±2:43 min:s, p<0.001.Changes in cardiovascular risk factors over the study period in the diabetic and non-diabetic groups are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>, and <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> compares these changes between the two groups. <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows changes in functional capacity in each group, and compares the two groups.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>ObesityOverweight was the most prevalent cardiovascular risk factor in the diabetic group (80.6%), of whom 22.9% were obese.Both groups showed improved anthropometric parameters over the course of the CRP (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>). The improvement was similar in the two groups for WC (p=0.058) but not for BMI, the mean decrease in BMI being significantly greater in absolute terms in the non-diabetic group (p=0.008).HypertensionOn admission to the CRP, 70.4% of diabetic and 52.4% of non-diabetic patients had a history of hypertension. At the first assessment, 28.1% of the diabetic group and 21.0% of the non-diabetic group presented high BP. Following the CRP, there was a significant decrease in the number of patients in both groups with uncontrolled BP (decrease of 70.4%, p<0.001, in the diabetic group and 80.0%, p<0.001, in the non-diabetic group), with a non-significant difference between the groups (p=0.195).DyslipidemiaDyslipidemia was the most common cardiovascular risk factor among non-diabetic patients (64.3%).At the end of phase II of the CRP, an improved lipid profile was seen in both groups, reflected in both a significant decrease in TC, LDL-C and TG and a significant increase in HDL-C (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>).Changes in the various lipid parameters following the CRP were similar in both groups, except for the decrease in TG, which in absolute terms was significantly greater in diabetic patients (p=0.039).SmokingOn admission to the program, 21.7% of the diabetic group and 37.1% of the non-diabetic group were smokers. At the end of phase II, there was a 90.0% reduction in the number of smokers in the diabetic group (p<0.001) and an 83.6% reduction in the non-diabetic group (p<0.001), a similar decrease in both groups (p=0.266).There was also a significant reduction in the number of cigarettes per day (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>), with no significant difference between the groups (p=0.194).Diabetes mellitusDiabetic patients showed improved control of DM following the CRP, reflected in significant reductions in fasting glucose and HbA1c (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).Sedentary lifestyleAt the beginning of the study, 61.3% of the diabetic group and 49.7% of the non-diabetic group had sedentary lifestyles, as shown by their IPAQ scores.Both groups showed significantly increased levels of physical activity over the course of the CRP, as expressed by their weekly exercise measured by the IPAQ (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>). The increase in IPAQ scores was similar in the two groups (p=0.628).Functional capacityAt the start of the study, diabetic patients presented worse functional capacity (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). By the end of the CRP, both groups showed significant improvement in mean METs (+1.3 [1.2], p<0.001, in the diabetic group vs. +1.5 [1.2], p<0.001, in the non-diabetic group) and in ET duration (+1:32 [1:22] min:s, p<0.001, in the diabetic group vs. +1:51 [2:56] min:s, p<0.001, in the non-diabetic group) (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). There was a significantly smaller improvement in functional capacity in the diabetic group in terms of METs (p=0.042), as well as in ET duration, although without statistical significance in the latter (p=0.107) (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).DiscussionThe metabolic abnormalities that characterize DM, particularly hyperglycemia, increased free fatty acids and insulin resistance, lead to changes at the molecular level that result in decreased availability of nitric oxide and increased oxidative stress, which in turn lead to vascular dysfunction.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> This accelerates atherosclerosis and thereby increases cardiovascular risk in diabetic patients.In 1997, the WHO considered overweight and obesity to be a rising epidemic, associated with five of the ten leading causes of death in industrialized countries: DM, IHD, stroke, atherosclerosis and some forms of cancer.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Obesity raises the risk of CAD, probably due to the adverse metabolic changes resulting from increased abdominal fat that play a central role in peripheral insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>There was a high prevalence of overweight and obesity in our study population, particularly in those with type 2 DM. The sedentary lifestyle found in 61.3% of the diabetic group may also have been a contributing factor.Unlike in other studies<a class="elsevierStyleCrossRefs" href="#bib0105">21,22</a> in which BMI did not fall significantly in diabetic patients, there was a significant decrease in BMI and WC in both groups by the end of phase II of the CRP. This may be due to the individualized assessment and counseling provided by a nutritionist in our program. In addition, all patients were given an individual exercise plan, although no specific measures were prescribed for obese patients.Hypertension and type 2 DM are frequently found together, which further increases the already higher cardiovascular risk of diabetic patients. The prevalence of hypertension in patients with diabetes is higher than in the general population (40–60% in those aged 45–75 years).<a class="elsevierStyleCrossRef" href="#bib0115">23</a> In our population, 70.4% of the diabetic group and 52.4% of the non-diabetic group presented hypertension, in agreement with other studies.<a class="elsevierStyleCrossRefs" href="#bib0120">24,25</a>Control of hypertension in diabetic patients is an essential preventive measure, since it reduces micro- and macrovascular complications, and target BP levels should be lower than in non-diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Each 10-mmHg decrease in systolic BP is associated with an average 12% reduction in diabetes-related complications, particularly cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>At the initial assessment, 28.1% of the diabetic group and 21.0% of the non-diabetic group presented elevated BP, and thus most patients had controlled BP at the start of the CRP. This may be because most were under optimized antihypertensive therapy, having been referred following hospitalization in the cardiology department. There was a statistically significant decrease in the number of patients with uncontrolled hypertension over the study period. The benefits of regular aerobic exercise by lowering BP in hypertensive patients are well documented in the literature.<a class="elsevierStyleCrossRefs" href="#bib0140">28,29</a> Nevertheless, the pathophysiological mechanisms underlying the antihypertensive effects of exercise are the subject of debate. Some studies report reductions in total peripheral resistance, sympathetic nerve activity and plasma norepinephrine levels,<a class="elsevierStyleCrossRefs" href="#bib0145">29,30</a> while according to others there is increased total peripheral resistance in the post-exercise recovery period, associated with a significant decrease in cardiac output.<a class="elsevierStyleCrossRefs" href="#bib0145">29,31</a> Improved endothelial function following exercise may also contribute to its antihypertensive effect.<a class="elsevierStyleCrossRefs" href="#bib0145">29,32</a>The lipid profile in patients with type 2 DM is usually characterized by hypertriglyceridemia and low HDL-C. LDL-C levels are often similar to those in non-diabetic individuals, but LDL particles are generally smaller and denser in diabetic patients and hence highly atherogenic, so even though LDL-C concentrations are similar, the rates of CAD are higher in diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0165">33</a>Appropriate treatment of dyslipidemia can lead to significant reductions in cardiovascular morbidity and mortality in diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Studies have demonstrated that for each 1% increase in HDL-C levels, IHD progression decreases by around 3%.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> A meta-analysis assessing the effects of aerobic exercise on the lipid profile of patients with type 2 DM compared to controls found that exercise improved all lipid parameters, although only the decrease in LDL-C was statistically significant.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> In our study population, the diabetic group presented a higher prevalence of dyslipidemia, with significantly higher TG and lower HDL-C values.Favorable changes in all lipid parameters were seen in both groups over the study period; there was a significantly greater fall in TG levels in the diabetic group, which may be explained by the fact that the initial approach to hypertriglyceridemia is blood glucose control,<a class="elsevierStyleCrossRef" href="#bib0180">36</a> and this improved significantly in the diabetic group. Furthermore, all diabetic patients received individualized nutritional counseling, which stressed the importance of reducing saturated fat intake, in accordance with the American Diabetes Association guidelines.<a class="elsevierStyleCrossRef" href="#bib0180">36</a>Smoking is a major independent risk factor for micro- and macrovascular complications in DM, especially among women, and so smoking cessation has a far greater impact in diabetic than in non-diabetic patients.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> By the end of the study, there had been a striking reduction in both the number of smokers and the number of cigarettes per day for those who continued to smoke, which highlights the importance of CRPs in encouraging smoking cessation. However, caution is needed in interpreting these results given the short follow-up period of the study, less than the minimum six months’ abstinence used to define successful smoking cessation.Blood glucose control is essential in diabetic patients to reduce the risk of cardiovascular disease, since there is an exponential relationship between fasting glucose and the incidence of cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> There was a significant decrease in fasting glucose and HbA1c in the diabetic group, reflecting better DM control following the CRP. Structured aerobic exercise and resistance training reduce HbA1c by 0.4–0.6%<a class="elsevierStyleCrossRefs" href="#bib0190">38,39</a>; each 1% fall in HbA1c leads to a 15–20% reduction in the incidence of major cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0200">40</a> The benefits for glycemic control are even greater if aerobic exercise is combined with resistance training.<a class="elsevierStyleCrossRef" href="#bib0205">41</a>High levels of physical activity are associated with reductions in cardiovascular risk and total mortality decreases by 20–30% for every 4184 kJ/week of energy expenditure.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> In our study, weekly physical activity levels as assessed by the IPAQ increased significantly and by a similar amount in both groups, which was an unexpected finding, given that most patients with type 2 DM are less physically active than non-diabetic individuals, probably due to their higher incidence of physical limitations, lower exercise tolerance and heightened perception of discomfort during exercise.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> It is thus essential to implement measures that promote higher levels of physical activity.The diabetic group in our study had lower functional capacity as assessed in METs than the non-diabetic group, in agreement with other studies.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22,24,44–46</a> Even in the absence of complications, they present reduced peak oxygen uptake for their age and BMI.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Hyperglycemia is associated with increased stiffness of the great vessels, including the aorta, which reduces coronary artery blood flow and myocardial work capacity, and therefore overall exercise capacity.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> The less favorable anthropometric profile of diabetic patients, together with left ventricular dysfunction and impairment of cardiac autonomic regulation, contributes to their lower exercise capacity.<a class="elsevierStyleCrossRef" href="#bib0220">44</a>Both groups in our study showed significant improvement in functional capacity during the CRP, albeit less marked in the diabetic group. There are conflicting results in the literature concerning gains in exercise capacity in diabetic and non-diabetic patients. Some studies agree with our results, demonstrating improvement in diabetic patients which, while significant, is less pronounced than in non-diabetic individuals.