The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial.

Background: The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established.The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD) compared with usual care.

Methods: A single centre, two arm, parallel group randomised controlled trial was performed.

Revision of the Dutch clinical algorithm for assessing patient needs in cardiac rehabilitation based on identified implementation problems.

Background: Despite all available evidence of its effectiveness, cardiac rehabilitation and secondary prevention (CRSP) is still insufficiently implemented in current clinical practice. Based on an analysis of implementation problems, recently the Dutch clinical algorithm for the assessment of patient's CRSP needs was revised. The purpose of this paper is to describe the revision process and its results to improve CRSP guideline implementation.

Improving guideline adherence for cardiac rehabilitation in the Netherlands.

Background: In 2004, the Netherlands Society of Cardiology released the current guideline on cardiac rehabilitation. Given its complexity and the involvement of various healthcare disciplines, it was supplemented with a clinical algorithm, serving to facilitate its implementation in daily practice. Although the algorithm was shown to be effective for improving guideline adherence, several shortcomings and deficiencies were revealed.

Design of a continuous multifaceted guideline-implementation strategy based on computerized decision support.

Implementation of clinical practice guidelines into daily care is hindered by a variety of barriers related to professional knowledge, collaboration in teams and organizations, and practicability of the guidelines. Clinical computerized decision support (CCDS) has been shown to be one of the most effective instruments to improve compliance to practice guidelines by tackling barriers related to professional knowledge. To address other barriers, however, additional interventions are needed.

Bone formation is increased to a greater extent than bone resorption during a cycling stage race.

This study examined the effects of participation in the Tour of Southland, a 6-day bicycle race, on serum markers of bone turnover in 5 elite male cyclists. During the race, energy intake matched expenditure. Osteocalcin was increased approximately 300% on days 1-5; and C-terminal telopeptide of type I collagen was elevated (43%) on day 3.

The effect of computerized decision support on barriers to guideline implementation: a qualitative study in outpatient cardiac rehabilitation.

Context: Computerized decision support systems (CDSSs) can be used to improve the implementation of clinical practice guidelines by changing the behaviour of care professionals. While the influence of system characteristics on the effectiveness of CDSSs is studied, little is known about the relation between cognitive, organizational and environmental factors, and CDSSs' effectiveness.

Objective: To assess the effect of CDSSs on cognitive, organizational, and environmental factors that hamper guideline implementation.

Energy intake and expenditure during a 6-day cycling stage race.

Energy intake (EI) and energy expenditure (EE) are relatively easy to measure accurately over short periods in a laboratory setting, but less so during a multi-day competition. Our goal was to measure EI and EE as accurately as possible during a 6-day, 10-stage cycling race. We prepared all meals and supplements, assessed EI (weighed diet-records) and macrontrient intake, total EE (doubly labelled water), resting metabolic rate (respiratory gas exchange), exercise EE (power meters), and body mass.

The impact of 100 hours of exercise and sleep deprivation on cognitive function and physical capacities.

In this study, we examined the effect of 96-125 h of competitive exercise on cognitive and physical performance. Cognitive performance was assessed using the Stroop test (n = 9) before, during, and after the 2003 Southern Traverse adventure race. Strength (MVC) and strength endurance (time to failure at 70% current MVC) of the knee extensor and elbow flexor muscles were assessed before and after racing.

Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation.

Objective: To determine the extent to which computerised decision support can improve concordance of multidisciplinary teams with therapeutic decisions recommended by guidelines.

Design: Multicentre cluster randomised trial.

Participants: Multidisciplinary cardiac rehabilitation teams in Dutch centres and their cardiac rehabilitation patients.

Is the MacNew quality of life questionnaire a useful diagnostic and evaluation instrument for cardiac rehabilitation?

Purpose: The MacNew health-related quality of life questionnaire is internationally used as a standard for psychosocial assessment in many cardiac rehabilitation centres. This study investigates its discriminating capacity between diagnostic disease categories, sex and age at entry (T1) and at the end (T2) of cardiac rehabilitation as well as the responsiveness of the MacNew during this period.

Method: Data were used from 6,749 cardiac rehabilitation patients at T1 and 1,654 at T2.

Motives for (not) participating in a lifestyle intervention trial.

Background: Non-participants can have a considerable influence on the external validity of a study. Therefore, we assessed the socio-demographic, health-related, and lifestyle behavioral differences between participants and non-participants in a comprehensive CVD lifestyle intervention trial, and explored the motives and barriers underlying the decision to participate or not.

Methods: We collected data on participants (n = 50) and non-participants (n = 50) who were eligible for inclusion in a comprehensive CVD lifestyle interventional trial.

Effects of intermittent hypoxia on SaO(2), cerebral and muscle oxygenation during maximal exercise in athletes with exercise-induced hypoxemia.

In a placebo-controlled study, the effects of intermittent hypoxic exposures (IHE) or a placebo control for 10 days, were examined on the extent of exercise-induced hypoxemia (EIH), cerebral and muscle oxygenation (near-infrared spectroscopy) and VO(2peak). Eight athletes who had previously displayed EIH (fall in saturation of arterial oxygen (SaO(2)) of >4% from rest) during an incremental maximal exercise test, volunteered for the present research. Prior to (baseline), and 2 days following (post) the IHE or placebo, an incremental maximal exercise test was performed whilst SaO(2), heart rate, cerebral and muscle oxygenation and respiratory gas exchange were measured continuously.

Multidisciplinary structured lifestyle intervention reduces the estimated risk of cardiovascular morbidity and mortality.

Background: Current guidelines for prevention and treatment of cardiovascular disease (CVD) emphasise the importance of a healthy lifestyle. However, successful lifestyle intervention is proving to be a challenge for healthcare professionals.

Objectives: Evaluation of the effect of lifestyle intervention on cardiovascular risk factors, on reaching treatment targets and on the estimated risk of cardiovascular morbidity and mortality.

Physical activity for primary and secondary prevention. Position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology.

There is now clear scientific evidence linking regular aerobic physical activity to a significant cardiovascular risk reduction, and a sedentary lifestyle is currently considered one of the five major risk factors for cardiovascular disease. In the European Union, available data seem to indicate that less than 50% of the citizens are involved in regular aerobic leisure-time and/or occupational physical activity, and that the observed increasing prevalence of obesity is associated with a sedentary lifestyle. It seems reasonable therefore to provide institutions, health services, and individuals with information able to implement effective strategies for the adoption of a physically active lifestyle and for helping people to effectively incorporate physical activity into their daily life both in the primary and the secondary prevention settings.