title: Cardiac rehabilitation to improve physical functioning in refractory angina: a pilot study.
abstract: OBJECTIVE
  Refractory angina patients suffer debilitating chest pain despite optimal medical therapy and previous cardiovascular intervention. Cardiac rehabilitation is often not prescribed due to a lack of evidence regarding potential efficacy and patient suitability. A randomised controlled study was undertaken to explore the impact of cardiac rehabilitation on cardiovascular risk factors, physical ability, quality of life and psychological morbidity among refractory angina sufferers.
  
  
  METHODS
  Forty-two refractory angina patients (65.1 ± 7.3 years) were randomly assigned to an 8-week Phase III cardiac rehabilitation program or symptom diary control. Physical assessment, Progressive Shuttle Walk test, Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, the York Angina Beliefs scale, ENRICHD Social Support Instrument and SF-36 were completed before and after intervention and at 8-week follow-up.
  
  
  RESULTS
  Following cardiac rehabilitation, patients demonstrated improved physical ability compared with controls in Progressive Shuttle Walk level attainment (p = 0.005) and total distance covered (p = 0.015). Angina frequency and severity remained unchanged in both groups, with the control demonstrating worsening SF-36 pain scale (63.43 ± 22.28 vs. 55.46 ± 23.98, p = 0.025). Cardiac rehabilitation participants showed improved Health Anxiety Questionnaire reassurance (1.71 ± 1.72 vs. 1.14 ± 1.23, p = 0.026) and York Beliefs anginal threat perception (12.42 ± 4.58 vs. 14.35 ± 4.73, p = 0.05) after cardiac rehabilitation. Physical measures were broadly unaffected.
  
  
  CONCLUSIONS
  Cardiac rehabilitation can be prescribed to improve physical ability without affecting angina frequency or severity among patients with refractory angina.
authors: Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK. asbury.elizabeth@gmail.com
authors: Elizabeth A
authors: EA
authors: Asbury
authors: Carolyn M
authors: CM
authors: Webb
authors: Heather
authors: H
authors: Probert
authors: Christine
authors: C
authors: Wright
authors: Mahmoud
authors: M
authors: Barbir
authors: Kim
authors: K
authors: Fox
authors: Peter
authors: P
authors: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D001007:Anxiety / Q000209:etiology; D002908:Chronic Disease; D004351:Drug Resistance; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D020127:Recovery of Function