<a class="elsevierStyleCrossRefs" href="#bib0225">45,46</a> However, others have reported significant gains that are similar in both patient groups.<a class="elsevierStyleCrossRefs" href="#bib0105">21,22,24,44,47</a> This discrepancy may be due to various factors, such as differences in the participants’ baseline characteristics (age, medication, disease severity, prevalence of comorbidities and exercise intensity) or differences in compliance with the exercise program or its duration.In the studies reporting less marked improvement in functional capacity in diabetic patients with CRPs, the reasons remain unclear, although it has been suggested that hyperglycemia plays an important role.<a class="elsevierStyleCrossRef" href="#bib0240">48</a> Other mechanisms may also contribute. Insulin is an important regulator of muscle proteins, stimulating the synthesis of mitochondrial proteins, and patients with type 2 DM generally present dysfunction of mitochondria in skeletal muscle. Given that peripheral muscle activity is the main factor governing exercise capacity, mitochondrial dysfunction may explain diabetic patients’ altered response to exercise.<a class="elsevierStyleCrossRef" href="#bib0240">48</a> Moreover, 42% of diabetic patients with no clinical evidence of peripheral vascular disease present significant lower-limb perfusion abnormalities, probably due to microvascular disease, which could also reduce the effect of cardiac rehabilitation on functional capacity.<a class="elsevierStyleCrossRef" href="#bib0245">49</a>The present study found an overall improvement in all parameters related to control of cardiovascular risk factors, as well as in functional capacity; the benefits derived from the CRP were similar in the diabetic group and the non-diabetic group in terms of reducing cardiovascular risk.This is the first study in Portugal to compare the results of a CRP in diabetic and non-diabetic patients in a large population sample.The learning process that takes place during the various sessions of the CRP encourages self-control of DM and self-discipline in maintaining a healthy lifestyle, together with self-monitoring of the possible complications and consequences of exercise on the clinical condition of diabetic patients.Study limitationsThe absence of a control group is a limitation as this would have enabled the natural evolution of the disease to be taken into account, but since comparative studies of usual care versus cardiac rehabilitation have consistently demonstrated the benefits of CRPs,<a class="elsevierStyleCrossRef" href="#bib0250">50</a> we are convinced that the favorable results found in both groups can be attributed specifically to the program.Another limitation is the short follow-up (three months), and so it is important to perform a long-term assessment.ConclusionsThe number of diabetic patients in CRPs is increasing, a trend that is likely to continue in view of the predicted rise in the prevalence of DM.The results of this study demonstrate that patients with type 2 DM may benefit from a CRP and achieve comparable results to non-diabetic patients in terms of improvements in their cardiovascular risk profile.Diabetic patients are at increased risk of cardiovascular events and thus need more aggressive secondary prevention measures. We therefore emphasize the importance of systematically referring diabetic patients to CRPs given their proven benefits in improving their quality of life.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres380890" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction and Aims" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec359708" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres380891" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução e objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec359709" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0015" "titulo" => "Cardiac rehabilitation program" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Supervised exercise" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Health education" ] ] ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Obesity" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Hypertension" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Dyslipidemia" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Smoking" ] 4 => array:2 [ "identificador" => "sec0060" "titulo" => "Diabetes mellitus" ] 5 => array:2 [ "identificador" => "sec0065" "titulo" => "Sedentary lifestyle" ] 6 => array:2 [ "identificador" => "sec0070" "titulo" => "Functional capacity" ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0080" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Conclusions" ] 10 => array:3 [ "identificador" => "sec0090" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0095" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0100" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0105" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0110" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-11-02" "fechaAceptado" => "2014-01-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec359708" "palabras" => array:5 [ 0 => "Cardiac rehabilitation" 1 => "Diabetes mellitus" 2 => "Ischemic heart disease" 3 => "Cardiovascular risk factors" 4 => "Functional capacity" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec359709" "palabras" => array:5 [ 0 => "Reabilitação cardíaca" 1 => "Diabetes mellitus" 2 => "Doença cardíaca isquémica" 3 => "Fatores de risco cardiovascular" 4 => "Capacidade funcional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Introduction and AimsDiabetic patients have a 2–4 times higher risk of cardiovascular disease than non-diabetic individuals.The aims of this study are to evaluate the effects of a cardiac rehabilitation program (phase II) in patients with diabetes and coronary disease and to compare the results with regard to control of cardiovascular risk factors and improvement in functional capacity with coronary patients without diabetes. MethodsThis was a prospective study of patients diagnosed with ischemic heart disease referred for a cardiac rehabilitation program between January 2009 and June 2013. The population was divided into two groups: diabetic and non-diabetic.Patients were assessed at the beginning of phase II and three months later and the following parameters were recorded: body mass index, waist circumference, lipid profile, blood glucose and glycated hemoglobin in diabetic patients, blood pressure, smoking, physical activity level (using the International Physical Activity Questionnaire) and functional capacity (on treadmill stress testing). ResultsThe study population consisted of 682 patients (253 diabetic and 429 non-diabetic). Diabetic patients were significantly older, had a worse cardiovascular risk profile (higher prevalence of overweight, dyslipidemia, hypertension and sedentary lifestyle) and lower functional capacity.At the end of phase II, there was a statistically significant improvement (p<0.05) in all risk factors and functional capacity, which was similar in both groups, except for body mass index, triglycerides and functional capacity. ConclusionsDiabetic patients may benefit from a cardiac rehabilitation program and achieve comparable results to non-diabetic patients." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "Introdução e objetivosDoentes diabéticos têm um risco de doença cardiovascular duas a quatro vezes superior a não diabéticos. Os objetivos do estudo são: avaliar os efeitos de um programa de reabilitação cardíaca (fase II) em doentes coronários diabéticos e comparar os seus resultados em termos de controlo de fatores de risco cardiovasculares e ganhos na capacidade funcional com doentes coronários não diabéticos. MétodosEstudo prospetivo integrando doentes com doença cardíaca isquémica orientados para programa de reabilitação cardíaca entre janeiro de 2009 e junho de 2013. Consideraram-se dois grupos: diabéticos e não diabéticos. Foram avaliados na primeira consulta da fase II e três meses depois, com registo dos seguintes parâmetros: índice de massa corporal, perímetro abdominal, perfil lipídico, hemoglobina glicada e glicose nos diabéticos, pressão arterial, tabagismo, nível de atividade física (através do International Physical Activity Questionnaire) e capacidade funcional (alcançada em prova de esforço). ResultadosAmostra de 682 doentes (253 diabéticos e 429 não diabéticos). Os diabéticos eram significativamente mais idosos, apresentavam pior perfil de risco cardiovascular (maior prevalência de excesso ponderal, dislipidemia, hipertensão arterial e sedentarismo) e menor capacidade funcional. No final da fase II ocorreu uma melhoria estatisticamente significativa (p<0,05) em todos os fatores de risco e na capacidade funcional, que foi semelhante nos dois grupos com exceção do índice de massa corporal, dos triglicerídeos e da capacidade funcional. ConclusõesDoentes diabéticos podem beneficiar com um programa de reabilitação cardíaca e alcançar resultados comparáveis a não diabéticos." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Toste S, Viamonte S, Barreira A, et al. Reabilitação cardíaca em doentes coronários com diabetes mellitus tipo 2: Estudo comparativo. Rev Port Cardiol. 2014;33:599–608." ] ] "nomenclatura" => array:1 [ 0 => array:3 [ "identificador" => "nom0005" "titulo" => "List of abbreviations" "listaDefinicion" => array:1 [ 0 => array:1 [ "definicion" => array:19 [ 0 => array:2 [ "termino" => "ACS" "descripcion" => "acute coronary syndrome" ] 1 => array:2 [ "termino" => "BMI" "descripcion" => "body mass index" ] 2 => array:2 [ "termino" => "BP" "descripcion" => "blood pressure" ] 3 => array:2 [ "termino" => "CAD" "descripcion" => "coronary artery disease" ] 4 => array:2 [ "termino" => "CRP" "descripcion" => "cardiac rehabilitation program" ] 5 => array:2 [ "termino" => "DM" "descripcion" => "diabetes mellitus" ] 6 => array:2 [ "termino" => "ET" "descripcion" => "exercise testing" ] 7 => array:2 [ "termino" => "HbA1c" "descripcion" => "glycated hemoglobin" ] 8 => array:2 [ "termino" => "HDL-C" "descripcion" => "high-density lipoprotein cholesterol" ] 9 => array:2 [ "termino" => "IHD" "descripcion" => "ischemic heart disease" ] 10 => array:2 [ "termino" => "IPAQ" "descripcion" => "International Physical Activity Questionnaire" ] 11 => array:2 [ "termino" => "LDL-C" "descripcion" => "low-density lipoprotein cholesterol" ] 12 => array:2 [ "termino" => "METs" "descripcion" => "metabolic equivalents" ] 13 => array:2 [ "termino" => "PCI" "descripcion" => "percutaneous coronary intervention" ] 14 => array:2 [ "termino" => "SD" "descripcion" => "standard deviation" ] 15 => array:2 [ "termino" => "TC" "descripcion" => "total cholesterol" ] 16 => array:2 [ "termino" => "TG" "descripcion" => "triglycerides" ] 17 => array:2 [ "termino" => "WC" "descripcion" => "waist circumference" ] 18 => array:2 [ "termino" => "WHO" "descripcion" => "World Health Organization" ] ] ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Values expressed as means (SD) or number (percentage) or median (interquartile range) [P50 (P25; P75)]. BMI: body mass index; CABG: coronary artery bypass grafting; ET: exercise test; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; METs: metabolic equivalents; PCI: percutaneous coronary intervention; SD: standard deviation; TC: total cholesterol; TG: triglycerides; WC: waist circumference." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Diabetic(n=253) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Non-diabetic(n=429) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.6 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.6 (11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">191 (75.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">338 (78.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.342 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Admission diagnosis</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute coronary syndrome, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">163 (64.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">324 (75.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post elective PCI, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (20.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 (15.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post CABG, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (14.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (8.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prevalence of cardiovascular risk factors</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI ≥25 kg/m2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">204 (80.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">258 (60.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">178 (70.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">225 (52.