title: Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells. A six-month follow-up study.
abstract: An increase of endothelial progenitor cells (EPCs) among acute myocardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0-10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.
authors.affiliation: Francesca Cesari, Department of Clinical and Experimental Medicine, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50127 Florence, Italy, Tel.: +39 055 7949420, Fax: +39 055 7949418 , E-mail: francesca.cesari@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Cesari
authors.forename: R
authors.initials: R
authors.lastname: Marcucci
authors.forename: A M
authors.initials: AM
authors.lastname: Gori
authors.forename: C
authors.initials: C
authors.lastname: Burgisser
authors.forename: S
authors.initials: S
authors.lastname: Francini
authors.forename: A T
authors.initials: AT
authors.lastname: Roberts
authors.forename: F
authors.initials: F
authors.lastname: Sofi
authors.forename: G F
authors.initials: GF
authors.lastname: Gensini
authors.forename: R
authors.initials: R
authors.lastname: Abbate
authors.forename: F
authors.initials: F
authors.lastname: Fattirolli
mesh_terms: D000208:Acute Disease; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D066026:Endothelial Progenitor Cells / Q000502:physiology*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009203:Myocardial Infarction / Q000453:epidemiology / Q000534:rehabilitation*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Lifestyle modifications; cardiac rehabilitation; endothelial progenitor cells; healthy lifestyle score