2. Risk Factor Modification Cardiac Rehabilitation Programs GROUP B

abundant, 13

alcohol or drug abuse and dependence, 13

angiography, 13

anxiety disorders, 13

approach, 13

approximately, 13

arrhythmias, 13

behavioural counselling, 13

blood glucose control, 13

complicated phenomena, 13

controlled heart failure, 13

coronary artery narrowing, 13

coronary bypass surgery, 13

coronary re-vascularization), 13

coronary spasm, 13

cost-benefit, 13

depressive or anxiety disorders, 13

discharge, at -, 13

drug therapy, 13

effectiveness, 13

plasma fibrinogen, 13

eligible patients, 13

employability, 13

excessive distress/stress and anger, 13

exercise-induced ischemia, 13

family and marital problems, 13

follow-up program, 13

guidelines, 13

health care professionals, 13

high-risk behaviours, 13

inadequate exercise tolerance, 13

inadequate social support, 13

in-hospital recovery phase, 13

initially, 13

latter, 13

lipid-lowering effect, 13

lipid-management program, 13

manifest, 13

moderate to severe depression, 13

multiple modifiable coronary risk factors, 13

nicotine gum or patches, 13

nutritional counselling, 13

nutritional recommendations, 13

outcome, 13

outpatient cardiac rehabilitation programs, 13

patient history, 13

pharmacological therapy, 13

plasma lipid and lipoprotein profile, 13

plasma triglyceride, 13

powerful facilitators, 13

psychological and physiological dependence, 13

psychosocial distress, 13

psychosocial interventions, 13

recovery, 13

recurrence, 13

referral liaisons, 13

registered dietician, 13

re-hospitalisation rates, 13

re-infarction, 13

relapse rate, 13

saturated fat, 13

self-help material, 13

self-sufficiency and productivity, 13

silent ischemia, 13

smoking cessation and maintenance of cessation, 13

social isolation, 13

sodium-restricted diets, 13

staff, 13

stress management, 13

subsequent referral, 13

substantial, 13

to determine, 13

to enrol in, 13

to monitor, 13

to necessitate, 13

to quit, 13

to succeed in, 13

treadmill testing, 13

work-related concerns, 13

I

Match the synonyms:

  1. approach
/
  1. efficiency

  1. discharge
/
  1. possible to be used

  1. effectiveness
/
  1. repetition of something

  1. employability
/
  1. observable facts

  1. guidelines
/
  1. release from hospital

  1. outcome
/
  1. medical appointment

  1. phenomena
/
  1. method

  1. recovery
/
  1. personnel

  1. recurrence
/
  1. guiding principles

  1. referral
/
  1. result

  1. staff
/
  1. recuperation

II

Match the synonyms:

  1. abundant
/

A.difficult

  1. approximately
/ B.acute
  1. complicated
/ C.entitled
  1. eligible
/ D.considerable
  1. inadequate
/ E.mentioned in the second place
  1. initially
/ F.following
  1. latter
/ G.rich
  1. manifest
/ H.reasonable
  1. moderate
/ I.in the beginning
  1. severe
/ J.poor
  1. subsequent
/ K.obvious
  1. substantial
/ L.more or less

III

Find the best context for the words below and use them in the correct form:

to determine to enrol in to monitor to necessitate to quit to succeed in

  1. I'm going to _____ smoking next week.
  2. They want to _____ their children _____ their local school.
  3. You need to be pretty tough to ______the property world.
  4. The new findings suggest that women ought to _____ their cholesterol levels.
  5. Reduction in government spending will _____ further cuts in public services and education.
  6. Once the medical examination had _____ that there was nothing seriously wrong with me, I felt much better.

IV

Read the text with your friend in your group and then discuss it with someone from the other group.

  1. What should the duration supervised participation in exercise training programs be based on?
  2. What is beneficial to patients with coronary artery disease (CAD)?
  3. What does angiography show in CAD patients?
  4. What should lipid-management programs include?
  5. Why are regular endurance programs important?.

Based on these guidelines, nutritional counselling should be provided to all participants in cardiac rehabilitation. It is desirable that a registered dietician provide such instructions. Specific additional nutritional recommendations can be made to obese patients about weight loss and to diabetic patients about blood glucose control. Sodium-restricted diets can be recommended for those with hypertension or heart failure.

