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Miao J, Yang H, Shi R, Wang C. The effect of cardiac rehabilitation on cardiopulmonary function after coronary artery bypass grafting: A systematic review and meta-analysis. iScience 2023; 26:107861. [PMID: 38058302 PMCID: PMC10696125 DOI: 10.1016/j.isci.2023.107861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/15/2023] [Accepted: 09/06/2023] [Indexed: 12/08/2023] Open
Abstract
We carried out a meta-analysis on the effect of cardiac rehabilitation (CR) on cardiopulmonary function after coronary artery bypass grafting (CABG). Four databases were searched for studies comparing CR with control. A random-effects model was used to pool mean difference (MD). The meta-analysis showed an increase in peak oxygen consumption (peak VO2) (MD = 1.93 mL/kg/min, p = 0.0006), and 6-min walk distance (6MWD) (MD = 59.21 m, p < 0.00001), and a decrease in resting heart rate (resting HR) (MD = 5.68 bpm, p < 0.0001) in the CR group. The subgroup analysis revealed aerobic exercise could further improve resting HR and peak HR, and physical/combination with aerobic exercise could further increase 6MWD. The improvement of peak VO2, workload, resting HR, peak HR, and 6MWD regarding CR performed within one week after CABG is greater than that one week after CABG. CR after CABG can improve the cardiopulmonary function, which is reflected by the improvement of peak VO2, 6MWD, and resting HR.
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Affiliation(s)
- Jiapeng Miao
- Department of Cardiovascular Medicine, Zhuzhou Central Hospital, Xiangya hospital Zhuzhou, Central South University, 116 Changjiang South Road, Zhuzhou 412000, China
| | - Huayun Yang
- Department of Cardiovascular Medicine, Guilin People’s Hospital, 12 Wenming Road, Guilin 541002, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Chengming Wang
- Department of Cardiovascular Medicine, Zhuzhou Central Hospital, Xiangya hospital Zhuzhou, Central South University, 116 Changjiang South Road, Zhuzhou 412000, China
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Gois CO, Conceição LSR, de Andrade Guimarães AL, Carvalho VO. Comment on: "exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis". Egypt Heart J 2023; 75:19. [PMID: 36928450 PMCID: PMC10020400 DOI: 10.1186/s43044-023-00344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Low cardiorespiratory fitness is associated with poor prognosis in individuals with coronary artery disease and after coronary artery bypass grafting surgery. Thus, we comment about a meta-analysis that adds important information about the effect of exercise training on cardiac autonomic function in individuals following coronary artery bypass grafting surgery. MAIN BODY The study by Kushwaha et al. showed positive effects for heart rate variability and heart rate recovery in subjects after coronary artery bypass grafting surgery in response to acute physical training. These data are relevant, since heart rate variability is an independent predictor of for all-cause and cardiovascular mortality for individuals with cardiovascular disorders. Additionally, attenuated heart rate recovery is associated with increased risk for the same outcomes. Moreover, we summarize the quantitative data from studies that compared the effect of physical training in comparison with control group in cardiorespiratory fitness in adults following coronary artery bypass grafting. CONCLUSIONS Our findings suggest that improvements in peak oxygen consumption result in an additional benefit in adults following coronary artery bypass grafting. Considered that, the increased cardiorespiratory fitness is an independent predictor of longer survival in coronary artery disease.
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Affiliation(s)
- Caroline Oliveira Gois
- Postgraduate Program in Health Science, Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe - UFS), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil. .,The GrEAt Group (Grupo de Estudos Em Atividade Físicasica), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil.