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">193 (76.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">276 (64.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (21.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159 (37.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sedentary lifestyle, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">155 (61.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">213 (49.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiovascular risk factors</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.8 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.3 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WC (cm), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.8 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.1 (9.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TC (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">178.0 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">177.1 (39.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.768 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL-C (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">109.4 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110.5 (32.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.686 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL-C (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.0 (31.0; 45.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.0 (32.0; 47.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.035 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TG (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143.0 (107.0; 207.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122.0 (98.5; 166.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Functional capacity</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ET intensity (METs), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.1 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ET duration (min:s), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6:51 (2:08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8:22 (2:43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580158.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study population on admission to the cardiac rehabilitation program." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Values expressed as means (SD) or number (percentage) or median (interquartile range) [P50 (P25; P75)]. BMI: body mass index; CPR: cardiac rehabilitation program; HbA1c: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; IPAQ: International Physical Activity Questionnaire; LDL-C: low-density lipoprotein cholesterol; METs: metabolic equivalents; SD: standard deviation; TC: total cholesterol; TG: triglycerides; WC: waist circumference." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Diabetic group (n=253) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-CPR assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.8 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.7 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WC (cm), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.8 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2.3 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High blood pressure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 (28.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 70.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TC (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">178.0 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−21.5 (41.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL-C (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">109.4 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.1 (33.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL-C (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.0 (31.0; 45.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+3.0 (−2.0; 8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TG (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143.0 (107.0; 207.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−24.0 (−64.0; 6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 90.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cigarettes/day, P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 (15.0; 30.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.0 (−30.0; −10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood glucose (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129.0 (106.0; 173.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−14.0 (−45.0; 0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HbA1c (%), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.6 (5.9; 8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.45 (−1.0; −0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPAQ score (METs/min/week), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">346.0 (0.0; 1006.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+1283.0 (693.0; 1923.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580160.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in cardiovascular risk factors after the cardiac rehabilitation program in diabetic patients." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Values expressed as means (SD) or number (percentage) or median (interquartile range) [P50 (P25; P75)]. BMI: body mass index; CPR: cardiac rehabilitation program; HDL-C: high-density lipoprotein cholesterol; IPAQ: International Physical Activity Questionnaire; LDL-C: low-density lipoprotein cholesterol; METs: metabolic equivalents; SD: standard deviation; TC: total cholesterol; TG: triglycerides; WC: waist circumference." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Non-diabetic group (n=429) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-CPR assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.3 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.9 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WC (cm), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.1 (9.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2.8 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High blood pressure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 (21.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 80.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TC (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">177.1 (39.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.8 (39.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL-C (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110.5 (32.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−21.0 (32.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL-C (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.0 (32.0; 47.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+4.0 (−1.0; 9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TG (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122.0 (98.5; 166.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−16.0 (−44.0; 7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159 (37.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 83.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cigarettes/day, P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 (10.0; 30.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.0 (−25.0. −10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPAQ score (METs/min/week), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">594.0 (0.0; 1386.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+1380.0 (597.0; 2289.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580159.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in cardiovascular risk factors after the cardiac rehabilitation program in non-diabetic patients." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Values expressed as means (SD) or number (percentage) or median (interquartile range) [P50 (P25; P75)]. BMI: body mass index; CPR: cardiac rehabilitation program; HDL-C: high-density lipoprotein cholesterol; IPAQ: International Physical Activity Questionnaire; LDL-C: low-density lipoprotein cholesterol; METs: metabolic equivalents; SD: standard deviation; TC: total cholesterol; TG: triglycerides; WC: waist circumference." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetic group(n=253) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-diabetic group(n=429) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (kg/m2), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.7 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.9 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WC (cm), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2.3 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−2.8 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.058 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High blood pressure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 70.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 80.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.195 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TC (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−21.5 (41.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.8 (39.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.806 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDL-C (mg/dl), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.1 (33.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−21.0 (32.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HDL-C (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+3.0 (−2.0; 8.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+4.0 (−1.0; 9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.148 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TG (mg/dl), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−24.0 (−64.0; 6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−16.0 (−44.0; 7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 90.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ 83.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.266 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cigarettes/day, P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.0 (−30.0; −10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−20.0 (−25.0; −10.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.194 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPAQ score (METs/min/week), P50 (P25; P75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1283.0 (693.0; 1923.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1380.0 (597.0; 2289.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.628 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580161.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of changes in cardiovascular risk factors after the cardiac rehabilitation program in the diabetic and non-diabetic groups." ] ] 4 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Values are expressed as means (SD). CRP: cardiac rehabilitation program; ET: exercise test; METs: metabolic equivalents; SD: standard deviation.p*: p value comparing the mean of differences between groups in response to the cardiac rehabilitation program." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Diabetic group (n=253)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Non-diabetic group (n=429)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p* \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-CRP assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Post-pre-CRP difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-CRP assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Post-pre-CRP difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">METs during ET, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+1.3 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.1 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+1.5 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of ET (min:s), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6:51 (2:08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+1:32 (1:22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8:22 (2:43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+1:51 (2:56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.107 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580157.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Changes in functional capacity after the cardiac rehabilitation program in each group and comparison between groups." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac rehabilitation and secondary prevention of coronary heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.A. 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Cardiac rehabilitation in patients with type 2 diabetes mellitus and coronary disease: A comparative study

Reabilitação cardíaca em doentes coronários com diabetes mellitus tipo 2: Estudo comparativo

Sofia Tostea,

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sofiatoste@gmail.com

Corresponding author.

