Clinical and functional features of the post-infarction course of coronary heart disease on the background of cardiac rehabilitation (with cycling training in the II phase) at 3-year follow-up

Main Article Content

V. O. Shumakov
I. E. Malynovska
N. M. Tereshchenko
L. M. Babii
O. V. Voloshina


The aim – to study the clinical and functional characteristics of patients after myocardial infarction (MI) who referred stage II of cardiac rehabilitation (CR) with physical training (PT) during 3 years follow-up.
Materials and methods. The study included 91 patients with primary Q-MI in the absence of contraindications to the CR. Criteria for inclusion were an early postinfarct angina, large aneurysm of the left ventricle, intracavitary formation of thrombus, the reduction of the EF to 35 % and below, complex cardiac arrhythmias and disturbances of conduction, the atrial fibrillation at the time of inclusion in the study, multivessel lession of coronary arteries, left bundle branch block, disorders of the musculoskeletal system, which prevented holding bicycle ergometry test, acute violation of cerebral circulation in the anamnesis, cancer and decompensation of comorbidities. Treatment was carried out according to modern recommendations; at admission coronary angiography with stenting of the infarct-occluded coronary artery was performed. Depending on the volume of rehabilitation measures, the patients were divided into two groups: group 1 consisted 47 patients who in the early post-hospital phase accomplished the program of PT on the bicycle ergometer; group 2 consisted of 44 patients in whom CR was carried out only in the form of distance walking and complexes of therapeutic exercises. Dosed physical load test on a bicycle ergometer, echocardiography, lipid metabolism indexes were evaluated in all patients at discharge from hospital. All exams were performed in dynamics in 4 months (the period corresponding to the end of the program 30 PT), after 1, 2 and 3 years.
Results and discussion. At baseline the patients of both groups did not differ in any of the clinical-functional and anamnestic data. The clinical course was evaluated by the following indices: recurrent MI, coronary artery bypass grafting and stenting. Events increased after 2 (7 patients in 1 and 9 patients in 2 group) and 3 (6 and 15 patients, respectively) years. During the first year, all patients took 100 % of P2Y12 receptor blockers, rosuvastatin and beta-blockers; aspirin was used in 95 % of patients in each group; the number of patients who have received ACE inhibitors increased to 81 % in group 1 and 91 % in group 2. A decrease in the doses of statins at the outpatient stage as they move away from acute MI has led to an increase in LDL cholesterol over the years. This index in 4 months after MI in 1st group was 1.82 (1.39–2.20) and 2nd group was 1.83 (1.49–2.21) mmol/l, after 1 year – 1.79 (1.48–2.04) and 2.80 (2.33–3.21) mmol/l, after 2 years – 2.48 (2.12–2.98) and 2.34 (1,93–3.01) mmol/l, after 3 years – 2.29 (2.15–2.49) and 2.40 (2.26–2.61) mmol/l, respectively. The tolerance to physical load with the best hemodynamic efficiency of the work has increased significantly to (140.0; 125.0–150.0) W after 1 year compared with the 2nd group (p<0.01). For 3 years, it remained high in the 1st group, and it decreased to baseline levels in the 2nd group. Postinfarction remodeling processes were manifested by a decrease in EDV and an increase in EF, especially in the 1st group (p<0.01) after six months without significant dynamics for 3 years.
Conclusions. CR with PT (30 sessions) contributed to an increase in exercise tolerance maximally after the end of training and lasted for 3 years. The aspects of psychological rehabilitation and health education for patients and their relatives were important (38 % of patients of the 1st group continued PT on their own at home). The training start time (on average, on the 15th or 40th day of MI) did not affect the results of the load test. It is important that a large percentage of patients continued to take the drugs recommended at discharge, but during 3 years follow up, the doses of the drugs were significantly reduced with insufficient control of hemodynamic and biochemical parameters, which led to the growth of one of the main factors in the progression of atherosclerosis – the level of low density lipoproteins.

Article Details


postinfarction course, cardiac rehabilitation, physical trainings, lipid metabolism, tolerance to physical activity, echocardiographic indexes


Коваленко В.М., Корнацький В.М. Стан здоров’я народу України та медичної допомоги третинного рівня.– К., 2019.– 183 с.

Лямина Н.П., Карпова Э.С., Карпова Э.С., Бизяева Е.А. Физические тренировки в кардиореабилитации и профилактике у больных ИБС после чрескожных коронарных вмешательств: границы эффективности и безопасности // Рос. кардиол. журн.– 2014.– № 6.– C. 93–98.

Суджаева О.А., Суджаева С.Г. Патофизиологические механизмы снижения и восстановления толерантности к физической нагрузке под влиянием физических тренировок на разных стадиях сердечно-сосудистого континуума // Медицинские новости.– 2016.– № 6.– C. 45–48.

