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Physical activity after coronary revascularization
Atividade física após revascularização coronária
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array:2 [ "nombre" => "Yesim" "apellidos" => "Guray" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117306613?idApp=UINPBA00004E" "url" => "/08702551/0000003600000010/v2_201711040052/S0870255117306613/v2_201711040052/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Physical activity after coronary revascularization" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "729" "paginaFinal" => "730" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Roberto Palma dos Reis" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Roberto" "apellidos" => "Palma dos Reis" "email" => array:1 [ 0 => "palma.reis@nms.unl.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidade de Cardiologia do Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Atividade física após revascularização coronária" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sedentary lifestyle is a reversible risk factor for cardiovascular disease (CVD) and CVD mortality.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2</span></a> Conversely, regular physical activity (PA) reduces vascular mortality by 20-30% in healthy individuals and in patients with coronary artery disease (CAD).<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2,3</span></a> In this context, PA leads to significant improvements in prognosis, particularly in CAD patients with or without intervention.</p><p id="par0010" class="elsevierStylePara elsevierViewall">PA increases fitness and improves mental health, as well as exerting a positive effect on various risk factors, including hypertension, LDL cholesterol and triglyceride levels, diabetes and overweight.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4,5</span></a> The improvements resulting from PA are independent of and additional to those of drugs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In their study published in this issue of the <span class="elsevierStyleItalic">Journal</span>,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> Acar et al. analyze the factors influencing PA in patients who have undergone coronary revascularization. In a population in which most patients (77%) were inactive, the parameters influencing sedentary habits on multivariate analysis were low education level and lack of regular follow-up.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first point to be noted in this study is the low level of regular PA in these patients (only 23%). Bearing in mind the known benefits of PA, this means that intervention in this area could significantly improve prognosis of CAD patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">An interesting finding in this paper is that, counterintuitively, age, body mass index, functional status and comorbidities presented no significant relation with PA levels. The sample is of reasonable size (202 patients), but not large, and it is plausible that the results would be different with a larger sample. But in the present study, all patients – young and old, normal weight and obese, in high or low functional classes, with or without comorbidities – presented similar levels of PA.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This implies that to achieve a physically active lifestyle, more important than physical capacity is awareness of the benefits of exercise (which is more likely with a higher education level) and willingness to make the effort, even with physical limitations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Employment status did not determine PA levels: patients who had retired presented similar PA levels to those still in employment, and, paradoxically, unemployment was associated with less PA (p=0.001).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Physicians cannot change patients’ educational level, but, with time and dedication, patients can be informed of the benefits of PA and persuaded to increase their exercise levels.</p><p id="par0045" class="elsevierStylePara elsevierViewall">At the same time, as the study shows, regular normal follow-up visits are important for maintaining good PA levels. It thus makes sense to maintain close follow-up of patients after a coronary revascularization procedure. It is vital to maintain appropriate medicines, but it is also important to maintain or achieve adequate levels of PA.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this context, clinicians’ workload should be adjusted in order to permit frequent follow-up visits for patients after coronary revascularization, as well as to provide sufficient time to ensure that patients follow a PA program, if necessary by contacting missing patients or their families. A complete medical team, including nurses, nutritionists and cardiovascular specialists, are of particular value in this regard.