, Sofia Viamontea, Ana Barreirab, Preza Fernandesb, José Lopes Gomesb, Severo Torresb

a Serviço de Fisiatria, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal

b Serviço de Cardiologia, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0100" class="elsevierStylePara elsevierViewall">Cardiac rehabilitation programs &#40;CRPs&#41; are multidisciplinary interventions that are designed to help cardiac patients achieve and maintain their maximum physical and psychosocial potential&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">CRPs are a valuable therapeutic option that provide multiple benefits by promoting healthy lifestyles and cardiovascular risk factor control&#44; symptom relief and optimization of functional capacity&#44; while reducing the incidence of new cardiovascular events&#44; thus helping patients to return to a productive and satisfying life&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Studies have reported a 25&#37; reduction in mortality following myocardial infarction &#40;MI&#41; in patients on CRPs compared to those not undergoing cardiac rehabilitation&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; CRPs continue to be underused in Portugal&#59; according to Diagnosis Related Groups data from 2007 and the 2007 survey of the Portuguese Society of Cardiology&#39;s Study Group on Exercise Physiology and Cardiac Rehabilitation&#44; only 3&#37; of patients discharged from hospital after MI were admitted to a CRP&#44; with even lower percentages for other cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In 2007&#44; Portugal was second from last in Europe for cardiac rehabilitation&#44; despite doubling patient numbers compared to 2004&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The clinical indications for a CRP include acute coronary syndrome &#40;ACS&#41;&#44; stable angina&#44; revascularization by percutaneous coronary intervention &#40;PCI&#41; or coronary artery bypass grafting&#44; valve surgery&#44; compensated heart failure and heart transplantation&#44; as well as for control of cardiovascular risk factors in patients at high risk of coronary artery disease &#40;CAD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">CRPs consist of three or four phases&#44; in accordance with the European<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and American<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> guidelines&#44; respectively&#44; beginning with admission for a cardiovascular event and ending at the point when the individual patient takes full responsibility for maintaining the strategies learned&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Patients with diabetes mellitus &#40;DM&#41; have a 2&#8211;4 times higher risk of cardiovascular disease&#44; particularly CAD&#44; than those without and DM doubles mortality due to a cardiovascular event&#44; even after adjustment for other cardiovascular risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The World Health Organization &#40;WHO&#41; has declared that DM is a major public health issue&#44; and that it is essential to implement health education measures&#44; given that there are predicted to be 366 million diabetic individuals worldwide by 2030&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In Portugal&#44; 11&#46;7&#37; of the population aged 20&#8211;79 years have diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Although mortality from coronary events has fallen in recent decades in the general population as a result of improved control of cardiovascular risk factors and more effective treatment of heart disease&#44; this has not been the case for diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The approach to reducing cardiovascular risk in diabetic patients includes diet modification&#44; control of cardiovascular risk factors&#44; regular exercise and drug therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> These strategies lead to favorable metabolic and endocrine responses&#44; which in the medium and long term will be reflected in reduced glycated hemoglobin &#40;HbA1c&#41;&#44; glucose intolerance and insulin resistance&#44; increased muscle glucose uptake&#44; reduced adipose tissue and increased exercise tolerance&#46; Together&#44; these benefits slow development of the micro- and macrovascular complications associated with DM&#44; thus reducing cardiovascular risk and improving patients&#8217; quality of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;13&#44;14</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Of patients referred for CRPs&#44; 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one at the beginning of the CRP and the second three months later&#46; The first assessment consisted of clinical history&#44; including sociodemographic data and personal and family history&#44; and physical examination of the cardiovascular&#44; musculoskeletal and neurological systems&#46; At both assessments&#44; data were collected on risk profile&#44; including blood pressure &#40;BP&#41;&#44; body mass index &#40;BMI&#41; &#40;in kg&#47;m<span class="elsevierStyleSup">2</span>&#41; and waist circumference &#40;WC&#41;&#44; smoking&#44; blood glucose and HbA1c&#44; and lipid profile after 12 hours fasting&#44; consisting of total cholesterol &#40;TC&#41;&#44; low-density lipoprotein cholesterol &#40;LDL-C&#41;&#44; high-density lipoprotein cholesterol &#40;HDL-C&#41; and triglycerides &#40;TG&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The following were used as reference values&#58; BP &#60;130&#47;80 mmHg in two consecutive measurements&#59; BMI 18&#8211;24&#46;9 kg&#47;m<span class="elsevierStyleSup">2</span> &#40;BMI 25&#8211;29&#46;9 kg&#47;m<span class="elsevierStyleSup">2</span> being classified as overweight and BMI &#8805;30 kg&#47;m<span class="elsevierStyleSup">2</span> being classified as obese&#41;&#59; WC &#60;80 cm in women and &#60;94 cm in men&#59; fasting capillary glucose &#60;110 mg&#47;dl and HbA1c &#60;6&#46;5&#37;&#59; TC &#60;190 mg&#47;dl&#44; LDL-C &#60;100 mg&#47;dl&#44; HDL-C &#62;45 mg&#47;dl in men and &#62;40 mg&#47;dl in women&#44; and TG &#60;150 mg&#47;dl&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Patients&#8217; level of physical activity was assessed using the International Physical Activity Questionnaire &#40;IPAQ&#41;&#44; which has been validated for the Portuguese population<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#59; this is designed to quantify &#40;in metabolic equivalents &#91;METs&#93;&#47;min&#47;week&#41; the amount of exercise taken in a week performing various activities &#40;including household chores&#44; employment&#44; sport and recreation&#41;&#46; The following categories were used in the analysis&#58; sedentary lifestyle &#40;&#60;600 METs&#47;min&#47;week&#41;&#59; moderate exercise &#40;600&#8211;3000 METs&#47;min&#47;week&#41;&#59; and vigorous exercise &#40;&#62;3000 METs&#47;min&#47;week&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">At each assessment&#44; all patients underwent treadmill exercise testing &#40;ET&#41;&#44; under their usual medication&#44; to determine parameters of chronotropic and hemodynamic response&#46; Maximum functional capacity during ET was estimated in METs&#44; based on the metabolic equations of the American College of Sports Medicine for treadmill exercise&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and total ET time was also recorded&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cardiac rehabilitation program</span><p id="par0175" class="elsevierStylePara elsevierViewall">The CRP includes individual counseling on strategies for control of cardiovascular risk factors&#44; supervised exercise sessions and group health education sessions&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Supervised exercise</span><p id="par0180" class="elsevierStylePara elsevierViewall">All patients took part in twice-weekly exercise sessions supervised by a cardiologist&#44; a physiatrist and a physiotherapist&#46; The CRP lasts for 8&#8211;12 weeks depending on cardiac risk stratification&#44; absence of complications during the program and patients&#8217; availability based on the distance from their place of residence and need to return to work&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Each session lasts between 60 and 90 minutes&#59; the exercise protocol includes a warm-up period&#44; aerobic training &#40;treadmill and arm and leg ergometers&#41;&#44; resistance training &#40;using elastic bands&#44; dumbbells&#44; exercise balls and other strength training equipment&#41;&#44; a cool-down period and flexibility exercises&#46; The intensity of aerobic exercise was determined for each individual patient&#44; based on their exercise heart rate calculated by the Karvonen formula<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> using the data obtained from ET&#44; and complemented by the patient&#39;s rating of perceived exertion on the Borg scale&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Prior to each exercise session&#44; a brief clinical assessment was performed that included a questionnaire on relevant symptoms and compliance with drug therapy&#44; and measurement of baseline heart rate and BP&#59; capillary glucose was also assessed in diabetic patients&#46; Heart rate was continuously monitored during each session by remote ECG monitoring or heart rate monitor&#44; in accordance with international guidelines on the appropriate level of supervision and monitoring for each patient&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">In addition&#44; patients were encouraged to exercise on the other days of the week in accordance with the guidelines on secondary prevention&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;17</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Health education</span><p id="par0200" class="elsevierStylePara elsevierViewall">Periodic group sessions involving patients and their relatives were held on various subjects&#44; including &#8220;Coronary Artery Disease&#8221;&#44; &#8220;Nutrition&#8221;&#44; &#8220;Stress&#8221; and &#8220;Exercise&#8221;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">When clinically indicated&#44; patients were referred for specialist consultations in the unit&#44; for endocrinology&#44; psychiatry&#44; smoking cessation&#44; urology or vascular surgery&#46; All diabetic patients were assessed by a nutritionist and prescribed an individualized diet program&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0210" class="elsevierStylePara elsevierViewall">Statistical analysis of the data was performed using Statistical Package for the Social Sciences &#40;SPSS&#41; version 17&#46;0&#46; Continuous variables are presented as means &#177; standard deviation &#40;SD&#41; for those with normal distribution and as medians and interquartile range &#40;P25&#8211;P75&#41; for those with non-normal distribution&#46; Differences within each patient group were assessed by the Student&#39;s t test for paired samples for continuous variables with normal distribution and by the Wilcoxon test for those with non-normal distribution&#46; Differences in CRP response between the groups were assessed by the Student&#39;s t test to compare means and by the Mann-Whitney test to compare medians&#46; Categorical variables were compared using the McNemar test for differences within groups and the chi-square test for differences between groups&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Values of p&#60;0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0220" class="elsevierStylePara elsevierViewall">The study population consisted of 682 patients &#40;253 diabetic and 429 non-diabetic&#41;&#46; Both groups had a higher proportion of males&#46; The most common admission diagnosis in both groups was ACS&#46; Full characterization