Exercise training as an integral part of cardiac rehabilitation in patients in the early post-infarction period: clinical and functional parallels
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Abstract
The aim – to determine the effectiveness of the program of exercise training at the early stages after myocardial infarction (MI) in the treatment of patients with urgent revascularization during one-year observation.
Material and methods. The study involved 91 male patients aged 33-68 (average age (52.3±1.5) years with Q-wave MI. In the first hours after MI onset, all patients had urgent coronary angiography, a stent was inserted into the culprit coronary artery and drug therapy was administered in accordance to the current protocols and guidelines. Depending on the amount of physical rehabilitation, the patients were divided into two groups: group 1 included 47 patients who underwent physical cycling course training (three times a week, a total of 30 sessions), group 2 consisted of 44 patients whose rehabilitation consisted in distance walking and remedial exercises. The examinations were carried out at discharge from the inpatient department (12–15 days). Both clinical, instrumental and biochemical tests were performed after 4, 6 and 12 months following MI.
Results. At the initial stage, the patients of either group didn’t demonstrate differences in clinical indicators or medical history data. At the first survey, the threshold power level and the cost of the work performed according to the indicator of the ratio of dual product to the level of performed work (DP/A) didn’t differ significantly. After 30 training sessions, the threshold power increased significantly (125.0 (125.0–140.0) W in group 1 at the value of DP/A 0.92 (0.76–1.17) units). In group 2, the threshold power increased to 100.0 (75.0–100.0) W, but at the level of DP/A (1.73±0.18) units. One year after MI the level of threshold power increased to 140,0 (125.0–150.0) W at low cost (1.17 (0.98–1.32) units) in group 1, while in group 2 the level of threshold power decreased and approached the data of the first survey (75,0 (75.0–100.0) W) with a significant increase of the cost of work (2.41 (1.73–3.36) units). Such dynamics of the indicators of exercise tolerance was accompanied by changes of hemodynamic indices.
Conclusions. Exercise training program increased physical tolerance with better parameters of bicycle ergometry after its interruption and preserving of the effect during one year after MI. This was accompanied by optimization of the remodeling and restoration of wall kinesis. The exercise training program contributed to improving the physical fitness in patients with late opening of the infarction-related coronary artery disease and incomplete revascularization. The effect of exercise training was short-lived and limited in multifocal lesions.
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Bubnova MG, Novikova NK, Aronov DM, Krasnitskiy VB, Kadushina EB. Klinicheskoye 16-letneye nablyudeniye za bolnymi. perenesshimi ostryy infarkt miokarda: fenomen vysokoy priverzhennosti k fizicheskoy reabilitatsii. Vestnik vosstanovitelnoy meditsiny [Journal of Restorative Medicine & Rehabilitation]. 2016;(4):12–19 (in Russ).
Chumakova GA, Kisileva EV, Aleshkevich VV, Chursina VI. Vybor optimalnoy intensivnosti trenirovok u bolnykh s infarktom miokarda i arterialnoy gipertoniyey. Serdechnaya nedostatochnost [Heart failure]. 2002;(5):215–217 (in Russ).
Gavrilenko TI, Ryzhkova NA, Parkhomenko AN. Miyeloperoksidaza i eye rol v razvitii ishemicheskoy bolezni serdtsa. Ukrainskyi Kardiolohichnyi Zhurnal [Ukrainian Journal of Cardiology]. 2014;(4):119–126 (in Russ).
Kuimov AD, Moskalenko IV. Kardioreabilitatsiya: novyy vzglyad na staryye problemy. Sibirskoye meditsinskoye obozreniye [Siberian Medical Review]. 2014;(1):5–11 (in Russ).
Kuchmenko OB, Mkhitaryan LS, Kupchynska O, Ievstratova IN, Vasylynchuk NM, Matova OV, Mostovyak MP, Drobotko TF. Visnyk of the Lviv University. Series Biology. 2016;(73):303–309.
Lyamina NP, Karpova ES, Karpova ES, Bizyayeva EA. Fizicheskiye trenirovki v kardioreabilitatsii i profilaktike u bolnykh IBS posle chreskozhnykh koronarnykh vmeshatelstv: granitsy effektivnosti i bezopasnosti. Rossiyskiy Kardiologicheskiy Zhurnal [Russian Journal of Cardiology]. 2014;(6):93–98 (in Russ).
Mkhitaryan LS, Kuchmenko OB, Shumakov VO, Malynovska IE, Ievstratova IN, Tereshchenko NM, Vasylynchuk NM, Drobotko TF. Yakisniy stan lipidnikh factoriv aterogenezu ta aktivnist zapalnoyi reakcii v pacientiv, yaki perenesli gostryy infarct myocardia. Ukrainskyi Kardiolohichnyi Zhurnal [Ukrainian Journal of Cardiology]. 2016;(4):55–61 (in Russ).
Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, Cowie A, Zawada A, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2017;6:CD007130.
BACPR. The BACPR standarts and core components for cardiovascular disease prevention and rehabilitation 2017 [Internet]. 3rd ed. [cited 2018 May 02]. Available from: http://www.bacpr.com/resources/BACPR_Standards_and_Core_ Components_2017.pdf
Haykowsky M, Scott J, Esch B, Schopflocher D, Myers J, Paterson I, Warburton D, Jones L, Clark AM. A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling. Trials. 2011;12:92.
Hedback B, Perk J. 5-year results of a comprehensive rehabilitation programme after myocardial infarction. Eur Heart J. 1987;8(3):234–242.
Kubo N, Ohmura N, Nakada I, Yasu T, Katsuki T, Fujii M, Saito M. Exercise at ventilatory threshold aggravates left ventricular remodeling in patients with extensive anterior acute myocardial infarction. Am Heart J. 2004;147(1):113–120.
Lee HY, Kim JH, Kim BO, Byun YS, Cho S, Goh CW, Ahn H, Rhee KJ, Kim C. Regular exercise training reduces coronary restenosis after percutaneous coronary intervention in patients with acute myocardial infarction. Int J Cardiol. 2013;167(6):2617–2622.
O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, Pina IL. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439–1450.
Peixoto TC, Begot I, Bolzan DW, Machado L, Reis MS, Papa V, Carvalho AC, Arena R, Gomes WJ, Guizilini S. 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;31(3):308–313.
Rauch B, Riemer T, Schwaab B, Schneider S, Diller F, Gohlke H, Schiele R, Katus H, Gitt A, Senges J. Short-term comprehensive cardiac rehabilitation after AMI is associated with reduced 1-year mortality: results from the OMEGA study. Eur J Prev Cardiol. 2014;21(9):1060–1069.
Wang W, Jiang Y, He HG, Koh KW. A randomised controlled trial on the effectiveness of a home-based self-management programme for community-dwelling patients with myocardial infarction. Eur J Cardiovasc Nurs. 2016;15(6):398–408.
Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis. 2017;16(1):132.
Xu L, Cai Z, Xiong M, Li Y, Li G, Deng Y, Hau WK, Li S, Huang W, Qiu J. 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;95(52):e5638.