Clinical and biochemical peculiarities at the different stages of cardiac rehabilitation in patients after myocardial infarction

Abstract

The aim – to study the dynamics of indices of the exercise tolerance and the qualitative status of the main classes of lipoproteins together with activity of corresponding enzymes in patients after acute myocardial infarction (MI) during the first 6 months of follow-up.
Material and methods. 76 patients were included in the study (mean age 52.2±1.2 years). They received basic therapy according to the current guidelines, including emergent stenting. 41 pt (1st gr) in addition to standard medical treatment had the course of 30 cycle ergometer exercise trainings 3 times per week in individual regimen and 35 pts (2nd gr) underwent medical treatment and walking without trainings. All of them were examined on the 14–16th days of myocardial infarction and in dynamics at 2,5; 4 and 6 months. Blood biochemistry assays were performed on the 14–16th days and in 5 months after myocardial infarction.
Results. There was no difference in main clinical and anamnestic indices in patients of both groups at the first examination. Regular cycle ergometer exercise trainings led to the significant increase of the level of work capacity at the 4th month from (60.7±3.0) to (114.0±2,9) kJ (P<0.05) with better economic efficiency of heart work. The level of tolerance to physical load which was achieved by pts in the 1st gr was preserved 2 months at least after physical training stopping (112.0±3.9) kJ (P<0.05). At the same time these indexes in the 2nd gr were (59.1±3.8), (65.8±3.0) and (69.8±4.4) kJ, respectively with worse economic efficiency of heart work. At the 1st exam it was established high level of free radical oxidation of proteins, associated with oxidation of low density lipoproteins (LDL), very low density lipoproteins (VLDL), and high density lipoproteins (HDL) with higher index of their oxidative modification and blood atherogenic potential. The accomplished training program significantly decreased the content of free radical oxidation of proteins in blood serum and lipoproteins (LDL+ VLDL, HDL).
Conclusions. The efficiency of physical training program at the cycle ergometer in early period after myocardial infarction was established during 6-months follow up. Regular activities in individual regimen in addition to standard medical treatment (with emergent stenting) led to significant increasing of the level of the completed work and economic efficiency of heart work. These clinical effects may be explained by the decreasing of intensity of oxidative stress and inflammation, the improvement of qualitative status of lipoproteins. After stopping of physical trainings the achieved tolerance to physical load was preserved at least for two months.