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Several scientific projects were initialized by the author dealing with strategies for an improved risk management in patients affected with cardiovascular risk factors. These programs were based on behavioral treatments which took place in a clinic for rehabilitation. In Germany, cardiovascular risk screening is a fundamental component of each clinical rehabilitation. For patients affected with relevant risk factors complex programs are established in rehabilitation clinics in order to reduce existing cardiovascular risk so that the long-term prognosis of the respective patients should be improved. These programs for risk reduction are based on intensive educations in nutrition, cooking, sports and psychological care, including coping strategies for stress management and relaxation techniques. In average, these clinical treatments are made over a period of 4 weeks. A first project for research of risk management was carried out in 1992 and 1993, based on 1537 rahabilitation patients affected with hypertension, enlarged blood lipid levels and/or obesity (Project 1). These patients were surveyed over a period of 13 months after discharge from rehabilitation care. In most cases, existing cardiovascular risk factors remained reduced at the end of the surveillance. For this project the author was awarded the German prize for research in prevention and rehabilitation 1994. A second project was based on 700 rehabilitation patients affected with the same risk factors, mentioned above. These patients were surveyed over a period of 3 years. Also in these cases, existing risk factors remained long-term reduced. Thus, rehabilitation programs are suitable to reduce cardiovascular risks in a relevant manner. Project 1: Long-term improvement of cardiovascular risk-factors by rehabilitation Significant reductions of existing risk factors remained apparent over a 13 months period The respective patients were affected with essential hypertension, dyslipidemia and pathological increases in body weight which are important measurable risk-factors for cardiovascular diseases. At the beginning of the residential rehabilitation, the averagee blood pressure in patients with hypertension was 162/95 mmHg. In cases with increased lipid levels, the initial average lipid values were 268 mg/dl for total cholesterol, 191 mg/dl for LDL-cholesterol, 51 mg/dl for HDL-cholesterol, 296 mg/dl for triglycerides and 5,6 for the cholesterol-HDL-quotient. In the obese patients, the average weight excess beyond the “Broca” normal weight was about 30% at the beginning of the convalescent care. 13 months after rehabilitation care, 25% of the initially hypertensive patients were still in remission, and more than 50% only in borderline hypertension. More than 50% of the patients with initial borderline hypertension remained in long-term remission. The part of manifestly hypertensive patients was long-term reduced for more than 2/3, the part of hypertensive patients with normalized blood presure was five times higher than at the beginning of the rehabilitation care. Antihypertensive drugs could be stopped or reduced in 25 % of all hypertensive patients. The average reduction in blood pressure was 20 mmHg for systolic and 10 mmHg for diastolic values. Under home conditions, the total cholesterol and LDL-cholesterol levels remained reduced by 14 % or 24 % in about 50 % of the patients affected with dyslipidemia. In 2/3 of the patients the triglyceride levels remained reduced by an average of 35 %. In the long-term, the cholesterol-HDL-quotient was reduced by about 0,9 in all cases with dyslipidemia. On average, pathological increases in body weight were reduced by 5 kg, corresponding to long-term reductions of existing weight excesses beyound the “Broca” normal weight by 7,5 %. A long-term complete normalization of body weight was achievable in 18 % of the patients, while a long-term reduction in 25 % of the adipose patients (exceeding the “Broca” normal weight by more than 20 %) was possible. In about 50 % of all cases a further weight reduction of 3,9 kg took place after discarge from rehabilitation care, that is under home conditions,corresponding to a long-term 13 % reduction of the patient´s weight beyond the normal “Broca” weight. About 1/5 of the cases maintained the same weight they had at the end of convalescence for a long period, in 1/3 of all cases this was followed by a slight weight increase at home without attaining the former overweight. The number of patients who attained or exceeded their former weight after the convalescence is about 6 %, a neglegible proportion. Depending on the kind of risk-factor, the number of patients who succeeded in achieving further reductions of existing risks within the 13 months follow up was up to 50 %. Thus, in a substantial majority of cases,
inpatient rehabilitation is capable to induce long-term improvements of cardiovascular risk-factors. Therefore, rehabiliation programs should lead to a considerable reduction in treatment costs for cardiovascular
diseases and their complications. Project 2: Long-term improvement of hypertension, dyslipidemia and obesity by rehabilitation – Results of a follow-up observation of patients over a three-years period Significant reductions of existing risk factors were also achieveable after a follow up period of three years, comparable with the findings described in project 1. Arterial hypertension remained reduced by an average of 20 mmHg for systolic and 10 mmHg for diastolic hypertension even 3 years after discharge from rehabilitation. These long-term reductions in blood pressure were already evident after one year and persisted at a constant level. In patients affected with increased lipid levels the values for total cholesterol, triglycerides, LDL-cholesterol and the cholesterol-HDL-quotient were significantly improved over the 3 years period. In average, 60 – 100 % of these patients showed improvements of their lipid values. The long-term reductions of the initial values were about 6,0 - 12,3 %. In 20 % of the obese patients a long-term normal body weight was achieveable. The average body weight of all patients investigated remained significantly lower than at the end of the rehabilitation care (minus 3,4 kg), corresponding with a reduction of the average weight surplus by 6 %. The proprotion of patients whose body-weight remained lower than at the beginning of the rehabilitation care was 70 %: In this subgroup, the average weight reduction was 4,9 kg or 7.1 %. At home, 34.5 % of these patients succeeded in reducing their body weight furthermore. In these patients, the average weight reduction was minus 13.5 kg or 12.4 %. With regard to all risk factors mentioned above the respective positive effects were completely achieveable by non-medicamentous treatments. These results show that a residential rehabilitation is suitable for inducing long-term improvements of existing risk factors at least over a period of three years. Therefore, rehabilitation programs seems to be able to contribute to primary prevention and cost-saving with respect to atherosclerotic diseases in a substantial manner.
Piper, J.: Long-term inprovement of hypertension by residential rehabilitation (in German) Piper, J.: Long-term improvement of dyslipidemia by residential rehabilitation (in German) Piper, J.: Long-term improvement of obesity by residential rehabilitation (in German) Piper, J.: Long-term improvement of cardiovascular risk factors by residential rehabilitation (in German) Piper, J., Mack, R.: Long-term improvement of hypertension, dyslipidemia and obesity by residential rehabilitation
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