COVID-19 is the disease caused by SARS CoV-2 and it was responsible for the pandemic decreed by the World Health Organization on March 11, 20201 (Centers For Disease Control and Prevention, 2020). The first case identified in Portugal dates back to March 2, 20202 (General Directorate of Health, 2020).
The appearance of the COVID-19 pandemic determined the change in human existence as it was known. All of these changes can lead to feelings of anguish, restlessness, disappointment, fear, anxiety and decreased quality of life3 (World Health Organization, 2020). Therefore, it can be inferred that the maintenance of an active lifestyle during the pandemic is very important for the general population, namely for patients with additional risk factors, with chronic diseases and the elderly8 (Jimenez, Carbonell, Lavie, 2020).
Health systems around the world had to reorganize, reallocate resources, reschedule procedures. At the organizational level,
the changes were immeasurable. The cardiac rehabilitation programs were one of the areas that were suspended or whose provision patterns were changed during the pandemic period 4 - 5 (Stanton, R. et al, 2020; Liu, C., Zhang, E., Wong, G.T.F., Hyun, S. & Hahm, H. C., 2020).
The cardiac rehabilitation program is traditionally divided into three phases. Phase I occurs during the hospitalization period and consists mainly of early mobilization and the beginning of the educational program about the disease, treatment, pharmacotherapy, diet, physical exercise, and control of cardiovascular risk
factors. Phase II occurs after discharge, on an outpatient basis, in this phase the patient attends a personalized and supervised physical exercise program and the educational program initiated in phase I continues. Phase III is the maintenance phase 6 - 7 (Thomas & Huang, 2019; Ponikowski et al., 2016).
Due to the changes implemented in the Cardiac Rehabilitation Program, it is important to understand the impact on patient’s lives8 (Madjid, M., Safavi-Naeini, P., Solomon, S.D. & Vardeny, O., 2020)..
The aim of this study is to assess patient’s quality of life after interruption of the Cardiac Rehabilitation (CR) phase II program, as well as to identify changes in patient’s pattern of physical activity.
Quantitative observational study developed with patients with cardiovascular disease attending CR phase II program, interrupted due to the pandemic COVID-19. The quality of life instrument and a questionnaire to asses’ patient’s level of physical activity were performed by telephone. All patients gave oral informed consent.
The E5-Q5-5L instrument was chosen to assess patient’s quality of life, since it is validated for the Portuguese population. This instrument allows measuring the quality of life perceived by the person, on the day it is applied. This scale consists of five questions about five dimensions - mobility, personal care, usual activities, pain / malaise, anxiety / depression. The patient must, for each of the dimensions, choose one of the five possible answers - no problems (1), mild problems (2), moderate problems (3), serious problems (4), incapable of / extreme problems (5) . The rating given in each dimension must be combined in order to obtain a 5-digit code that represents the health status of the person. In addition to these questions, the person is asked to rate their general health on a scale of 0 to 100. The value zero corresponds to the “worst health you can imagine” and the value 100, which describes the “best health you can imagine” 9 -10 (Compostella et al., 2017; EuroQol Research Foundation, 2019).
In addition to the application of the E5-Q5-5L questionnaire, patients were also asked about the physical activity habits they were
practicing and how this activity was performed. The questions asked intended to assess whether the patients were: 1) exercising, 2) how many days a week, 3) for how long, 4) what parameters are monitored before, during and after training, 5) what kind of training they are performing and 6) symptoms developed during the training. They were also asked if they felt that the pandemic limited them in the practice of physical activity, which is an important arm of the management of the therapeutic regime. Finally, they were asked whether they consider that the CR sessions so far have been useful.
Thirty-five patients were contacted by telephone, with an average age of 62.3 years, mostly male (80%). The pathophysiological characterization, namely disease etiology, cardiovascular risk factors and etiology of disease are described
in Table 1. On average, patients underwent 8.8 (± 4.4) supervised exercise training sessions before suspension of the CR program. These sessions were always preceded by a nursing consultation to assess hemodynamic stability for training.
Regarding the assessment of quality of life and taking into account the 5 domains of the scale, the lowest score was found in the domain of personal care, meaning that this was the less affected domain of quality of life. No patient attributed 5 to any domain. The highest the score, the lower the level of perceived quality of life. The whole results of the EQ scale are presented in Table 2.
Considering the questionnaire carried out on the practice of physical activity, we found that 85.7% of patients reported maintaining physical activity at least 4 to 5 days per week (minimum 1 and maximum 7); fifteen referred to perform physical activity based on the recommendations given by the hospital’s health care team and fifteen refer to perform physical activity according to their own convictions. Regarding the duration of the session, patients report practicing an average of 34 minutes per training session (minimum 10 minutes and maximum 150 minutes) preferring aerobic training (walking mostly). A small percentage of patients undergo strength training in combination with aerobic training: 5.7%, with no patient reporting strength training isolated. We observed the same tendency for running and cycling training, with no patients doing it. Patients were also asked which vigilances they performed prior to the training session and what symptoms they had during them, the results obtained are shown in Table 3.
All patients reported that their frequency in the PRC was very useful and that they would like to return to the programme if there is such a possibility.
Summary and conclusion
In general the patient’s quality of life is substantial high according to the results found and patients consider a high level of health – about 80%. Most of the patients continued carrying out physical activity, mostly according to the recommendations given in the hospital. The surveillances are properly performed, and patients recognisze the importance of the CR programme. Apparently, the pandemic did not cause a significant negative impact on the patient’s life. However, frequent follow up should be performed in order to reinforce the safety measures.
- Bruno Miguel Delgado, PhD, MsC, Rehabilitation nurse. Cardiology departement of Centro Hospitalar Universitario do Porto, Portugal.
- Ivo Claudio Lopes, MsC, Rehabilitation nurse. Cardiology departement of Centro Hospitalar Universitario do Porto, Portugal.
- Luisa Raquel Carneiro, MsC, Nurse practitioner. Cardiology departement of Centro Hospitalar Universitario do Porto, Portugal.
- Sandra Pereira, Nurse practitioner. Cardiology departement of Centro Hospitalar Universitario do Porto, Portugal.