Tunes and T-shirts for cardiac rehabilitation

By Piriya Mahendra, medwireNews Reporter

Two studies presented at the European Society of Cardiology (ESC) Congress in Munich, Germany, showed how researchers are developing innovative approaches to help patients get the most out of cardiac rehabilitation.

Marina Ilic (University of Niš, Serbia) spoke about using music as an additional therapy to exercise training for patients undergoing cardiac rehabilitation, while Erik Skobel (Centre of Cardiac and Pulmonary Rehabilitation, Rehaklinik Rosenquelle, Germany) unveiled a new technology comprising an electrocardiogram (ECG) monitor within a T-shirt that could aid the heart rate detection of patients undertaking home training as part of rehabilitation.

Favorite tune gives endothelial function a boost

Ilic and team found that patients with stable coronary artery disease (CAD) who listened to their favorite music for 30 minutes each day in addition to undertaking their regular exercise regime and standard therapy had a greater improvement in endothelial function, assessed by change in nitric oxide (NO) and reservoir for bioavailable NO (RSNO), than those who undertook exercise training alone.

Patients who used music therapy plus exercise training experienced a significantly greater increase in NO level from baseline to 3 weeks (from 32.7 to 49.0 mmol/L) compared with those who undertook exercise training alone (from 31.5 to 42.0 mmol/L). Patients who did not undertake cardiac rehabilitation and received normal community care experienced a smaller increase in NO than both exercise groups, from 34.0 to 38.0 mmol/L.

Levels of RSNO increased in both groups, from 3.2 mmol/L at baseline to 5.3 mmol/L at 3 weeks in the music group, and from 3.0 mmol/L to 4.4 mmol/L in the training-only group, compared with an increase from 2.9 mmol/L to 3.5 mmol/L in the community care-only group.

Ilic told medwireNews: "There is a connection between the heart and the brain. When the patients listen to their favorite music, the positive emotion that is provoked by the music stimulates the brain to produce the hormone substance, endorphin. This substance stimulates the upregulation of the production of the substance in the endothelium which vasodilates blood vessels."

Ilic believes this type of music therapy should be used in all cardiac rehabilitation programs. "It does not cost anything," she said. "I think it is good to combine exercise training and music."

From tunes to T-shirts

At the same session, Skobel unveiled the Guided-Exercise (G-Ex) device, a closed-loop management system for monitoring of cardiac rehabilitation in patients with CAD. The device works using electrodes that are held to the skin by a purpose-designed T-shirt worn by the patient.

The electrodes sense vital parameters including ECG, respiration, and activity during training and stream these data live to a personal digital assistant (PDA), so that the patient can see whether they have reached their target heart rate.

"Despite the fact that the multiple advantages of cardiac rehabilitation are well known, there is a lack of home-based supervised training," Skobel explained during his presentation. "Thus, participation in phase III cardiac rehabilitation is low." He believes that new devices such as the G-Ex are needed to improve supervised training for cardiac patients.

In this phase I study of the system, Skobel and team found an "excellent correlation" between heart rate as measured by G-Ex and standard 12-lead ECG.

Furthermore, breathing frequency during exercise as measured by G-Ex was "well correlated" with ECG readings, while additional heart rate measurement with the PDA also exhibited an excellent correction for heart rate, noted Skobel.

The device is also able to detect arrhythmias including atrial fibrillation and ventricular ectopic heart beat, he said.

"The sensor combined with a dedicated T-shirt is easy to handle and to wear," remarked Skobel. "The whole system seems feasible for the monitoring of home-based cardiac rehabilitation." He says that the device will be marketed next year.

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