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It makes no sense to invest in the best and most expensive technologies, like coronary artery bypass grafting or multiple percutaneous coronary intervention, and then to abandon the patient without using less costly but effective measures, such as appropriate medication and PA programs, thereby risking losing the previous investment.</p><p id="par0060" class="elsevierStylePara elsevierViewall">I believe that the best way to obtain a good level of PA after coronary revascularization is to include the patient in a comprehensive cardiac rehabilitation program (CRP) as soon as possible after the procedure.</p><p id="par0065" class="elsevierStylePara elsevierViewall">It is known that after a coronary intervention patients are more willing to adopt healthier lifestyles, reducing smoking and alcohol consumption and making efforts to have a more balanced diet.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> This is a good opportunity to increase PA levels, ideally beginning with a CRP.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Despite the reported benefits of CRPs in CAD patients, these programs are scarce and unavailable to most patients. In a 1998 survey the overall admission rate of CAD patients to a CRP in Portugal was only 0.7%.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> The number of cardiac rehabilitation centers in Portugal increased between 1998 and 2014 from seven to 22 (12 public and 10 private, most in the Lisbon and Porto areas).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> But 22 centers, not evenly distributed throughout the country, are insufficient for the needs of the large number of CAD patients who undergo coronary intervention. It can be concluded that CRPs are a health area with considerable room for improvement.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The present paper, raising the issue of PA after coronary intervention and its determining factors, deserves special attention.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.M. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 3 | 9 |
| 2024 Outubro | 42 | 26 | 68 |
| 2024 Setembro | 48 | 21 | 69 |
| 2024 Agosto | 49 | 23 | 72 |
| 2024 Julho | 40 | 28 | 68 |
| 2024 Junho | 29 | 18 | 47 |
| 2024 Maio | 35 | 14 | 49 |
| 2024 Abril | 40 | 30 | 70 |
| 2024 Maro | 29 | 19 | 48 |
| 2024 Fevereiro | 30 | 22 | 52 |
| 2024 Janeiro | 29 | 25 | 54 |
| 2023 Dezembro | 40 | 27 | 67 |
| 2023 Novembro | 35 | 25 | 60 |
| 2023 Outubro | 26 | 15 | 41 |
| 2023 Setembro | 22 | 15 | 37 |
| 2023 Agosto | 27 | 19 | 46 |
| 2023 Julho | 20 | 15 | 35 |
| 2023 Junho | 39 | 10 | 49 |
| 2023 Maio | 38 | 17 | 55 |
| 2023 Abril | 23 | 9 | 32 |
| 2023 Maro | 35 | 25 | 60 |
| 2023 Fevereiro | 34 | 21 | 55 |
| 2023 Janeiro | 14 | 12 | 26 |
| 2022 Dezembro | 38 | 27 | 65 |
| 2022 Novembro | 45 | 28 | 73 |
| 2022 Outubro | 43 | 29 | 72 |
| 2022 Setembro | 17 | 38 | 55 |
| 2022 Agosto | 31 | 44 | 75 |
| 2022 Julho | 34 | 50 | 84 |
| 2022 Junho | 16 | 21 | 37 |
| 2022 Maio | 23 | 30 | 53 |
| 2022 Abril | 26 | 32 | 58 |
| 2022 Maro | 27 | 54 | 81 |
| 2022 Fevereiro | 24 | 36 | 60 |
| 2022 Janeiro | 24 | 35 | 59 |
| 2021 Dezembro | 20 | 27 | 47 |
| 2021 Novembro | 43 | 44 | 87 |
| 2021 Outubro | 40 | 40 | 80 |
| 2021 Setembro | 26 | 22 | 48 |
| 2021 Agosto | 38 | 35 | 73 |
| 2021 Julho | 22 | 13 | 35 |
| 2021 Junho | 32 | 35 | 67 |
| 2021 Maio | 28 | 44 | 72 |
| 2021 Abril | 56 | 45 | 101 |
| 2021 Maro | 55 | 23 | 78 |
| 2021 Fevereiro | 53 | 17 | 70 |
| 2021 Janeiro | 26 | 19 | 45 |
| 2020 Dezembro | 30 | 21 | 51 |
| 2020 Novembro | 45 | 18 | 63 |
| 2020 Outubro | 34 | 10 | 44 |
| 2020 Setembro | 56 | 19 | 75 |
| 2020 Agosto | 10 | 9 | 19 |
| 2020 Julho | 45 | 15 | 60 |
| 2020 Junho | 31 | 18 | 49 |
| 2020 Maio | 15 | 7 | 22 |
| 2020 Abril | 28 | 23 | 51 |
| 2020 Maro | 31 | 12 | 43 |
| 2020 Fevereiro | 37 | 13 | 50 |
| 2020 Janeiro | 21 | 9 | 30 |
| 2019 Dezembro | 22 | 7 | 29 |
| 2019 Novembro | 29 | 10 | 39 |
| 2019 Outubro | 22 | 8 | 30 |
| 2019 Setembro | 22 | 7 | 29 |
| 2019 Agosto | 30 | 13 | 43 |
| 2019 Julho | 69 | 4 | 73 |
| 2019 Junho | 90 | 16 | 106 |
| 2019 Maio | 109 | 8 | 117 |
| 2019 Abril | 54 | 14 | 68 |
| 2019 Maro | 18 | 11 | 29 |
| 2019 Fevereiro | 32 | 5 | 37 |
| 2019 Janeiro | 12 | 4 | 16 |
| 2018 Dezembro | 37 | 10 | 47 |
| 2018 Novembro | 51 | 12 | 63 |
| 2018 Outubro | 80 | 14 | 94 |
| 2018 Setembro | 25 | 10 | 35 |
| 2018 Agosto | 18 | 12 | 30 |
| 2018 Julho | 13 | 9 | 22 |
| 2018 Junho | 32 | 10 | 42 |
| 2018 Maio | 37 | 12 | 49 |
| 2018 Abril | 46 | 10 | 56 |
| 2018 Maro | 62 | 10 | 72 |
| 2018 Fevereiro | 25 | 9 | 34 |
| 2018 Janeiro | 20 | 18 | 38 |
| 2017 Dezembro | 37 | 20 | 57 |
| 2017 Novembro | 140 | 38 | 178 |
| 2017 Outubro | 6 | 9 | 15 |
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