OBJECTIVE: To evaluate the accuracy of a smartphone application measuring heart rates (HRs), during an exercise and discussed clinical potential of the smartphone application for cardiac rehabilitation exercise programs. METHODS: Patients with heart disease (14 with myocardial infarction, 2 with angina pectoris) were recruited. Exercise protocol was comprised of a resting stage, Bruce stage II, Bruce stage III, and a recovery stage. To measure HR, subjects held smartphone in their hands and put the tip of their index finger on the built-in camera for 1 minute at each exercise stage such as resting stage, Bruce stage II, Bruce stage III, and recovery stage. The smartphones recorded photoplethysmography signal and HR was calculated every heart beat. HR data obtained from the smartphone during the exercise protocol was compared with the HR data obtained from a Holter electrocardiography monitor (control). RESULTS: In each exercise protocol stage (resting stage, Bruce stage II, Bruce stage III, and the recovery stage), the HR averages obtained from a Holter monitor were 76.40±12.73, 113.09±14.52, 115.64±15.15, and 81.53±13.08 bpm, respectively. The simultaneously measured HR averages obtained from a smartphone were 76.41±12.82, 112.38±15.06, 115.83±15.36, and 81.53±13 bpm, respectively. The intraclass correlation coefficient (95% confidence interval) was 1.00 (1.00–1.00), 0.99 (0.98–0.99), 0.94 (0.83–0.98), and 1.00 (0.99–1.00) in resting stage, Bruce stage II, Bruce stage III, and recovery stage, respectively. There was no statistically significant difference between the HRs measured by either device at each stage (p>0.05). CONCLUSION: The accuracy of measured HR from a smartphone was almost overlapped with the measurement from the Holter monitor in resting stage and recovery stage. However, we observed that the measurement error increased as the exercise intensity increased.
Electrocardiography, Ambulatory ; Fingers ; Hand ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Male* ; Myocardial Infarction ; Myocardial Ischemia* ; Photoplethysmography ; Rehabilitation ; Smartphone*

OBJECTIVE: To observe the effect and safety of cardiac rehabilitation (CR) exercise in ischemic cardiomyopathy and to compare the results between patients with preserved left ventricular ejection fraction (LVEF) and reduced LVEF. METHODS: Patients with ischemic cardiomyopathy with LVEF <50% were included as subjects. The patients were classified into the preserved LVEF (pLVEF; LVEF 41%–49%) group and the reduced LVEF (rLVEF; LVEF ≤40%) group. Patients underwent hourly aerobic exercise training sessions with an intensity of 60%–85% of heart rate reserve, three times a week for 6 weeks. Graded exercise test and transthoracic echocardiogram were performed in all study patients before and after completion of the CR exercise program. RESULTS: After completion of the CR exercise program, both groups (pLVEF, n=30; rLVEF, n=18) showed significant increases in LVEF and VO(2max). In the pLVEF group, LVEF and VO(2max) increased from 45.1%±4.8% to 52.5%±9.6% (p<0.001) and from 24.1±6.3 to 28.1±8.8 mL/kg/min (p=0.002), respectively. In the rLVEF group, LVEF and VO(2max) increased from 29.7%±7.7% to 37.6%±10.3% (p<0.001) and from 17.6±4.7 to 21.2±5.1 mL/kg/min (p<0.001), respectively. Both groups completed their exercise program safely. CONCLUSION: In both groups, patients with ischemic cardiomyopathy who completed a 6-week supervised CR exercise program demonstrated remarkable improvements in cardiopulmonary function. This result implies that neither of the two groups showed higher efficacy in comparison to each other, but we can conclude that CR exercise in the rLVEF group was as effective and safe as that in the pLVEF group.
Cardiomyopathies* ; Exercise ; Exercise Test ; Exercise Therapy ; Heart Rate ; Humans ; Myocardial Ischemia ; Rehabilitation* ; Stroke Volume*