of the study population on admission to the CRP is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">Diabetic patients were significantly older &#40;61&#46;6&#177;9&#46;1 vs&#46; 58&#46;6&#177;11&#46;0 years&#44; p&#60;0&#46;001&#41; and presented worse cardiovascular risk profiles &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; greater prevalence of overweight &#40;80&#46;6&#37; vs&#46; 60&#46;1&#37;&#44; p&#60;0&#46;001&#41; and significantly higher BMI and WC&#59; greater prevalence of dyslipidemia &#40;76&#46;3&#37; vs&#46; 64&#46;3&#37;&#44; p&#61;0&#46;004&#41; and significantly higher TG and lower HDL-C&#59; and greater prevalence of hypertension &#40;70&#46;4&#37; vs&#46; 52&#46;4&#37;&#44; p&#60;0&#46;001&#41; and sedentary lifestyle &#40;61&#46;3&#37; vs&#46; 49&#46;7&#37;&#44; p&#61;0&#46;013&#41;&#46; However&#44; they had a lower prevalence of smoking &#40;21&#46;7&#37; vs&#46; 37&#46;1&#37;&#44; p&#60;0&#46;001&#41;&#46; Functional capacity was significantly lower in diabetic patients&#58; 7&#46;9&#177;2&#46;1 METs vs&#46; 9&#46;1&#177;2&#46;4 METs&#44; p&#60;0&#46;001&#59; ET duration&#58; 6&#58;51&#177;2&#58;08 min&#58;s vs&#46; 8&#58;22&#177;2&#58;43 min&#58;s&#44; p&#60;0&#46;001&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Changes in cardiovascular risk factors over the study period in the diabetic and non-diabetic groups are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#44; and <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> compares these changes between the two groups&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows changes in functional capacity in each group&#44; and compares the two groups&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Obesity</span><p id="par0235" class="elsevierStylePara elsevierViewall">Overweight was the most prevalent cardiovascular risk factor in the diabetic group &#40;80&#46;6&#37;&#41;&#44; of whom 22&#46;9&#37; were obese&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Both groups showed improved anthropometric parameters over the course of the CRP &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;&#46; The improvement was similar in the two groups for WC &#40;p&#61;0&#46;058&#41; but not for BMI&#44; the mean decrease in BMI being significantly greater in absolute terms in the non-diabetic group &#40;p&#61;0&#46;008&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Hypertension</span><p id="par0245" class="elsevierStylePara elsevierViewall">On admission to the CRP&#44; 70&#46;4&#37; of diabetic and 52&#46;4&#37; of non-diabetic patients had a history of hypertension&#46; At the first assessment&#44; 28&#46;1&#37; of the diabetic group and 21&#46;0&#37; of the non-diabetic group presented high BP&#46; Following the CRP&#44; there was a significant decrease in the number of patients in both groups with uncontrolled BP &#40;decrease of 70&#46;4&#37;&#44; p&#60;0&#46;001&#44; in the diabetic group and 80&#46;0&#37;&#44; p&#60;0&#46;001&#44; in the non-diabetic group&#41;&#44; with a non-significant difference between the groups &#40;p&#61;0&#46;195&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Dyslipidemia</span><p id="par0250" class="elsevierStylePara elsevierViewall">Dyslipidemia was the most common cardiovascular risk factor among non-diabetic patients &#40;64&#46;3&#37;&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">At the end of phase II of the CRP&#44; an improved lipid profile was seen in both groups&#44; reflected in both a significant decrease in TC&#44; LDL-C and TG and a significant increase in HDL-C &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Changes in the various lipid parameters following the CRP were similar in both groups&#44; except for the decrease in TG&#44; which in absolute terms was significantly greater in diabetic patients &#40;p&#61;0&#46;039&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Smoking</span><p id="par0265" class="elsevierStylePara elsevierViewall">On admission to the program&#44; 21&#46;7&#37; of the diabetic group and 37&#46;1&#37; of the non-diabetic group were smokers&#46; At the end of phase II&#44; there was a 90&#46;0&#37; reduction in the number of smokers in the diabetic group &#40;p&#60;0&#46;001&#41; and an 83&#46;6&#37; reduction in the non-diabetic group &#40;p&#60;0&#46;001&#41;&#44; a similar decrease in both groups &#40;p&#61;0&#46;266&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">There was also a significant reduction in the number of cigarettes per day &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;&#44; with no significant difference between the groups &#40;p&#61;0&#46;194&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Diabetes mellitus</span><p id="par0275" class="elsevierStylePara elsevierViewall">Diabetic patients showed improved control of DM following the CRP&#44; reflected in significant reductions in fasting glucose and HbA1c &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Sedentary lifestyle</span><p id="par0280" class="elsevierStylePara elsevierViewall">At the beginning of the study&#44; 61&#46;3&#37; of the diabetic group and 49&#46;7&#37; of the non-diabetic group had sedentary lifestyles&#44; as shown by their IPAQ scores&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Both groups showed significantly increased levels of physical activity over the course of the CRP&#44; as expressed by their weekly exercise measured by the IPAQ &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;&#46; The increase in IPAQ scores was similar in the two groups &#40;p&#61;0&#46;628&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Functional capacity</span><p id="par0290" class="elsevierStylePara elsevierViewall">At the start of the study&#44; diabetic patients presented worse functional capacity &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; By the end of the CRP&#44; both groups showed significant improvement in mean METs &#40;&#43;1&#46;3 &#91;1&#46;2&#93;&#44; p&#60;0&#46;001&#44; in the diabetic group vs&#46; &#43;1&#46;5 &#91;1&#46;2&#93;&#44; p&#60;0&#46;001&#44; in the non-diabetic group&#41; and in ET duration &#40;&#43;1&#58;32 &#91;1&#58;22&#93; min&#58;s&#44; p&#60;0&#46;001&#44; in the diabetic group vs&#46; &#43;1&#58;51 &#91;2&#58;56&#93; min&#58;s&#44; p&#60;0&#46;001&#44; in the non-diabetic group&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; There was a significantly smaller improvement in functional capacity in the diabetic group in terms of METs &#40;p&#61;0&#46;042&#41;&#44; as well as in ET duration&#44; although without statistical significance in the latter &#40;p&#61;0&#46;107&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0295" class="elsevierStylePara elsevierViewall">The metabolic abnormalities that characterize DM&#44; particularly hyperglycemia&#44; increased free fatty acids and insulin resistance&#44; lead to changes at the molecular level that result in decreased availability of nitric oxide and increased oxidative stress&#44; which in turn lead to vascular dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This accelerates atherosclerosis and thereby increases cardiovascular risk in diabetic patients&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">In 1997&#44; the WHO considered overweight and obesity to be a rising epidemic&#44; associated with five of the ten leading causes of death in industrialized countries&#58; DM&#44; IHD&#44; stroke&#44; atherosclerosis and some forms of cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Obesity raises the risk of CAD&#44; probably due to the adverse metabolic changes resulting from increased abdominal fat that play a central role in peripheral insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">There was a high prevalence of overweight and obesity in our study population&#44; particularly in those with type 2 DM&#46; The sedentary lifestyle found in 61&#46;3&#37; of the diabetic group may also have been a contributing factor&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Unlike in other studies<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> in which BMI did not fall significantly in diabetic patients&#44; there was a significant decrease in BMI and WC in both groups by the end of phase II of the CRP&#46; This may be due to the individualized assessment and counseling provided by a nutritionist in our program&#46; In addition&#44; all patients were given an individual exercise plan&#44; although no specific measures were prescribed for obese patients&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Hypertension and type 2 DM are frequently found together&#44; which further increases the already higher cardiovascular risk of diabetic patients&#46; The prevalence of hypertension in patients with diabetes is higher than in the general population &#40;40&#8211;60&#37; in those aged 45&#8211;75 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In our population&#44; 70&#46;4&#37; of the diabetic group and 52&#46;4&#37; of the non-diabetic group presented hypertension&#44; in agreement with other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">Control of hypertension in diabetic patients is an essential preventive measure&#44; since it reduces micro- and macrovascular complications&#44; and target BP levels should be lower than in non-diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Each 10-mmHg decrease in systolic BP is associated with an average 12&#37; reduction in diabetes-related complications&#44; particularly cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">At the initial assessment&#44; 28&#46;1&#37; of the diabetic group and 21&#46;0&#37; of the non-diabetic group presented elevated BP&#44; and thus most patients had controlled BP at the start of the CRP&#46; This may be because most were under optimized antihypertensive therapy&#44; having been referred following hospitalization in the cardiology department&#46; There was a statistically significant decrease in the number of patients with uncontrolled hypertension over the study period&#46; The benefits of regular aerobic exercise by lowering BP in hypertensive patients are well documented in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> Nevertheless&#44; the pathophysiological mechanisms underlying the antihypertensive effects of exercise are the subject of debate&#46; Some studies report reductions in total peripheral resistance&#44; sympathetic nerve activity and plasma norepinephrine levels&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> while according to others there is increased total peripheral resistance in the post-exercise recovery period&#44; associated with a significant decrease in cardiac output&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;31</span></a> Improved endothelial function following exercise may also contribute to its antihypertensive effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;32</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">The lipid profile in patients with type 2 DM is usually characterized by hypertriglyceridemia and low HDL-C&#46; LDL-C levels are often similar to those in non-diabetic individuals&#44; but LDL particles are generally smaller and denser in diabetic patients and hence highly atherogenic&#44; so even though LDL-C concentrations are similar&#44; the rates of CAD are higher in diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0335" class="elsevierStylePara elsevierViewall">Appropriate treatment of dyslipidemia can lead to significant reductions in cardiovascular morbidity and mortality in diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Studies have demonstrated that for each 1&#37; increase in HDL-C levels&#44; IHD progression decreases by around 3&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> A meta-analysis assessing the effects of aerobic exercise on the lipid profile of patients with type 