| | - Lino Sergio Rocha Conceição
- The GrEAt Group (Grupo de Estudos Em Atividade Físicasica), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil
| | - Alana Lalucha de Andrade Guimarães
- Postgraduate Program in Health Science, Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe - UFS), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil.,The GrEAt Group (Grupo de Estudos Em Atividade Físicasica), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil
| | - Vitor Oliveira Carvalho
- Postgraduate Program in Health Science, Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe - UFS), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil.,The GrEAt Group (Grupo de Estudos Em Atividade Físicasica), Av. Marechal Rondon, s/n -Jardim Rosa Elze, São Cristóvão, Sergipe, 49100-000, Brazil
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Kushwaha P, Moiz JA, Mujaddadi A. Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis. Egypt Heart J 2022; 74:67. [PMID: 36138168 PMCID: PMC9500144 DOI: 10.1186/s43044-022-00306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise training improves cardiac autonomic function is still debatable in patients with coronary artery bypass grafting (CABG). The aim of the present review is to assess the effect of exercise on CABG patient's heart rate variability (HRV) and heart rate recovery (HRR) parameters. MAIN BODY Databases (PubMed, Web of Science and PEDro) were accessed for systematic search from inception till May 2022. Eleven potential studies were qualitatively analyzed by using PEDro and eight studies were included in the quantitative synthesis. Meta-analysis was conducted by using a random-effect model, inverse-variance approach through which standardized mean differences (SMDs) were estimated. The analysis of pooled data showed that exercise training improved HRV indices of standard deviation of the R-R intervals (SDNN) [SMD 0.44, 95% CI 0.17, 0.71, p = 0.002], square root of the mean squared differences between adjacent R-R intervals (RMSSD) [SMD 0.68, 95% CI 0.28, 1.08, p = 0.0008], high frequency (HF) [SMD 0.58, 95% CI 0.18, 0.98, p = 0.005] and low frequency-to-high frequency (LF/HF) ratio [SMD - 0.34, 95% CI - 0.65, - 0.02, p = 0.03]. CONCLUSIONS Exercise training enhances cardiac autonomic function in CABG patients. Owing to the methodological inconsistencies in assessing HRV, the precise effect on autonomic function still remains conflicted. Future high-quality trials are needed focusing on precise methodological approach and incorporation of various types of exercise training interventions will give clarity regarding autonomic adaptations post-exercise training in CABG. Trial registration CRD42021230270 , February 19, 2021.
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Affiliation(s)
- Purnima Kushwaha
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India
| | - Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India.
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El Missiri A, Amin SA, Tawfik IR, Shabana AM. Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery. Egypt Heart J 2020; 72:69. [PMID: 33052491 PMCID: PMC7560662 DOI: 10.1186/s43044-020-00107-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Cardiac rehabilitation has been shown to reduce cardiac mortality, improve quality of life, and reduce hospitalizations. Cardiac rehabilitation programs are usually performed over a 12-week period. Studies have shown that similar benefits could be achieved with shorter programs. Abnormal heart rate recovery after exercise has been associated with an increased risk of cardiovascular events and mortality. The main aim of this study was to compare the effect of a 6-week phase 2 cardiac rehabilitation program on heart rate recovery to a 12-week one in patients who had recovered from an anterior wall ST segment elevation myocardial infarction. Results This prospective study included 60 patients enrolled in cardiac rehabilitation programs randomized into two equal groups: a 6-week and a 12-week program. Baseline patient demographics, lipid profile, and left ventricular ejection fraction (LVEF) were assessed. METs achieved, total exercise time, resting heart rate, peak heart rate, and heart rate recovery at 1 min were examined. These were re-assessed at the end of each program. Results showed no difference between both groups at the end of each program regarding lipid profile and LVEF. Patients enrolled in the 12-week cardiac rehabilitation program were able to achieve more METs, had a longer exercise time, a higher peak heart rate, and had a lower resting heart rate at the end of the program. Heart rate recovery was slightly higher in patients enrolled in the 6-week program 26.5 ± 6.78 versus 23.17 ± 6.12 bpm (p = 0.051). On comparing the magnitude of change between both programs, those in the 12-week program had more increase in HDL-C levels, METs achieved, and exercise time. Additionally, they had more reduction of resting heart rate. Heart rate recovery was more increased for those in the 6-week program. Conclusion Although heart rate recovery increases after completion of each of a 6-week and 12-week cardiac rehabilitation program compared to their baseline, there is no difference on comparing heart rate recovery between both programs at their end. Patients enrolled in a standard 12-week cardiac rehabilitation program achieve more METs, have a longer exercise time, a higher peak HR, and a lower resting HR at the end of the program compared to those in the 6-week program.
