Article

OBJECTIVE: To assess the safety and efficacy of an early home-based walking
program for first-time implantable cardioverter-defibrillator (ICD) recipients.
DESIGN: Pre-post intervention trial. SETTING: Institutional and private practice.
PARTICIPANTS: Cardiac patients (N=301) with an initial ICD implantation for
primary or secondary prevention; able to read, speak, and write English; and
having access to telephone. INTERVENTIONS: Early home-based walking protocol
implemented 1-month post-ICD implant. Exercise tolerance monitored by study
nurses via telephone. MAIN OUTCOME MEASURES: Safety assessment was based on the
frequency of ICD therapies and hospitalizations, and efficacy assessment was
based on pedometer measures and self-report of ICD self-efficacy and physical
activity. RESULTS: ICD recipients were on average 64.1+/-11.9 years old,
predominantly men, and white, with an ejection fraction of <35% and a mean
Charlson comorbidity score of 2.3+/-1.5. Nineteen individuals (6.3%) received 28
ICD shocks; 15 (53.6%) were appropriate and 13 (46.4%) inappropriate.
Antitachycardia pacing therapies were delivered 72 times in 18 individuals (6%),
with 61 (84.7%) being appropriate and 11 (15.3%) inappropriate. Five ICD shocks
(2 appropriate and 3 inappropriate) and 2 antitachycardia pacing therapies
occurred during walking. Five participants (2%) were hospitalized for an ICD
shock, none of which was associated with walking. Average steps per day increased
by 806 over 3 months. Perceived exercise self-efficacy improved significantly as
did weekly exercise. Predictors of receiving any ICD shock were younger age
(P<.0001), moderate to severe renal disease (P=.001), and lymphoma (P=.024).
CONCLUSIONS: Early ambulation after an initial ICD was safe and effective, with
few ICD shocks and improved efficacy.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS