Cardiovascular rehabilitation in patients after acute coronary syndrome

Czech version

Authors: R. Vysoký ^1,2,3; O. Ludka ^4,5; F. Dosbaba ²; L. Baťalík ²; S. Nehyba ⁴; J. Špinar ^4,5
Authors‘ workplace: Ústav ochrany a podpory zdraví LF MU, Brno ¹; Rehabilitační oddělení , FN Brno ²; Katedra podpory zdraví, FSpS MU Brno ³; Interní kardiologická klinika LF MU a FN Brno ⁴; Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně ⁵
Published in: Kardiol Rev Int Med 2014, 16(6): 507-511
Category: Cardiology Review

Overview

Introduction:
Cardiovascular rehabilitation is currently part of standard therapy in patients after acute coronary syndrome. The interventional cardiovascular rehabilitation training program is a part of the second rehabilitation phase, which is a key point in all secondary‑ preventive processes in patients with coronary artery disease. Patients are hemodynamically adapted to normal physical exercise, their aerobic capacity is gradually increased, and they learn about the principles of regular aerobic‑resistance training.

Design:
This study is focused on assessing the impact of modified aerobic‑resistance training on cardiorespiratory parameters in patients after an acute coronary event.

Methods:
The study included 106 patients (85% men), mean age 60.4 ± 10.9 years, with a left ventricular ejection fraction 57.4 ± 7.2%. The time form acute coronary event to the start of the training program was 35 ± 8 days; in patients after coronary artery bypass graft this was 50 ± 16 days. All patients completed a 2-month aerobic‑resistance training program with 3 sessions a week. A training session lasted 100 min (including 60 min of aerobic training).

Results:
The completion of the intervention training program led to a significant increase in work tolerance (1.8 ± 0.3 vs. 2.0 ± 0.4 W/ kg; p < 0.001) and peak oxygen consumption (22.8 ± 4.5 vs. 25.9 ± 5.5 pVO₂; p < 0.001). Other results observed were a non‑significant decrease in resting heart rate, systolic and diastolic blood pressure values.

Conclusion:
A modified intervention training program leads to improvements in aerobic capacity, which is one of the major prognostic factors in patients after acute coronary syndrome.

Keywords:
cardiac rehabilitation – secondary prevention – aerobic training – resistance training – aerobic capacity – coronary artery disease – acute coronary syndrome

Sources

1. Chaloupka V, Siegelová J, Špinarová L et al. Rehabilitace nemocných s kardiovaskulárním onemocněním. Doporučené postupy ČKS. Cor et Vasa 2006; 48 (Suppl 4): K127– K145.

2. Vysoký R, Chaloupková Š. Seznámení s kardiovaskulární rehabilitací. Sestra 2007; 17: 49.

3. Gupta R, Sandreson BK, Bittner V. Outcomes at one year follow up of women and men with coronary artery disease discharged from cardiac rehabilitation with benefits are maintained? J Cardiopulm Rehabil Prev 2007; 27: 11– 18.

4. Chaloupka V, Elbl L. Rehabilitace po infarktu myokardu. Kardiol Rev 2005; 7: 5– 9.

5. Chaloupka V, Elbl L. Rehabilitace po infarktu myokardu (II): způsoby zátěže. Kardiol Rev 2005; 7: 73– 76.

6. Chaloupka V, Elbl L. Rehabilitace po infarktu myokardu (III). Kardiol Rev 2005; 7: 187– 190.

7. Elbl L, Chaloupka V, Nehyba S et al. Význam kombinovaného rehabilitačního programu u nemocných s chronickou ischemickou chorobou srdeční. Vnitř Lék 2005; 51: 957– 964.

8. Elbl L, Chaloupka V, Tomášková I et al. Vliv kombinovaného aerobního a silového tréninku na funkcí levé komory srdeční u nemocných po akutním infarktu myokardu. Vnitř Lék 2005; 51: 190– 197.

9. Mífková L, Kožantová L, Siegelová J. Kombinovaný trénink u pacientů po akutním infarktu myokardu. Med Sport Boh Slov 2005; 14: 115– 123.

10. Máček M. Fyziologie a klinické aspekty pohybové aktivity. Praha: Galén 2005: 215– 223.

11. Máček M, Máčková J. Potřeba pohybové aktivity ve vyšším věku. Med Sport Boh Slov 2008; 17: 34– 42.

12. Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil 2007; 14: 12– 17.

13. Boule NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2diabetes mellitus: a meta analysis of controlled clinical trials. JAMA 2001; 286: 1218– 1227.

14. Kodama S, Tanaka S, Saito K et al. Effect of aerobic exercise training on serum levels in high density lipoprotein cholesterol: a meta analysis. Arch Intern Med 2007; 167: 999– 1008.

15. Kelley GA, Kelley KS, Franklin B. Aerobic exercise and lipids and lipoproteins in patiens with cardiovascular dinase: a meta analysis of randomized controlled trials. J Cardiopulm Rehabil 2006; 26: 131– 139.

16. Jančík J, Svačinová H, Dobšák P et al. Kombinovaný trénink u nemocných se systolickou dysfunkcí levé komory srdeční. Vnitř lék 2003; 49: 280– 284.

17. Elbl L, Chaloupka V, Nehyba S et al. Vliv kombinovaného aerobního tréninku na změny autonomní modulace u nemocných po akutním infarktu myokardu. Vnitř Lék 2005; 51: 421– 429.

18. Elbl L, Chaloupka V, Tomášková I et al. Silový trénink u nemocných po akutním infarktu myokardu se sníženou ejekční frakcí levé komory. Vnitř Lék 2005; 51: 41– 47.

19. Kavanagh T, Mertens DJ, Hamm LF et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J AM Coll Cardiol 2003; 42: 2139– 2143.

20. Kavanagh T, Mertens DJ, Hamm LF et al. Prediction of long‑term prognosis in 12,169 men referred for cardiac rehabilitation. Circulation 2002; 106: 666– 671.

21. Myers J, Prakash M, Froelicher V et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793– 801.

22. Ades PA, Savage PD, Brawner CA et al. Aerobic capacity in patients entering cardiac rehabilitation. Circulation 2006; 113: 2706– 2712.

23. Panovský R, Jančár R, Meluzín J et al. Srovnání řízeného a nekontrolovaného aerobního tréninku u nemocných s chronickou ischemickou chorobou srdeční. Kardiol Rev 2005; 7: 67– 72.

24. Magalhaes S, Viamonte S, Miguel Ribeiro M et al. Long‑term effects of a cardiac rehabilitation program in the control of cardiovascular risk factors. Rev Port Cardiol 2013; 32:191– 199. doi: 10.1016/ j.repc.2012.08.005.