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Affiliation(s)
- Ahmed El Missiri
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt.
| | - Sameh Atteya Amin
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
| | - Islam Reda Tawfik
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
| | - Adel Mohamed Shabana
- Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia square, Abbasia, Cairo, 11566, Egypt
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Two early rehabilitation training models in male patients after coronary artery bypass surgery: application of continuous walking training as an alternative to interval cycle ergometer training. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:87-93. [PMID: 32728371 PMCID: PMC7379224 DOI: 10.5114/kitp.2020.97265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
Introduction Walking training is a good alternative to the commonly used cycle ergometer training. It is still necessary to develop rehabilitation programs based on walking characterized by a high degree of safety and effectiveness. Aim Application of continuous walking training as an alternative to interval cycle ergometer training in men after coronary artery bypass graft (CABG) surgery, using the 6-minute walk test (6-MWT) to determine the initial training load. Material and methods Forty-four men aged 45 to 76 years, up to 3 months after CABG surgery, were randomly assigned to continuous training on a treadmill (study group) or interval training on a cycle ergometer (control group), performed 6 times per week (12-15 sessions). Participants underwent the treadmill exercise stress test (TEST) and 6-MWT at the begining and after completion of the rehabilitation program. Before and 3 minutes after the 6th and 12th training session blood lactate concentration was determined. Results Energy expenditure in TEST increased from 4.4 to 6.3 MET in the study group and from 5.0 to 6.5 MET in the control group. Distance walked in 6-MWT increased from 420 to 519 m and from 438 to 510 m, respectively. Resting heart rate (HR) and double product (DP) decreased only in the study group as well as systolic blood pressure (SBP), HR and DP at peak exercise load in baseline TEST. Mean energy expenditure during training sessions was 2.6 MET in the study group and 2.8 MET in the control group (NS). Exercise blood lactate concentration did not exceed 2.0 mmol/l in both groups. Conclusions Both rehabilitation programs were of similar effectiveness and their intensity did not exceed the anaerobic threshold.
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Osailan A, Abdelbasset WK. Exercise-based cardiac rehabilitation for postcoronary artery bypass grafting and its effect on hemodynamic responses and functional capacity evaluated using the Incremental Shuttle Walking Test: A retrospective pilot analysis. J Saudi Heart Assoc 2020; 32:25-33. [PMID: 33154888 PMCID: PMC7640605 DOI: 10.37616/2212-5043.1005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a common surgical procedure for the restoration of blood flow into stenotic or blocked coronary arteries. Cardiac rehabilitation has been implemented to some extent worldwide for the management of postoperative CABG. However, studies about the effect of exercise training on hemodynamic responses of the heart using the Incremental Shuttle Walking (ISWT) test are limited in Saudi Arabia. OBJECTIVES To investigate the effect of exercise-based cardiac rehabilitation (Phase 3, hospital-based) on some hemodynamic responses including blood pressure, heart rate (HR) and heart rate recovery (HRR), and rate pressure product (RPP) using ISWT on post-CABG patients. METHODS Fifteen CABG (51.4 ± 6.4 years, 14 male, 1 female) patients without altering their medication were enrolled in a hospital-based cardiac rehabilitation program (Phase 3) between 2011 and 2012 for supervised individual exercise training sessions (three times per week for 8 weeks; 60-minute session at a moderate intensity). Patients performed two tests (ISWT1 and ISWT2) and one before exercise training program and one after, during which resting systolic blood pressure (SBP) and diastolic blood pressure (DBP), post-ISWT SBP and DBP, resting HR, peak HR, HRR (which was defined as the absolute change from peak HR to 1-minute post peak HR), and RPP at rest and at the end of the ISWT were measured. Exercise training sessions included both aerobic and resistance exercises, which were preceded by a cooling down period and followed by a recovery period. RESULTS Paired t-test showed a significant reduction in both resting SBP (p = 0.04) and DBP (p = 0.03), and a significant increase in post-ISWT2 SBP (p = 0.004), peak HR (p = 0.003), HRR (p = 0.03), and RPP at maximum (p = 0.002) after 8 weeks of supervised exercise training. In addition, there was a significant increase in the speed and distance achieved on ISWT2 (p < 0.001) after the training program. CONCLUSION Supervised exercise training (cardiac rehabilitation) for 8 weeks was effective in improving hemodynamic responses and functional exercise capacity in CABG patients. Cardiac rehabilitation should be implemented more frequently and health-care providers should be aware of its importance. Further research is needed in this area to confirm these findings in the region.
