William P. Marley, Ph.D., FACSM, FAACVPR
Professor Emeritus/Director/Principal Investigator
Human Performance Laboratory Programs
Marshall University College of Health Professions
School of Kinesiology
Diabetes Exercise and Cardiac Rehabilitation Center
The Center for Lung Health
MARSHALL UNIVERSITY MEDICAL CENTER
Our research over the past 20 years has provided convincing evidence for the effectiveness of intensive multifactorial therapeutic lifestyle intervention (IMTLI) strategies in managing cardiac, pulmonary, and diabetes patients. A regimen of supervised exercise, sensible nutrition, smoke cessation, stress management, and self-management education influences patients in other ways: for example, they begin taking their medications on time and in the right doses; diabetes patients begin checking their blood glucose on a more regular basis.
The improved compliance of our patients with their medical regimen is repeatedly reflected in improved clinical profiles: better cholesterol and triglycerides, better blood glucose (BG) and hypertension control, and leaner body composition. Reduced symptoms in the form of angina pectoris, claudication and dyspnea improve the quality of their lives (QOL).
Our 4-year study of compliance and effective BG control confirmed the dedication of our patients. We assume this will permit them to reap the long-term benefits shown in the medical literature: reduced premature disability in the form of blindness, lower extremity amputation, and kidney disease, reduced premature death, increased longevity, and improved QOL. We conducted another 4-year study in conjunction with a regional insurance carrier of 4,642 cardiac rehabilitation patients, which included IMTLI strategies. This research, however, revealed an anemic cardiac referral rate for cardiac rehabilitation (CR), less than 20%, for eligible cardiac patients. This finding is especially disappointing as current medical opinion considers CR to be a standard of care.
The impact of our interventions has been accompanied by reduced dependence on the health care system as witnessed by significant reductions in medications, emergency room visits, hospital admissions, and visits to physicians. Three-month Phase II interventions for both cardiac patients and pulmonary patients have also had a significant impact on the so-called bottom line. A study of 52 cardiac patients with comorbid diabetes resulted in a projected annual savings in paid health care claims of more than $120,000. Similar research with 33 pulmonary patients showed projected annual savings of $80,000.
Our most recent publication, A Descriptive Study of Diabetes Mellitus Patients With Comorbid Cardiovascular Disease Enrolled in a Community Lifetime Maintenance Therapeutic Lifestyle Intervention Program, a study of 115 diabetes patients with comorbid cardiovascular disease, reports unique gender and age group data. These data reveal clinical trends and profiles that can prove helpful for clinicians in managing these patients.