2 DM compared to controls found that exercise improved all lipid parameters&#44; although only the decrease in LDL-C was statistically significant&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> In our study population&#44; the diabetic group presented a higher prevalence of dyslipidemia&#44; with significantly higher TG and lower HDL-C values&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Favorable changes in all lipid parameters were seen in both groups over the study period&#59; there was a significantly greater fall in TG levels in the diabetic group&#44; which may be explained by the fact that the initial approach to hypertriglyceridemia is blood glucose control&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> and this improved significantly in the diabetic group&#46; Furthermore&#44; all diabetic patients received individualized nutritional counseling&#44; which stressed the importance of reducing saturated fat intake&#44; in accordance with the American Diabetes Association guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0345" class="elsevierStylePara elsevierViewall">Smoking is a major independent risk factor for micro- and macrovascular complications in DM&#44; especially among women&#44; and so smoking cessation has a far greater impact in diabetic than in non-diabetic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> By the end of the study&#44; there had been a striking reduction in both the number of smokers and the number of cigarettes per day for those who continued to smoke&#44; which highlights the importance of CRPs in encouraging smoking cessation&#46; However&#44; caution is needed in interpreting these results given the short follow-up period of the study&#44; less than the minimum six months&#8217; abstinence used to define successful smoking cessation&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Blood glucose control is essential in diabetic patients to reduce the risk of cardiovascular disease&#44; since there is an exponential relationship between fasting glucose and the incidence of cardiovascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> There was a significant decrease in fasting glucose and HbA1c in the diabetic group&#44; reflecting better DM control following the CRP&#46; Structured aerobic exercise and resistance training reduce HbA1c by 0&#46;4&#8211;0&#46;6&#37;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a>&#59; each 1&#37; fall in HbA1c leads to a 15&#8211;20&#37; reduction in the incidence of major cardiovascular events&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> The benefits for glycemic control are even greater if aerobic exercise is combined with resistance training&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p><p id="par0355" class="elsevierStylePara elsevierViewall">High levels of physical activity are associated with reductions in cardiovascular risk and total mortality decreases by 20&#8211;30&#37; for every 4184 kJ&#47;week of energy expenditure&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> In our study&#44; weekly physical activity levels as assessed by the IPAQ increased significantly and by a similar amount in both groups&#44; which was an unexpected finding&#44; given that most patients with type 2 DM are less physically active than non-diabetic individuals&#44; probably due to their higher incidence of physical limitations&#44; lower exercise tolerance and heightened perception of discomfort during exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> It is thus essential to implement measures that promote higher levels of physical activity&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">The diabetic group in our study had lower functional capacity as assessed in METs than the non-diabetic group&#44; in agreement with other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22&#44;24&#44;44&#8211;46</span></a> Even in the absence of complications&#44; they present reduced peak oxygen uptake for their age and BMI&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Hyperglycemia is associated with increased stiffness of the great vessels&#44; including the aorta&#44; which reduces coronary artery blood flow and myocardial work capacity&#44; and therefore overall exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> The less favorable anthropometric profile of diabetic patients&#44; together with left ventricular dysfunction and impairment of cardiac autonomic regulation&#44; contributes to their lower exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p><p id="par0365" class="elsevierStylePara elsevierViewall">Both groups in our study showed significant improvement in functional capacity during the CRP&#44; albeit less marked in the diabetic group&#46; There are conflicting results in the literature concerning gains in exercise capacity in diabetic and non-diabetic patients&#46; Some studies agree with our results&#44; demonstrating improvement in diabetic patients which&#44; while significant&#44; is less pronounced than in non-diabetic individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#44;46</span></a> However&#44; others have reported significant gains that are similar in both patient groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22&#44;24&#44;44&#44;47</span></a> This discrepancy may be due to various factors&#44; such as differences in the participants&#8217; baseline characteristics &#40;age&#44; medication&#44; disease severity&#44; prevalence of comorbidities and exercise intensity&#41; or differences in compliance with the exercise program or its duration&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">In the studies reporting less marked improvement in functional capacity in diabetic patients with CRPs&#44; the reasons remain unclear&#44; although it has been suggested that hyperglycemia plays an important role&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Other mechanisms may also contribute&#46; Insulin is an important regulator of muscle proteins&#44; stimulating the synthesis of mitochondrial proteins&#44; and patients with type 2 DM generally present dysfunction of mitochondria in skeletal muscle&#46; Given that peripheral muscle activity is the main factor governing exercise capacity&#44; mitochondrial dysfunction may explain diabetic patients&#8217; altered response to exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> Moreover&#44; 42&#37; of diabetic patients with no clinical evidence of peripheral vascular disease present significant lower-limb perfusion abnormalities&#44; probably due to microvascular disease&#44; which could also reduce the effect of cardiac rehabilitation on functional capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p><p id="par0375" class="elsevierStylePara elsevierViewall">The present study found an overall improvement in all parameters related to control of cardiovascular risk factors&#44; as well as in functional capacity&#59; the benefits derived from the CRP were similar in the diabetic group and the non-diabetic group in terms of reducing cardiovascular risk&#46;</p><p id="par0380" class="elsevierStylePara elsevierViewall">This is the first study in Portugal to compare the results of a CRP in diabetic and non-diabetic patients in a large population sample&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">The learning process that takes place during the various sessions of the CRP encourages self-control of DM and self-discipline in maintaining a healthy lifestyle&#44; together with self-monitoring of the possible complications and consequences of exercise on the clinical condition of diabetic patients&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Study limitations</span><p id="par0390" class="elsevierStylePara elsevierViewall">The absence of a control group is a limitation as this would have enabled the natural evolution of the disease to be taken into account&#44; but since comparative studies of usual care versus cardiac rehabilitation have consistently demonstrated the benefits of CRPs&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> we are convinced that the favorable results found in both groups can be attributed specifically to the program&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">Another limitation is the short follow-up &#40;three months&#41;&#44; and so it is important to perform a long-term assessment&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusions</span><p id="par0400" class="elsevierStylePara elsevierViewall">The number of diabetic patients in CRPs is increasing&#44; a trend that is likely to continue in view of the predicted rise in the prevalence of DM&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">The results of this study demonstrate that patients with type 2 DM may benefit from a CRP and achieve comparable results to non-diabetic patients in terms of improvements in their cardiovascular risk profile&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Diabetic patients are at increased risk of cardiovascular events and thus need more aggressive secondary prevention measures&#46; We therefore emphasize the importance of systematically referring diabetic patients to CRPs given their proven benefits in improving their quality of life&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Ethical disclosures</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Protection of human and animal subjects</span><p id="par0415" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Confidentiality of data</span><p id="par0420" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Right to privacy and informed consent</span><p id="par0425" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflicts of interest</span><p id="par0430" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2013-11-02"
    "fechaAceptado" => "2014-01-27"
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            2 => "Ischemic heart disease"
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          "palabras" => array:5 [
            0 => "Reabilita&#231;&#227;o card&#237;aca"
            1 => "Diabetes <span class="elsevierStyleItalic">mellitus</span>"