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Affiliation(s)
- Ahmad Osailan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
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Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis. Clin Auton Res 2020; 31:187-203. [PMID: 32270406 DOI: 10.1007/s10286-020-00687-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CAD patients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.
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Gambassi BB, Almeida FDJF, Almeida AEAF, Ribeiro DAF, Gomes RSA, Chaves LFC, Sousa TMDS, Nina VJDS. Acute Response to Aerobic Exercise on Autonomic Cardiac Control of Patients in Phase III of a Cardiovascular Rehabilitation Program Following Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2019; 34:305-310. [PMID: 31310469 PMCID: PMC6629226 DOI: 10.21470/1678-9741-2019-0030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/17/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the acute response to aerobic exercise on autonomic cardiac control of patients undergoing coronary artery bypass grafting (CABG). METHODS The study sample consisted of eight patients (age: 58.6±7.7 years; body mass index: 26.7±3.5 kg.m2) who underwent a successful CABG (no complications during surgery and/or in the following weeks). To assess heart rate variability (HRV), participants remained in a supine position with a 30-degree head elevation for 20 minutes. Electrocardiographic signal (protocol with three derivations) was collected from 600 Hz sample rate to obtain beat-to-beat intervals (R-R interval). This assessment was performed before, after one hour and after 24 hours of the exercise session. All patients underwent a 35 minutes aerobic exercise session (AES) (low-moderate intensity) on the cycle ergometer. RESULTS Significant differences were found in the time domain, with positive changes in root mean square of successive RR interval differences (rMSSD) (ms) (parasympathetic component) (one [P=0.017] and 24 hours [P=0.007] post-session). In the frequency domain, we found a significant difference in high frequency (HF) (ms2) (parasympathetic component) (one hour [P=0.048] post-session). The low frequency (LF)/HF ratio (sympathetic and parasympathetic components with a predominance of the sympathetic component) reached statistical significance only 24 hours (P=0.018) post-session. Additionally, the largest effect size was observed only for the LF/HF ratio at one (d=-0.8) and 24 hours (d=-1.3) after one AES. CONCLUSION The practice of (acute) aerobic exercise improved autonomic cardiac control in patients undergoing CABG.