Чумакова Г.А., Кисилева Е.В., Алешкевич В.В., Чурсина В.И. Выбор оптимальной интенсивности тренировок у больных с инфарктом миокарда и артериальной гипертонией // Сердеч. недостаточность.– 2002.– № 5.– C. 215–217.

Ades P.A., Keteyian S.J., Wright J.S. et al. Increasing cardiac rehabilitation participation from 20 % to 70 %: a road map From the Million Hearts Cardiac Rehabilitation Collaborative // Mayo Clin. Proc.– 2017.– Vol. 92.– P. 234–242. doi:

Antman E.M., Hand M., Armstrong P.W. Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST‑Elevation Myocardial Infarction // J. Am. Coll. Cardiol.– 2008.– Vol. 51.– P. 210–247. doi:

Al Quait A., Doherty P. Overview of Cardiac Rehabilitation Evidence, Benefits and Utilisation // Global J. Health Science.– 2018.– Vol. 10, N 2.– Р. 38–48. doi:

Conraads V.M., Pattyn N., De Maeyer C. et al. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study // Int. J. Cardiol.– 2015.– Vol. 179.– P. 203–210. doi:

Ekblom O., Ek A., Cider A. et al. Increased Physical Activity Post–Myocardial Infarction Is Related to Reduced Mortality: Results From the SWEDEHEART Registry // J. Am. Heart Assoc.– 2018.– Vol. 7, N 24.– P. e010108. doi:

Ibanez B., James S., Agewall S. et al., ESC Scientific Docu­­­ment Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) // Eur. Heart J.– 2018.– Vol. 39, N 2. – P. 119–177. doi:

Jakobsen L., Niemann T., Thorsgaard N. et al. Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention // Circ. Cardiovasc. Interv.– 2012.– N 5.– P. 641–648. doi:

Ji H., Fang L., Yuan L., Zhang Q. Effects of exercise-based cardiac rehabilitation in patients with acute coronary syndrome: a meta-analysis // Med. Sci Monit.– 2019.– Vol. 25.– P. 5015–5027. doi:

Kamani C.H., Gencer B., Montecucco F. et al. Stairs instead of elevators at the workplace decreases PCSK9 levels in a healthy population // Eur. J. Clin. Invest.– 2015.– Vol. 45, N 10.– P. 1017–1024. doi: 10.1111/eci.12480.

Kämpfer J., Yagensky A., Zdrojewski T. et al. Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: an international prospective cohort study // BMJ Open.– 2017.– Vol. 11; 7(8).– P. e012715. doi:

Lahoud R., Howe M., Krishnan S.M. et al. Effect of use of combination evidence-based medical therapy after acute coronary syndromes on long-term outcomes // Am. J. Cardiol.– 2012.– Vol. 109, N 2.– P. 159–164. doi:

Moran A.E., Forouzanfar M.H., Roth G.A. et al. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study // Circulation.– 2014.– Vol. 129.– P. 1483–1492. doi:

Prabhu N.V., Maiya A.G., Prabhu N.S. Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review // Cardiol. Res. Pract.– 2020.– Vol. 21.– 1236968. doi:

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, N 18.– P. 1914–1939. doi:

Ribeiro H.B., Lemos P.A. Seeking actual benchmarks in acute coronary syndromes for European countries: insights from the EURHOBOP registry // Heart.– 2014.– Vol. 100.– P. 1147–1148. doi:

Ritchey M.D., Loustalot F., Wall H.K. et al. Million Hearts: Description of the National Surveillance and Modeling Methodology Used to Monitor the Number of Cardio­­­­vascular Events Prevented During 2012–2016 // J. Am. Heart Assoc.– 2017.– Vol. 6.– Р. e006021. doi:

Ritchey M.D., Maresh S., McNeely J. et al. Tracking cardiac rehabilitation participation and completion among medicare beneficiaries to inform the efforts of a national initiative сirculation. cardiovascular quality and outcomes // Circulation: Cardiovascular Quality and Outcomes.– 2020.– Vol. 13.– Р. e005902. doi: PMID: 31931615.

Thomas R.J., Balady G., Banka G. et al. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures // J. Amer. Coll. Cardiology.– 2018.– Vol. 71, N 16. doi:

Turk-Adawi K.I., Oldridge N.B., Tarima S.S. et al. Cardiac rehabilitation patient and organizational factors: What keeps patients in programs? // J. Amer. Heart Association.– 2013.– Vol. 2, N 5. doi:].

Wang Y., Xu D. Effects of aerobic exercise on lipids and lipoproteins // Lipids Health Dis.– 2017.– Vol. 16, N 1.– P. 132. doi:

Zhang Y., Cao H., Jiang P., Tang H. Cardiac rehabilitation in acute myocardial infarction patients after percutaneous coronary intervention: A community-based study // Medicine (Baltimore).– 2018.– Vol. 97, N 8.– P. e9785. doi:

Most read articles by the same author(s)

1 2 > >>