PURPOSE: This study was to analyze research reports published in Korea on cardiac rehabilitation for patients with cardiovascular disease. METHODS: Based on inclusion criteria, 19 research reports were included in this review. Published year of selected articles was between 1996 and 2008. Nineteen studies were analyzed by guidelines of the cardiac rehabilitation programs done by the American Heart Association (AHA) and Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The characteristics of patients were mostly of ischemic heart disease, 50-59 yr old, and male. Educational sessions were administered twice, and each lesson lasted less than 30 min. Exercise was done 3 times per week for 6 weeks. Most educational content were about risk factors, but there was no information, such as coping with feelings. Most exercise was performed as ROM, treadmill, and cycle ergometer. A large percentage of outcome indicators were health behavior, hemodynamic changes, and exercise capacity. There was more 'no effect' than 'positive effect' in trait anxiety and depression, whereas similar in physiologic domain. CONCLUSION: Various types of cardiac rehabilitation in Korea were performed by researchers. Therefore, we need to develop the standard protocol, to add psychosocial intervention, and to study cost effectiveness of cardiac rehabilitation.
Cardiovascular Diseases/*rehabilitation ; Exercise Therapy ; Humans ; Korea ; Male ; Myocardial Ischemia/rehabilitation ; Patient Education as Topic ; Program Development

Cardiovascular diseases including ischemic heart disease have been emerging as one of the most important public health problems in Korea. Although secondary prevention and rehabilitation are essential components in the management of patients with ischemic heart disease, its program has not been provided to all the patients. There are several barriers, such as availability and accessibility, low awareness of both patients and physicians in implementing cardiac rehabilitation program. Home-based and community-based programs under the direction of medical supervision are needed to further widen its availability and accessibility, as well as hospital-based programs. Cardiac rehabilitation programs emphasize risk factor control and life style change, besides exercise training. Health education, diet, counseling, psychosocial support, and exercise are all important in restoring the patient's quality of life. For this purpose, cardiac rehabilitation should be well integrated with preventive cardiology, and a multidisciplinary approach is mandatory. Since Korean society is very rapidly aging, a big impact on future trend of ischemic heart disease, preventive cardiology and cardiac rehabilitation will play a very important role to overcome the approaching wave of cardiovascular epidemic.
Aging ; Cardiology ; Cardiovascular Diseases ; Coronary Artery Disease* ; Coronary Vessels* ; Counseling ; Diet ; Health Education ; Humans ; Korea ; Life Style ; Myocardial Ischemia ; Organization and Administration ; Public Health ; Quality of Life ; Rehabilitation* ; Risk Factors ; Secondary Prevention

Cardiovascular diseases including ischemic heart disease have been emerging as one of the most important public health problems in Korea. Although secondary prevention and rehabilitation are essential components in the management of patients with ischemic heart disease, its program has not been provided to all the patients. There are several barriers, such as availability and accessibility, low awareness of both patients and physicians in implementing cardiac rehabilitation program. Home-based and community-based programs under the direction of medical supervision are needed to further widen its availability and accessibility, as well as hospital-based programs. Cardiac rehabilitation programs emphasize risk factor control and life style change, besides exercise training. Health education, diet, counseling, psychosocial support, and exercise are all important in restoring the patient's quality of life. For this purpose, cardiac rehabilitation should be well integrated with preventive cardiology, and a multidisciplinary approach is mandatory. Since Korean society is very rapidly aging, a big impact on future trend of ischemic heart disease, preventive cardiology and cardiac rehabilitation will play a very important role to overcome the approaching wave of cardiovascular epidemic.
Aging ; Cardiology ; Cardiovascular Diseases ; Coronary Artery Disease* ; Coronary Vessels* ; Counseling ; Diet ; Health Education ; Humans ; Korea ; Life Style ; Myocardial Ischemia ; Organization and Administration ; Public Health ; Quality of Life ; Rehabilitation* ; Risk Factors ; Secondary Prevention

PURPOSE: This study was done to evaluate the effectiveness of cardiac rehabilitation education individualized to PCI patients in order to improve their knowledge of these diseases and to lessen their anxiety. METHOD: A Quasi-experimental design with non-equivalent control group non-synchronized design was used. The experimental group had the PCI operation for ischemic heart disease and individualized cardiac rehabilitation education and counseling twice for 25 minutes each time using an educational booklet developed by the authors. The effects of the education were analyzed using a knowledge assessment tool, state anxiety inventory and anxiety visual analogue scale. RESULTS: The experimental group who received the individualized cardiac rehabilitation education showed a high level of knowledge about diseases compared to the control group and particularly showed a significant difference in knowledge about the drugs used for treatment. However, no significant difference was observed between the two groups in the level of state anxiety and anxiety visual analogue scale.
Anxiety ; Counseling ; Education* ; Humans ; Myocardial Ischemia ; Pamphlets ; Percutaneous Coronary Intervention* ; Rehabilitation*