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Affiliation(s)
| | - Fabiano de Jesus Furtado Almeida
- Department of Physical Education, Universidade Ceuma, São
Luís, MA, Brazil
- Programa de Pós-Graduação em Ciências da
Saúde, Universidade Federal do Maranhão (UFMA), São
Luís, MA, Brazil
- Department of Physical Education, Universidade Estadual do
Maranhão (UEMA), São Luís, MA, Brazil
| | | | | | | | | | | | - Vinicius José da Silva Nina
- Programa de Pós-Graduação em Ciências da
Saúde, Universidade Federal do Maranhão (UFMA), São
Luís, MA, Brazil
- Hospital Universitário da Universidade Federal do
Maranhão (HUUFMA), São Luís, MA, Brazil
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Mitchell BL, Lock MJ, Davison K, Parfitt G, Buckley JP, Eston RG. What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis. Br J Sports Med 2018; 53:1341-1351. [PMID: 30121584 DOI: 10.1136/bjsports-2018-099153] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Assess the role of exercise intensity on changes in cardiorespiratory fitness (CRF) in patients with cardiac conditions attending exercise-based cardiac rehabilitation. DESIGN Systematic review with meta-analysis. DATA SOURCES MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO and Web of Science. ELIGIBILITY CRITERIA FOR SELECTION Studies assessing change in CRF (reported as peak oxygen uptake; V̇O2peak) in patients post myocardial infarction and revascularisation, following exercise-based cardiac rehabilitation. Studies establishing V̇O2peak via symptom-limited exercise test with ventilatory gas analysis and reported intensity of exercise during rehabilitation were included. Studies with mean ejection fraction <40% were excluded. RESULTS 128 studies including 13 220 patients were included. Interventions were classified as moderate, moderate-to-vigorous or vigorous intensity based on published recommendations. Moderate and moderate-to-vigorous-intensity interventions were associated with a moderate increase in relative V̇O2peak (standardised mean difference±95% CI=0.94±0.30 and 0.93±0.17, respectively), and vigorous-intensity exercise with a large increase (1.10±0.25). Moderate and vigorous-intensity interventions were associated with moderate improvements in absoluteV̇O2peak (0.63±0.34 and 0.93±0.20, respectively), whereas moderate-to-vigorous-intensity interventions elicited a large effect (1.27±0.75). Large heterogeneity among studies was observed for all analyses. Subgroup analyses yielded statistically significant, but inconsistent, improvements in CRF. CONCLUSION Engagement in exercise-based cardiac rehabilitation was associated with significant improvements in both absolute and relative V̇O2peak. Although exercise of vigorous intensity produced the greatest pooled effect for change in relative V̇O2peak, differences in pooled effects between intensities could not be considered clinically meaningful. REGISTRATION Prospero CRD42016035638.
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Affiliation(s)
- Braden L Mitchell
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Merilyn J Lock
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - John P Buckley
- Institute of Medicine, University Centre Shrewsbury/University of Chester, Shrewsbury, UK
| | - Roger G Eston
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
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Elshazly A, Khorshid H, Hanna H, Ali A. Effect of exercise training on heart rate recovery in patients post anterior myocardial infarction. Egypt Heart J 2018; 70:283-285. [PMID: 30591744 PMCID: PMC6303535 DOI: 10.1016/j.ehj.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/21/2018] [Indexed: 12/01/2022] Open
Abstract
Background Regular exercise training has been shown to reduce mortality, improve functional capacity; and control the risk factors in myocardial infarction (MI) patients. Heart rate recovery (HRR) is a strong independent mortality predictor in patients with previous MI. Aim The main objective of this study was to investigate the impact of exercise training on heart rate recovery in patients post anterior myocardial infarction. Methods We recruited patients one month after having anterior MI who were referred to cardiac rehabilitation (CR) clinic in Ain Shams University hospital between October 2016 and July 2017. All the patients participated in exercise training sessions 3 times a week for 12 weeks. Symptom limited treadmill exercise test was done before and after exercise training program to calculate heart rate recovery in 1st minute (HRR1) and 2nd minute (HRR2). Results A total of 50 patients, including 44 (88%) males, completed the exercise training program. The mean age was 51 years. Statistically significant improvement in HRR1 and HRR2 was observed (p value <0.001) after completion of exercise based cardiac rehabilitation program. Significant improvement in resting heart rate was also observed (p value <0.001). Moreover, metabolic equivalent (METs) and HR reserve were improved significantly (p value <0.001). No statistically significant changes were observed in resting systolic and diastolic blood pressures and maximum HR (p value = 0.95, 0.76 and 0.31 respectively). Conclusion Exercise training improves HRR, resting HR, METs and HR reserve in post anterior MI patients.
