Recovery of the exercise tolerance in patients after acute coronary syndrome under contemporary medical care
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Abstract
The aim – to evaluate the recovery of the exercise tolerance during first 6 months after acute myocardial infarction (MI) with emergent coronary angiography and stenting through adding cycle ergometer physical trainings (PT) to standard medical care.
Material and methods. 76 patients (men, 52.2±1.2 years old) were prospectively evaluated in dynamics during 1–1.5; 2.5; 4 and
6 months after MI. All of them received standard medical care and everyday dosage walking. They were divided into two groups (gr). The 1st gr (41 pts) in addition to previous treatment had PT at cycle ergometer 3 times per week in individual regimen with 75 % of achieved load (complete program consisted of 30 sessions). After 15 PT sessions the control test was performed and intensity of next training regimen was corrected according to its result. 35 pts (2nd gr) received medical treatment and walking without PT.
Results. The additional sub-analysis was performed according to the 1) time of opening of infarct-related coronary artery (< 2 hours, 2–6 hours and > 6 hours) and 2) complete/incomplete revascularization. The threshold levels of work capacity were quite high in pts of the 1st and 2nd grs with opening of infarct-related coronary artery up to 2 hours at the beginning of the study (87.5±3.2 W in 1st and 91.7±3.2 W in 2nd gr). The increasing load was observed after 15 trainings in the 1st gr up to 116.7±3.6 W (Р<0.01), at the same time in the 2nd gr – up to 100.0±0.0 W, with further increasing of capacity in the 1st gr up to 130.0±3.6 W (Р<0.01). After late revascularization (> 6 hours) in the 1st gr the increase of work capacity from first to second and fourth tests was 88.5±4.6, 113.5±4.6 (Р<0.05) and 128.8±3.6 W (Р<0.01), in 2nd gr – 81.3±4.5, 85.4±3.7 and 90.0± 6.7 W, respectively (Р<0.01). Regardless of the extension of revascularization, the work capacity in the 1st gr increased (125.0±4.3 W at 2.5 th and 133.0±3.3 W at 6th month, Р<0.01), just as up to the 6th month in the 2nd gr. It achieved 104.0±6.5 W in complete revascularization and 85.7±5.0 W in incomplete revascularization.
Conclusions. It was established high effect of PT (30 sessions) at the cycle ergometer in individual regimen in early period after myocardial infarction during the 6-month follow up. Quite good recovery of work capacity in pts without PT was revealed only in subgroup with early revascularization (< 2 hours). Further studies are required to explain equally high effect of PT in pts with complete and incomplete revascularization.
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References
Balsam P., Główczyńska R., Zaczek R. et al. The effect of cycle ergometer exercise training on improvement of exercise capacity in patients after myocardial infarction // Kardiol Pol.– 2013.– Vol. 71 (10).– P. 1059–1064.
Che L., Wang L.M., Jiang J.F. et al. Effects of early submaximal cardiopulmonary exercise test and cardiac rehabilitation for patients with acute myocardial infarction after percutaneous coronary intervention: a comparative study // Zhonghua Yi Xue Za Zhi.– 2008.– Vol. 88 (26).– P. 1820–1823.
Dalal H.M., Doherty P., Taylor R.S. Cardiac rehabilitation // BMJ.– 2015.– Vol. 351.– P. 1–8.
Daniłowicz-Szymanowicz L., Figura-Chmielewska M., Ratkowski W. et al. Effect of various forms of physical training on the autonomic nervous system activity in patients with acute myocardial infarction // Kardiol. Pol.– 2013.– Vol. 71 (6).– P. 558–565.
Franklin B., Brinks J., Cardiac Rehabilitation: Under-recognized/Underutilized // Curr. Treat Options Cardio Med.– 2015.– Vol. 17.– P. 62–79.
Gersh B.J., Stone G.W., White H.D. et al. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future? // JAMA.– 2005.– Vol. 293.– P. 979–986.
Lawler P.R., Filion K.B., Eisenberg M.J. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials // Am. Heart J.– 2011.– Vol. 162 (4).– P. 571–584.
Lee H.Y., Kim J.H., Kim B.O. et al. Regular exercise training reduces coronary restenosis after percutaneous coronary intervention in patients with acute myocardial infarction // Int. J. Cardiol.– 2013.– Vol. 167 (6).– P. 2617–2622.
Lewin R., Doherty P. Cardiac rehabilitation and mortality reduction after myocardial infarction: the emperor’s new clothes? // Heart.– 2013.– Vol. 99.– P. 909–911.
Peixoto T.C., Begot I., Bolzan D.W. et al. Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial // Can. J. Cardiol.– 2015.– Vol. 31 (3).– P. 308–313.
Rauch B., Davos C.H., Doherty P. et al. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies – The Cardiac Rehabilitation Outcome Study (CROS) // Eur. J. Prev. Cardiol.– 2016.– Vol. 23 (18).– P. 1914–1939.
Taylor R.S., Anderson L., Oldridge N. et al. The Efficacy of Exercise-Based Cardiac Rehabilitation: The Changing Face of Usual Care // J. Amer. Coll. Cardiology.– 2016.– Vol. 69 (9).– P. 1207–1208.
Xu L., Cai Z., Xiong M et al. Efficacy of an early home-based cardiac rehabilitation program for patients after acute myocardial infarction: A three-dimensional speckle tracking echocardiography randomized trial // Medicine (Baltimore).– 2016.– Vol. 95 (52).– P. 5638–5644.