            2 => "Doen&#231;a card&#237;aca isqu&#233;mica"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Aims</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Diabetic patients have a 2&#8211;4 times higher risk of cardiovascular disease than non-diabetic individuals&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The aims of this study are to evaluate the effects of a cardiac rehabilitation program &#40;phase II&#41; in patients with diabetes and coronary disease and to compare the results with regard to control of cardiovascular risk factors and improvement in functional capacity with coronary patients without diabetes&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This was a prospective study of patients diagnosed with ischemic heart disease referred for a cardiac rehabilitation program between January 2009 and June 2013&#46; The population was divided into two groups&#58; diabetic and non-diabetic&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Patients were assessed at the beginning of phase II and three months later and the following parameters were recorded&#58; body mass index&#44; waist circumference&#44; lipid profile&#44; blood glucose and glycated hemoglobin in diabetic patients&#44; blood pressure&#44; smoking&#44; physical activity level &#40;using the International Physical Activity Questionnaire&#41; and functional capacity &#40;on treadmill stress testing&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The study population consisted of 682 patients &#40;253 diabetic and 429 non-diabetic&#41;&#46; Diabetic patients were significantly older&#44; had a worse cardiovascular risk profile &#40;higher prevalence of overweight&#44; dyslipidemia&#44; hypertension and sedentary lifestyle&#41; and lower functional capacity&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">At the end of phase II&#44; there was a statistically significant improvement &#40;p&#60;0&#46;05&#41; in all risk factors and functional capacity&#44; which was similar in both groups&#44; except for body mass index&#44; triglycerides and functional capacity&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diabetic patients may benefit from a cardiac rehabilitation program and achieve comparable results to non-diabetic patients&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Doentes diab&#233;ticos t&#234;m um risco de doen&#231;a cardiovascular duas a quatro vezes superior a n&#227;o diab&#233;ticos&#46; Os objetivos do estudo s&#227;o&#58; avaliar os efeitos de um programa de reabilita&#231;&#227;o card&#237;aca &#40;fase II&#41; em doentes coron&#225;rios diab&#233;ticos e comparar os seus resultados em termos de controlo de fatores de risco cardiovasculares e ganhos na capacidade funcional com doentes coron&#225;rios n&#227;o diab&#233;ticos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo prospetivo integrando doentes com doen&#231;a card&#237;aca isqu&#233;mica orientados para programa de reabilita&#231;&#227;o card&#237;aca entre janeiro de 2009 e junho de 2013&#46; Consideraram-se dois grupos&#58; diab&#233;ticos e n&#227;o diab&#233;ticos&#46; Foram avaliados na primeira consulta da fase <span class="elsevierStyleSmallCaps">II</span> e tr&#234;s meses depois&#44; com registo dos seguintes par&#226;metros&#58; &#237;ndice de massa corporal&#44; per&#237;metro abdominal&#44; perfil lip&#237;dico&#44; hemoglobina glicada e glicose nos diab&#233;ticos&#44; press&#227;o arterial&#44; tabagismo&#44; n&#237;vel de atividade f&#237;sica &#40;atrav&#233;s do <span class="elsevierStyleItalic">International Physical Activity Questionnaire</span>&#41; e capacidade funcional &#40;alcan&#231;ada em prova de esfor&#231;o&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Amostra de 682 doentes &#40;253 diab&#233;ticos e 429 n&#227;o diab&#233;ticos&#41;&#46; Os diab&#233;ticos eram significativamente mais idosos&#44; apresentavam pior perfil de risco cardiovascular &#40;maior preval&#234;ncia de excesso ponderal&#44; dislipidemia&#44; hipertens&#227;o arterial e sedentarismo&#41; e menor capacidade funcional&#46; No final da fase <span class="elsevierStyleSmallCaps">II</span> ocorreu uma melhoria estatisticamente significativa &#40;p&#60;0&#44;05&#41; em todos os fatores de risco e na capacidade funcional&#44; que foi semelhante nos dois grupos com exce&#231;&#227;o do &#237;ndice de massa corporal&#44; dos triglicer&#237;deos e da capacidade funcional&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Doentes diab&#233;ticos podem beneficiar com um programa de reabilita&#231;&#227;o card&#237;aca e alcan&#231;ar resultados compar&#225;veis a n&#227;o diab&#233;ticos&#46;</p>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Toste S&#44; Viamonte S&#44; Barreira A&#44; et al&#46; Reabilita&#231;&#227;o card&#237;aca em doentes coron&#225;rios com diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2&#58; Estudo comparativo&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;599&#8211;608&#46;</p>"
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    ]
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      0 => array:3 [
        "identificador" => "nom0005"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
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          0 => array:1 [
            "definicion" => array:19 [
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                "termino" => "ACS"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>"
              ]
              1 => array:2 [
                "termino" => "BMI"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">body mass index</p>"
              ]
              2 => array:2 [
                "termino" => "BP"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">blood pressure</p>"
              ]
              3 => array:2 [
                "termino" => "CAD"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">coronary artery disease</p>"
              ]
              4 => array:2 [
                "termino" => "CRP"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">cardiac rehabilitation program</p>"
              ]
              5 => array:2 [
                "termino" => "DM"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">diabetes mellitus</p>"
              ]
              6 => array:2 [
                "termino" => "ET"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">exercise testing</p>"
              ]
              7 => array:2 [
                "termino" => "HbA1c"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">glycated hemoglobin</p>"
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              8 => array:2 [
                "termino" => "HDL-C"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">high-density lipoprotein cholesterol</p>"
              ]
              9 => array:2 [
                "termino" => "IHD"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">ischemic heart disease</p>"
              ]
              10 => array:2 [
                "termino" => "IPAQ"
                "descripcion" => "<p id="par0055" class="elsevierStylePara elsevierViewall">International Physical Activity Questionnaire</p>"
              ]
              11 => array:2 [
                "termino" => "LDL-C"
                "descripcion" => "<p id="par0060" class="elsevierStylePara elsevierViewall">low-density lipoprotein cholesterol</p>"
              ]
              12 => array:2 [
                "termino" => "METs"
                "descripcion" => "<p id="par0065" class="elsevierStylePara elsevierViewall">metabolic equivalents</p>"
              ]
              13 => array:2 [
                "termino" => "PCI"
                "descripcion" => "<p id="par0070" class="elsevierStylePara elsevierViewall">percutaneous coronary intervention</p>"
              ]
              14 => array:2 [
                "termino" => "SD"
                "descripcion" => "<p id="par0075" class="elsevierStylePara elsevierViewall">standard deviation</p>"
              ]
              15 => array:2 [
                "termino" => "TC"
                "descripcion" => "<p id="par0080" class="elsevierStylePara elsevierViewall">total cholesterol</p>"
              ]
              16 => array:2 [
                "termino" => "TG"
                "descripcion" => "<p id="par0085" class="elsevierStylePara elsevierViewall">triglycerides</p>"
              ]
              17 => array:2 [
                "termino" => "WC"
                "descripcion" => "<p id="par0090" class="elsevierStylePara elsevierViewall">waist circumference</p>"
              ]
              18 => array:2 [
                "termino" => "WHO"
                "descripcion" => "<p id="par0095" class="elsevierStylePara elsevierViewall">World Health Organization</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Values expressed as means &#40;SD&#41; or number &#40;percentage&#41; or median &#40;interquartile range&#41; &#91;P50 &#40;P25&#59; P75&#41;&#93;&#46; BMI&#58; body mass index&#59; CABG&#58; coronary artery bypass grafting&#59; ET&#58; exercise test&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; LDL-C&#58; low-density lipoprotein cholesterol&#59; METs&#58; metabolic equivalents&#59; PCI&#58; percutaneous coronary intervention&#59; SD&#58; standard deviation&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#59; WC&#58; waist circumference&#46;</p>"
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Admission diagnosis</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acute coronary syndrome&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163 &#40;64&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">324 &#40;75&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post elective PCI&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;20&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;15&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Post CABG&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;14&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;8&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Prevalence of cardiovascular risk factors</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMI &#8805;25 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">204 &#40;80&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">258 &#40;60&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178 &#40;70&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225 &#40;52&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193 &#40;76&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">276 &#40;64&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;21&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159 &#40;37&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sedentary lifestyle&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155 &#40;61&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">213 &#40;49&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiovascular risk factors</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;8 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;3 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>WC &#40;cm&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;8 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;1 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TC &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&#46;0 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177&#46;1 &#40;39&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;768&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL-C &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#46;4 &#40;34&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#46;5 &#40;32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;686&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HDL-C &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;0 &#40;31&#46;0&#59; 45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;0 &#40;32&#46;0&#59; 47&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TG &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&#46;0 &#40;107&#46;0&#59; 207&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#46;0 &#40;98&#46;5&#59; 166&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Functional capacity</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ET intensity &#40;METs&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;9 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ET duration &#40;min&#58;s&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#58;51 &#40;2&#58;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#58;22 &#40;2&#58;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab580158.png"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population on admission to the cardiac rehabilitation program&#46;</p>"