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Affiliation(s)
- Ahmed Elshazly
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Hazem Khorshid
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Hany Hanna
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Ammar Ali
- Department of Cardiology, Ain Shams University, Cairo, Egypt
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Ivanova OА, Kuklin SG. THE RATE OF CARDIAC RHYTHM RECOVERY POST EXERTION IN PHYSICAL REHABILITATION OF CARDIOLOGICAL PATIENTS. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-2-95-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Taken the rising mortality and morbidity of the population due to cardiovascular diseases (CVD), rehabilitation of cardiovascular patients remains actual. Regular exercises are the leading components of cardiorehabilitation, that is evidently beneficial. Taken this, the question raises on the adequacy and efficacy of training regimens. Utilization of the parameter representing the velocity of heart rate decline by every minute of recovery phase after the exertion, is quite informative. The borderline set for heart rate, with increasing cardiovascular risk if below. Dynamics of such parameter during the programs of physical rehabilitation might be a marker of the events efficacy. Recently, there is a deficiency of information on the normal parameters of heart rate recovery rate in CVD patients. Hence a question raises, on the unification of approaches in evaluation of recovery period and data collection on the influence of long term exercises on CVD prognosis.
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Affiliation(s)
- O. А. Ivanova
- Irkutskaya State Medical Academy of Postgraduate Education — branch of FSBEI CPE “Russian Medical Academy of Continuous Professional Development” of the Ministry of Health
| | - S. G. Kuklin
- Irkutskaya State Medical Academy of Postgraduate Education — branch of FSBEI CPE “Russian Medical Academy of Continuous Professional Development” of the Ministry of Health
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Multimedia Exercise Training Program Improves Distance Walked, Heart Rate Recovery, and Self-efficacy in Cardiac Surgery Patients. J Cardiovasc Nurs 2018; 31:343-9. [PMID: 25774840 DOI: 10.1097/jcn.0000000000000246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patient education has been shown to be more effective when delivered using multimedia than written materials. However, the effects of using multimedia to assist patients in cardiac rehabilitation have not been investigated. OBJECTIVE The purpose of this study is to examine the effect of an inpatient multimedia exercise training program on distance walked in the 6-minute walking test (6MWT), heart rate recovery, and walking self-efficacy of patients who had undergone heart surgery. METHODS For this longitudinal quasi-experimental study, 60 consecutive patients were assigned to an experimental (n = 20; inpatient multimedia exercise training program) or control (n = 40; routine care) group. Data were collected at 3 times (before surgery, 1 to 2 days before hospital discharge, and 1 month after hospital discharge) and analyzed with the generalized estimating equation approach. RESULTS Most subjects were men (66.7%), had a mean age of 61.32 ± 13.4 years and left ventricular ejection fraction of 56.96% ± 13.28%, and underwent coronary artery bypass graft surgery (n = 34, 56.7%). Subjects receiving the exercise training program showed significantly greater improvement than those in the control group in the 6MWT walking distance (P < .001), heart rate recovery (P = .04), and self-efficacy (P = .002) at hospital discharge. Furthermore, the intervention effects on 6MWT distance (P < .001) and self-efficacy (P < .001) were sustained at 1 month after hospital discharge. CONCLUSION Our inpatient multimedia exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained their improvement in 6MWT and self-efficacy 1 month later.
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Blokzijl F, Dieperink W, Keus F, Reneman MF, Mariani MA, van der Horst IC. Cardiac rehabilitation for patients having cardiac surgery: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:817-829. [PMID: 29616525 DOI: 10.23736/s0021-9509.18.10462-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is recommended for all cardiac patients including patients after cardiac surgery. Since the effect of CR after cardiac surgery has not been well established yet, we conducted a systematic review on the effects of CR for patients after cardiac surgery compared to treatment as usual. EVIDENCE ACQUISITION A systematic review of randomized clinical trials (RCTs), quasi-randomized and prospective observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE was undertaken until October 18th, 2017. Adults after any kind of cardiac surgery were included. Primary outcome was all-cause mortality, other outcomes were serious adverse events, health-related quality of life, work participation, functioning and costs/cost-effectiveness. Risk of bias was evaluated, and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. EVIDENCE SYNTHESIS Eighteen RCTs and 15 observational studies were included. Low risk of bias was only observed in one observational study. Meta-analysis of RCTs suggested no significant difference of CR compared to control on mortality (random-effects relative risk (RR) 0.93 (95% CI: 0.40-1.81), while observational studies suggested statistically significant beneficial effect associated with CR (random-effects RR=0.49, 95% CI: 0.35 - 0.68). CR did not significantly affect any of the other outcomes. Due to the limited data TSA could not be performed. CONCLUSIONS The body of evidence does not allow us to reach any reliable conclusions about the effectiveness of CR following cardiac surgery. Future trials need to be conducted with low risks of bias and clearly defined outcomes.