  1. What is smoking in patients with CAD associated with?
  2. How do patients who quit smoking after an MI benefit?

Smoking cessation and maintenance of cessation are complicated phenomena involving both psychological and physiological dependence. A variety of techniques have been developed to aid in smoking cessation. The effectiveness of interventions varies, depending on the population and nature of the intervention. The following important conclusions can be drawn from several studies: (1) most smokers who succeed in stopping quit on their own; (2) interventions combining several components (such as those discussed below) are more successful than those relying on a single component; (3) the relapse rate is high for those who initially succeed at smoking cessation, and efforts must be directed toward maintenance of cessation; (4) health care professionals can be powerful facilitators of smoking behaviour change; and (5) pharmacological therapy for smoking cessation with nicotine gum or patches is much more effective when performed in conjunction with behavioural counselling.

  1. What should an organized approach to smoking cessation and maintenance of cessation consists of?
  2. What could follow-up programs offer to cardiac patients?
  3. Where could patients unable to maintain smoking cessation be sent?
  4. What could eligible patients obtain?

Psychosocial Interventions in Cardiac Rehabilitation Programs

Psychosocial problems are very common in patients enrolled in outpatient cardiac rehabilitation programs. Family and marital problems as well as social isolation are frequent. Moderate to severe depression occurs in 10% to 20% of patients after an MI, and anxiety disorders are manifest in approximately 5% to 10% of patients. Health education and counselling, psychotherapy, and stress management show promising results in improving the quality of life and reducing psychosocial distress among patients with CAD, especially in the early phases of recovery.

  1. What should patients entering cardiac rehabilitation programs be assessed for?
  2. Who should referral liaisons be established with?
  3. What else may be of additional benefit?

Return to Work

Improvement in functional capacity is likely to promote increased performance of activities among patients with cardiac disease that will foster self-sufficiency and productivity. However, assessing the effects of exercise training on rates of return to work is difficult because many additional factors appear to influence this outcome. Recommendations regarding return to work using data obtained from treadmill testing in patients after MI may reduce time until return to work. Published guidelines can assist physicians and health care providers in establishing the employability of patients with CAD, using information that can be reliably provided from patient history, physical examination, and exercise test evaluation.

  1. In what three ways are comprehensive cardiac rehabilitation programs cost effective?
  2. What patients should cardiac rehabilitation include?
  3. When should cardiac rehabilitation be introduced to MI, coronary bypass surgery, or cardiac transplantation patients?

Homework

I

Can you recognise phrases related with nutritional counselling?

  1. progression of
/
  1. control

  1. plasma lipid and lipoprotein
/
  1. patients

  1. obese
/
  1. profile

  1. diabetic
/
  1. levels

  1. increases in HDL cholesterol
/
  1. program

  1. Sodium-restricted
/
  1. recommendations

  1. nutritional
/
  1. patients

  1. blood glucose
/
  1. coronary artery narrowing

  1. lipid-management
/
  1. plasma triglyceride levels

  1. substantial lipid-lowering
/
  1. fat and cholesterol

  1. reductions in
/
  1. diets

  1. saturated
/
  1. effect

II

Can you identify problems connected with smoking cessation?

  1. elevated plasma
/
  1. counselling.

  1. maintenance of
/
  1. spasm

  1. psychological and physiological
/
  1. fibrinogen

  1. relapse
/
  1. programs

  1. coronary
/
  1. cessation

  1. follow-up
/
  1. gum or patches

  1. self-help
/
  1. dependence

  1. behavioural
/
  1. rate

  1. nicotine
/
  1. materials

III

Are you familiar with the main issues related with psychosocial interventions in cardiac rehabilitation?

  1. work-related
/
  1. abuse and dependence

  1. referral
/
  1. anxiety disorders

  1. social
/
  1. marital problems

  1. outpatient cardiac
/
  1. concerns

  1. psychosocial
/
  1. rehabilitation programs

  1. inadequate social
/
  1. distress

  1. alcohol or drug
/
  1. liaisons

  1. family and
/
  1. isolation

  1. depressive or
/
  1. support