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      1 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Values expressed as means &#40;SD&#41; or number &#40;percentage&#41; or median &#40;interquartile range&#41; &#91;P50 &#40;P25&#59; P75&#41;&#93;&#46; BMI&#58; body mass index&#59; CPR&#58; cardiac rehabilitation program&#59; HbA1c&#58; glycated hemoglobin&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; IPAQ&#58; International Physical Activity Questionnaire&#59; LDL-C&#58; low-density lipoprotein cholesterol&#59; METs&#58; metabolic equivalents&#59; SD&#58; standard deviation&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#59; WC&#58; waist circumference&#46;</p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Diabetic group &#40;n&#61;253&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-CPR assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;8 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;7 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#40;cm&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;8 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;3 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High blood pressure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 70&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&#46;0 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;21&#46;5 &#40;41&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-C &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#46;4 &#40;34&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;1 &#40;33&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HDL-C &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;0 &#40;31&#46;0&#59; 45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;3&#46;0 &#40;&#8722;2&#46;0&#59; 8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TG &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&#46;0 &#40;107&#46;0&#59; 207&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;24&#46;0 &#40;&#8722;64&#46;0&#59; 6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 90&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cigarettes&#47;day&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0 &#40;15&#46;0&#59; 30&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;0 &#40;&#8722;30&#46;0&#59; &#8722;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Blood glucose &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#46;0 &#40;106&#46;0&#59; 173&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;14&#46;0 &#40;&#8722;45&#46;0&#59; 0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HbA1c &#40;&#37;&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;6 &#40;5&#46;9&#59; 8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;45 &#40;&#8722;1&#46;0&#59; &#8722;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPAQ score &#40;METs&#47;min&#47;week&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">346&#46;0 &#40;0&#46;0&#59; 1006&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;1283&#46;0 &#40;693&#46;0&#59; 1923&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Non-diabetic group &#40;n&#61;429&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-CPR assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;3 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;9 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#40;cm&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;1 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;8 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High blood pressure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;21&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 80&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177&#46;1 &#40;39&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;8 &#40;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-C &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110&#46;5 &#40;32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;21&#46;0 &#40;32&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HDL-C &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;0 &#40;32&#46;0&#59; 47&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;4&#46;0 &#40;&#8722;1&#46;0&#59; 9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TG &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#46;0 &#40;98&#46;5&#59; 166&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;16&#46;0 &#40;&#8722;44&#46;0&#59; 7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159 &#40;37&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 83&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cigarettes&#47;day&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0 &#40;10&#46;0&#59; 30&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;0 &#40;&#8722;25&#46;0&#46; &#8722;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPAQ score &#40;METs&#47;min&#47;week&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">594&#46;0 &#40;0&#46;0&#59; 1386&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;1380&#46;0 &#40;597&#46;0&#59; 2289&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Values expressed as means &#40;SD&#41; or number &#40;percentage&#41; or median &#40;interquartile range&#41; &#91;P50 &#40;P25&#59; P75&#41;&#93;&#46; BMI&#58; body mass index&#59; CPR&#58; cardiac rehabilitation program&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; IPAQ&#58; International Physical Activity Questionnaire&#59; LDL-C&#58; low-density lipoprotein cholesterol&#59; METs&#58; metabolic equivalents&#59; SD&#58; standard deviation&#59; TC&#58; total cholesterol&#59; TG&#58; triglycerides&#59; WC&#58; waist circumference&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetic group&#40;n&#61;253&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-diabetic group&#40;n&#61;429&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-post CRP difference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;7 <span class="elsevierStyleBold">&#40;</span>1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;9 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#40;cm&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;3 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;8 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High blood pressure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 70&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 80&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;195&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;21&#46;5 &#40;41&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;8 &#40;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-C &#40;mg&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;1 <span class="elsevierStyleBold">&#40;</span>33&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;21&#46;0 &#40;32&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">HDL-C &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;3&#46;0 &#40;&#8722;2&#46;0&#59; 8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;4&#46;0 &#40;&#8722;1&#46;0&#59; 9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TG &#40;mg&#47;dl&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;24&#46;0 &#40;&#8722;64&#46;0&#59; 6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;16&#46;0 &#40;&#8722;44&#46;0&#59; 7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 90&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; 83&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cigarettes&#47;day&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;0 &#40;&#8722;30&#46;0&#59; &#8722;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;20&#46;0 &#40;&#8722;25&#46;0&#59; &#8722;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;194&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPAQ score &#40;METs&#47;min&#47;week&#41;&#44; P50 &#40;P25&#59; P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1283&#46;0 &#40;693&#46;0&#59; 1923&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1380&#46;0 &#40;597&#46;0&#59; 2289&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;628&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Values are expressed as means &#40;SD&#41;&#46; CRP&#58; cardiac rehabilitation program&#59; ET&#58; exercise test&#59; METs&#58; metabolic equivalents&#59; SD&#58; standard deviation&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">p&#42;&#58; p value comparing the mean of differences between groups in response to the cardiac rehabilitation program&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-CRP assessment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Post-pre-CRP difference&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;9 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#43;1&#46;3 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#43;1&#46;5 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Duration of ET &#40;min&#58;s&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#43;1&#58;32 &#40;1&#58;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#58;22 &#40;2&#58;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;1&#58;51 &#40;2&#58;56&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab580157.png"
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Changes in functional capacity after the cardiac rehabilitation program in each group and comparison between groups&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:50 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac rehabilitation and secondary prevention of coronary heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;A&#46; Ades"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra001529"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "345"
                        "paginaInicial" => "892"
                        "paginaFinal" => "902"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11565523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac rehabilitation secondary prevention programs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2014.01.023

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Year/Month	Html	Pdf	Total

2024 November	11	7	18
2024 October	63	34	97
2024 September	71	28	99
2024 August	58	25	83
2024 July	54	33	87
2024 June	40	20	60
2024 May	68	30	98
2024 April	62	30	92
2024 March	62	17	79
2024 February	71	23	94
2024 January	46	42	88
2023 December	49	24	73
2023 November	61	37	98
2023 October	37	16	53
2023 September	28	34	62
2023 August	30	12	42
2023 July	26	13	39
2023 June	28	14	42
2023 May	53	25	78
2023 April	18	12	30
2023 March	55	29	84
2023 February	46	22	68
2023 January	35	18	53
2022 December	59	34	93
2022 November	59	31	90
2022 October	48	31	79
2022 September	34	33	67
2022 August	41	38	79
2022 July	52	46	98
2022 June	40	33	73
2022 May	41	28	69
2022 April	48	49	97
2022 March	44	48	92
2022 February	54	45	99
2022 January	59	27	86
2021 December	39	34	73
2021 November	62	33	95
2021 October	56	42	98
2021 September	24	26	50
2021 August	34	30	64
2021 July	19	31	50
2021 June	19	21	40
2021 May	29	31	60
2021 April	49	47	96
2021 March	80	23	103
2021 February	66	26	92
2021 January	33	16	49
2020 December	42	26	68
2020 November	39	18	57
2020 October	42	11	53
2020 September	56	8	64
2020 August	15	2	17
2020 July	48	7	55
2020 June	33	11	44
2020 May	39	5	44
2020 April	38	5	43
2020 March	34	6	40
2020 February	32	29	61
2020 January	41	9	50
2019 December	27	3	30
2019 November	39	9	48
2019 October	26	5	31
2019 September	17	7	24
2019 August	41	8	49
2019 July	41	10	51
2019 June	29	20	49
2019 May	35	8	43
2019 April	30	12	42
2019 March	18	7	25
2019 February	26	12	38
2019 January	24	11	35
2018 December	43	11	54
2018 November	95	12	107
2018 October	173	22	195
2018 September	36	17	53
2018 August	37	14	51
2018 July	29	7	36
2018 June	27	10	37
2018 May	45	22	67
2018 April	32	7	39
2018 March	45	4	49
2018 February	24	3	27
2018 January	27	4	31
2017 December	46	7	53
2017 November	56	16	72
2017 October	53	20	73
2017 September	43	19	62
2017 August	39	12	51
2017 July	35	16	51
2017 June	44	11	55
2017 May	39	15	54
2017 April	31	20	51
2017 March	35	9	44
2017 February	26	5	31
2017 January	34	3	37
2016 December	42	13	55
2016 November	25	8	33
2016 October	33	11	44
2016 September	25	6	31
2016 August	16	1	17
2016 July	12	9	21
2016 June	8	14	22
2016 May	15	7	22
2016 April	61	2	63
2016 March	78	31	109
2016 February	80	42	122
2016 January	96	20	116
2015 December	93	24	117
2015 November	65	18	83
2015 October	92	23	115
2015 September	73	20	93
2015 August	64	17	81
2015 July	62	8	70
2015 June	150	9	159
2015 May	56	15	71
2015 April	45	19	64
2015 March	63	17	80
2015 February	58	17	75
2015 January	41	19	60
2014 December	73	35	108
2014 November	109	40	149

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