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Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands -
| | - Willem Dieperink
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Villelabeitia-Jaureguizar K, Vicente-Campos D, Senen AB, Jiménez VH, Garrido-Lestache MEB, Chicharro JL. Effects of high-intensity interval versus continuous exercise training on post-exercise heart rate recovery in coronary heart-disease patients. Int J Cardiol 2017. [PMID: 28648356 DOI: 10.1016/j.ijcard.2017.06.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart rate recovery (HRR) has been considered a prognostic and mortality indicator in both healthy and coronary patients. Physical exercise prescription has shown improvements in VO2peak and HRR, but most of the studies have been carried out applying continuous training at a moderate intensity, being very limited the use of protocols of high intensity interval training in coronary patients. We aimed to compare the effects of a moderate continuous training (MCT) versus a high intensity interval training (HIIT) programme on VO2peak and HRR. METHODS Seventy three coronary patients were assigned to either HIIT or MCT groups for 8weeks. Incremental exercise tests in a cycloergometer were performed to obtain VO2peak data and heart rate was monitored during and after the exercise test to obtain heart rate recovery data. RESULTS Both exercise programmes significantly increase VO2peak with a higher increase in the HIIT group (HIIT: 4.5±4.46ml/kg/min vs MCT: 2.46±3.57ml/kg/min; p=0.039). High intensity interval training resulted in a significantly increase in HRR at the first and second minute of the recovery phase (15,44±7,04 vs 21,22±6,62, p<0,0001 and 23,73±9,64 vs 31,52±8,02, p<0,0001, respectively). CONCLUSIONS The results of our research show that the application of HIIT to patients with chronic ischemic heart disease of low risk resulted in an improvement in VO2peak, and also improvements in post-exercise heart-rate recovery, compared with continuous training.
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Korzeniowska-Kubacka I, Bilińska M, Piotrowska D, Stepnowska M, Piotrowicz R. The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction. Eur J Cardiovasc Nurs 2016; 16:390-396. [DOI: 10.1177/1474515116682123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iwona Korzeniowska-Kubacka
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Maria Bilińska
- Department of Arrhythmia, Institute of Cardiology, Warsaw, Poland
| | - Dorota Piotrowska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Stepnowska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
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Nascimento PMC, Vieira MC, Sperandei S, Manoel Serra S. Supervised exercise improves autonomic modulation in participants in cardiac rehabilitation programs. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Al Dera H, Aldahash R. Physical therapy program improves the physiological impact towards better quality of life and low cardiac risk factors in patients following coronary artery bypass grafting. Systematic review. ACTA MEDICA INTERNATIONAL 2016. [DOI: 10.5530/ami.2016.1.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nascimentoa PMC, Vieiraa MC, Sperandeib S, Serraa SM. Supervised exercise improves autonomic modulation in participants in cardiac rehabilitation programs. Rev Port Cardiol 2015; 35:19-24. [PMID: 26711536 DOI: 10.1016/j.repc.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/21/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES An attenuated heart rate recovery (HRR) response after exercise testing is a robust predictor of mortality. Regular exercise can enhance various physiological parameters. Studies indicate that participation in a cardiac rehabilitation program can improve heart rate recovery. The aim of this study was to analyze changes in functional capacity and autonomic modulation in patients following a cardiac rehabilitation program. METHODS Between 2009 and 2014, 248 individuals were assessed through exercise testing, at baseline and after six months of participation in a cardiac rehabilitation program. The exercise test was performed on a treadmill using a ramp protocol. The first minute of active recovery was standardized at a speed of 1.5 mph and slope of 2.5%. The degree of parasympathetic modulation was assessed by the difference between peak exercise heart rate and heart rate at one minute of recovery. The subjects were divided into two groups according to pre-training HRR (≤ 12 bpm and >12 bpm). RESULTS Exercise training resulted in a similar increase in metabolic equivalent values in both groups, but only the HRR ≤ 12 bpm group showed improvement after training (F=16.13; p<0.001), with a mean increase from 7.4 ± 3.69 bpm to 13.0 ± 9.74 bpm. CONCLUSIONS The cardiac rehabilitation program had a positive impact in a group that had both low functional capacity and reduced parasympathetic activity, producing a favorable effect on these recognized prognostic markers.
