Annulus versus anulus

Effects of Maximal Exercise Tolerance on Subjectively Perceived Well-Being and Quality of Life of Some Heart Patients Undergoing Cardiac Rehabilitation Francis and Rector1 point out that, albeit mystery prevails about the low correlation between the extent of heart patients’ left ventricular dysfunction at rest and maximal exercise tolerance, exercise intolerance is a predictor of cardiac disease prognosis. Although suggesting heart patients dislike stress tests, they nevertheless call for more study on the relationship of exercise tolerance, maximal oxygen consumption, prognosis, and quality of life. While sampled heart patients (Table I) in cardiac rehabilitation at Baylor University Medical Center (BUMC) were psychologically prepared for and therefore accepted stress tests without objection, we believe the realm of cardiologic responsibility comprises challenging all heart patients’ maximal exercise tolerance to assesstheir functional disability and develop care regimens toward their physiologic stability, hence their enhanced self-perceived well-being and quality of life. Conclusions drawn from results of 6 months of research 1 of us (Free2) conducted in this cardiac rehabilitation program under the medical direction of 1 of us (Berman) address these issues. The World Health Organization3 delines rehabilitation as all measures taken to reduce the impact of disabling [morbidity] and handicapping [personal and societal] conditions and to aid in social reintegration of the patients. Because personal senses of well-being circumscribe and then coalesce with perceived quality of life, they are important to this end. Well-being is a subjective state assessable only by self-report. It includes feelings of adjustment, comfort, and fulfillment and is biased by one’s personality and self-perceived competences to conduct satisfying relationships, carry out responsibility, and be active. In essence, the degree of subjectively perceived well-being is keyed to self-accomplishment and self-direction and

TABLE

I Demography of Study Sample’

TABLE

II One-Year Schedule of Cardiac Rehabilitation’

Weeks l-6 (3Hweek): 3 months: 6 months: 9 months: 12 months:

cycle 1, monitored session, work/previous class cycle 2 (schedule/cycle 1) maximal exercise tolerance testing cycle 3 (schedule/cycle 1) maximal exercise tolerance testing

directly correlates with one’s felt level of quality of life. Data gathered from heart patients (Table I) who participated in at least 1 cycle (Table II) of noncompetitive formal group cardiac rehabilitation at BUMC contained personal reports of their enhanced senses of wellbeing, thus quality of life. They credited these phenomena to elevated self-esteem ensuing from felt control and power over their heart disease, achieved by performing exercise tolerance tests, seeing their colleagues do the same, and experiencing collegiality and conviviality among themselves, their medical doctors (their favorites), and their therapists-personal physiologic improvement notwithstanding. In presenting data showing little correlation in heart patients’ views of changes in the relationship of their maximal exercise tolerance and quality of life, the authors posit that subjectively perceived increases in quality of life do not depend on improved maximal exercise tolerance. They theorize that felt enhanced well-being and quality of life are more important to most heart patients than increased exercise tolerance and length of survival. We agree. Increased exercise tolerance, however, is widely believed to promote feeling better which, after all, enhances well-being and thus quality of life without regard to its quantity-an unknown anyway. A goal, then, of BUMC’s program is to effect measurable physiologic gain. While all patients in our study met this goal (at least on the short-term), also impressive was that each patient

reported felt enhanced well-being that, in turn, strengthened her or his self-confidence to attempt social reintegration, and hence increased life’s quality. We conclude that our data reinforce the efficacy of measuring maximal exercise tolerance for therapeutic decision-making toward reducing morbidity, aiding in social reintegration, and enhancing well-being and quality of life for all heart disease patients, particularly those with poor anatomic left ventricular function. Mary Moore Free, Walter I. Berman,

PhD MD

Dallas, Texas 29 March 1994 1. Francis GS, Rector TS. Maximal exercise tolerance as a therapeutic end point in heat failure-arc we relying on the right measure? Am J Cardiol 199473: 304-306. 2. Free MM. An anthropological perspective on some cultural aspects of cardiac rehabilitation. Baylor Universiry Medical Center Proceedings 1990,3:21-3 1. 3. World Health Organization. Report of the WHO expert committee on disability, prevention and rehabilitation. Technical Report Series No. 668, 1981.

Annulus

Versus Anulus

I truly enjoyed Dr. Cheng’s explanation of “Dilation Versus Dilatation,” having been a culprit myself.’ He mentioned dilation of stenotic valve may sometimes result in dilatation, not dilation of its annulus. Now he can tell us when to use “annulus” versus “anulus.” Steven

N. Singh,

MD

Washington, D.C. 30 March 1994 1. Cheng TO. Dilation versus dilatation. Am J Cardi01 1994,73:421.

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