PURPOSE: Despite the decrease in the number of lower limb amputation in ischemic limb patients as a result of advances in vascular reconstruction surgery, amputation still plays an important role in the management of end-stage peripheral vascular disease. Owing to the importance of the amputation level in postoperative rehabilitation and prevention of reamputation, there have been many reports defining theses level. Clinical characteristics were determined by retrospectively reviewing medical records of patients who underwent lower limb amputation for peripheral vascular disease. METHOD: Between June 1997 and September 2002, lower limb amputation was performed in 73 patients with peripheral vascular disease. RESULT: Mean follow-up period was 15 months; male to female ratio was 7.1 to 1; and mean age was 62.6 years. Associated diseases included DM (39 patients), hypertension (15 patients), ischemic heart disease (13 patients), and cerebrovascular disease (6 patients). Etiologies were atherosclerosis in 47.9%, Buerger's disease in 15.1%, DM foot in 13.7%, acute arterial embolization in 2.7%, ruptured abdominal aortic aneurysm in 1.4%, and combined atherosclerosis with DM foot in 19.2%. Bypass surgery was performed in 24 cases and only 4 cases underwent radiologic vascular intervention. The frequency of amputation was one surgery in 50 cases and more than two surgeries in 23 cases. Amputation level was digit amputation in 49 cases (67.1%), transmetatarsal in 10 cases (13.7%), below-knee in 11 cases (15.1%) and above-knee in 3 cases (4.1%). In 73 cases, reamputation was performed in 19 cases (26%) for poor stump wound healing. The cause of reamputation was atherosclerosis in 17.1%, Buerger's disease in 27.3%, DM foot in 60.0% and combined atherosclerosis with DM foot in 28.6%; the reamputation rate was the highest in DM foot patients. Bypass surgery for improved blood flow in the stump was performed in 24 cases, among these cases, reamputation was performed in 2 cases (8.3%). CONCLUSION: Amputation in ischemic limb patients was most commonly performed in artherosclerosis patients and the most common amputation level was digit. The reamputation rate was the highest in DM foot patients; a more careful selection of the amputation level in DM foot patients may be needed.
Amputation* ; Aortic Aneurysm, Abdominal ; Arteries ; Atherosclerosis ; Extremities ; Female ; Follow-Up Studies ; Foot ; Humans ; Hypertension ; Lower Extremity* ; Male ; Medical Records ; Myocardial Ischemia ; Peripheral Vascular Diseases ; Rehabilitation ; Retrospective Studies ; Thromboangiitis Obliterans ; Wound Healing

This study is aimed at developing a cardiac rehabilitation program and enlightening the effects of the program on patient's health behavior compliance, cardiovascular functional capacity, and quality of life. Using a quasi-experimental approach the nonequivalent control group pretest - posttest design was accepted for this study. The subjects of this study consisted of 55 patients with ischemic heart disease at the Cardiac Center of 'G' Hospital located in Inchon from May 1, 1998 to April 30, 1999. The patients were divided into two groups: the experimental group, which participated in the cardiac program with 30 patients and 25 patients of a control group were not involved in the program. There were two phases in the cardiac rehabilitation program: the first phase was a team approach education. It focused on reducing the risk of ischemic heart problems. The second phase was individual training by using a home based exercise program, which was comprised of 8 weeks, three sessions per week, 40-60 minutes per session, and followed by consultation. Every session involved 20-40 minutes of aerobic exercise at 40-60% of heart rate reserve, 11~13 RPE and 10 minutes of warm-up and 10 minutes of cool-down exercises. The experimental tools for the study were the health behavior compliance scale developed by Lee, Yoon-hee (1992), and quality of life scale developed by McGirr et al.(1990). RPPsubmax were measured by the treadmill. The collected data was processed by SPSS and analyzed by X2test and t-test. The results of this study were as follows: 1. The health behavior compliance in experimental group was significantly increased (t=5.091, p=.000) when compared to the control group. 2. RPPsubmax also decreased significantly in the experimental group when compared to the control group(t=-2.109, p=.040). 3. The quality of life significantly improved in the experimental group (t=3.853, p=.000) as compared to the control group. As the above results of this study revealed, the effectiveness of the cardiac rehabilitation program of the study was confirmed. It increased the health behavior compliance for reducing the risk of further coronary events, enhanced the cardiovascular functional capacity, and eventually improved the patient's quality of life.
Compliance* ; Cool-Down Exercise ; Education ; Exercise ; Health Behavior* ; Heart ; Heart Rate ; Humans ; Incheon ; Myocardial Ischemia* ; Quality of Life* ; Rehabilitation*

This study is aimed at developing a cardiac rehabilitation program and enlightening the effects of the program on patient's health behavior compliance, cardiovascular functional capacity, and quality of life. Using a quasi-experimental approach the nonequivalent control group pretest - posttest design was accepted for this study. The subjects of this study consisted of 55 patients with ischemic heart disease at the Cardiac Center of 'G' Hospital located in Inchon from May 1, 1998 to April 30, 1999. The patients were divided into two groups: the experimental group, which participated in the cardiac program with 30 patients and 25 patients of a control group were not involved in the program. There were two phases in the cardiac rehabilitation program: the first phase was a team approach education. It focused on reducing the risk of ischemic heart problems. The second phase was individual training by using a home based exercise program, which was comprised of 8 weeks, three sessions per week, 40-60 minutes per session, and followed by consultation. Every session involved 20-40 minutes of aerobic exercise at 40-60% of heart rate reserve, 11~13 RPE and 10 minutes of warm-up and 10 minutes of cool-down exercises. The experimental tools for the study were the health behavior compliance scale developed by Lee, Yoon-hee (1992), and quality of life scale developed by McGirr et al.(1990). RPPsubmax were measured by the treadmill. The collected data was processed by SPSS and analyzed by X2test and t-test. The results of this study were as follows: 1. The health behavior compliance in experimental group was significantly increased (t=5.091, p=.000) when compared to the control group. 2. RPPsubmax also decreased significantly in the experimental group when compared to the control group(t=-2.109, p=.040). 3. The quality of life significantly improved in the experimental group (t=3.853, p=.000) as compared to the control group. As the above results of this study revealed, the effectiveness of the cardiac rehabilitation program of the study was confirmed. It increased the health behavior compliance for reducing the risk of further coronary events, enhanced the cardiovascular functional capacity, and eventually improved the patient's quality of life.
Compliance* ; Cool-Down Exercise ; Education ; Exercise ; Health Behavior* ; Heart ; Heart Rate ; Humans ; Incheon ; Myocardial Ischemia* ; Quality of Life* ; Rehabilitation*

OBJECTIVE: This study was done to evaluate the risk factors associated with recurrence after first-ever stroke. METHOD: We retrospectively studied 256 first-ever stroke patients treated in Dong-Eui hospital from March 1997 to February 1998. Telephone or out-patient interviews were performed with these patients regarding stroke recurrence and treatment for hypertension and diabetes mellitus. These were divided into two groups, those with recurrence and those without. Evaluated risk factors for stroke recurrence were the following: history of diabetes mellitus, hypertension, heart disease, smoking, alcohol drinking, and transient ischemic attack; clinical findings at admission of hypertension, diabetes mellitus, hyperlipidemia, heart disease, type and location of stroke; treatment compliance for diabetes mellitus and hypertension after discharge. RESULTS: The recurrence rate after first-ever stroke was 12.9%. In univariate analysis, significant risk factors for stroke recurrence were history of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge (p<0.05). In multivariate analysis, significant risk factors for stroke recurrence were atrial fibrillation at admission (odds ratio=3.43) and non-compliance with therapy for hypertension after discharge (odds ratio=7.51)(p<0.05). CONCLUSION: History of smoking, clinical findings at admission of diabetes mellitus, atrial fibrillation, ischemic heart disease, and non-compliance with therapy for diabetes mellitus and hypertension after discharge are considered to be important factors for recurrence of stroke. So treatment and education for those factors associated with stroke recurrence are needed during rehabilitation program.
Alcohol Drinking ; Atrial Fibrillation ; Compliance ; Diabetes Mellitus ; Education ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Ischemic Attack, Transient ; Multivariate Analysis ; Myocardial Ischemia ; Outpatients ; Recurrence* ; Rehabilitation ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Stroke* ; Telephone