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Kadda O, Kotanidou A, Manginas A, Stavridis G, Nanas S, Panagiotakos DB. Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial. J Clin Nurs 2015; 24:1611-21. [PMID: 25727522 DOI: 10.1111/jocn.12762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 01/20/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the one-year prognosis of a lifestyle counselling intervention (diet, smoking cessation and exercise) among patients who had open heart surgery. BACKGROUND Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries. Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease. DESIGN Randomised, nonblind and lifestyle counselling intervention study with a one-year follow-up. METHODS A randomised, nonblind intervention study was performed on 500 patients who had open heart surgery. After hospital discharge, 250 patients (intervention group) were randomly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology (European Journal Preventive Cardiology, 19, 2012, 585). The remaining 250 patients (control group) received the regular instructions. Primary end-point was the development of a cardiovascular disease (nonfatal event) during the first year; secondary end-points included fatal events, smoking abstinence, dietary habits and a physical activity evaluation. RESULTS According to the primary end-point, the odds of having a nonfatal cardiovascular disease event are 0·56-times (95%CI 0·28, 0·96, p = 0·03) lower for the intervention group compared to the control group. One-year after surgery, it was found that participants in the intervention group were 1·96-times (95%CI 1·31, 2·93, p < 0·001) more likely to achieve dietary recommendations, 3·32-times (95%CI 2·24, 4·91, p < 0·001) more likely to achieve physical activity recommendations and 1·34-times (95%CI 1·15, 1·56, p < 0·001) more likely to return to work. CONCLUSION Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event. Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient's needs. RELEVANCE TO CLINICAL PRACTICE A well-structured cardiac rehabilitation programme adjusted to the patient's profile is a safe and cost-effective way to improve patients' outcome.
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Affiliation(s)
- Olga Kadda
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | | | - George Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Serafim Nanas
- Department of Critical Care, School of Medicine, University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Karakulak UN, Maharjan N, Tutkun E, Yılmaz ÖH. Additional diagnostic parameter for coronary artery disease during exercise test: heart rate recovery. Anatol J Cardiol 2015; 15:163. [PMID: 25625448 PMCID: PMC5337009 DOI: 10.5152/akd.2015.6012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dayan V, Ricca R. [Cardiac rehabilitation after coronary artery bypass surgery]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:286-92. [PMID: 25240582 DOI: 10.1016/j.acmx.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/29/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022] Open
Abstract
Ischemic heart disease is the leading cause of death worldwide with an increase in the incidence in younger populations. Today revascularization strategies are capable of alleviating acute ischemia and/or chronic ischemia. These can be performed percutaneously or through surgery. Even if we improve myocardial perfusion by these methods, the main determinant in maintaining patency of coronary arteries and bypass is a correctly instituted secondary prevention. This is the main focus of cardiac rehabilitation proposals. Although much has been published about the role of cardiac rehabilitation after percutaneous revascularization, there is little work able to synthesize the current state of cardiac rehabilitation in patients undergoing coronary artery bypass surgery. The aim of this paper is to review the effect of rehabilitation in the return to work, survival, functional capacity, depression and anxiety, as well as compare centralized vs. home rehabilitation in this patient population.
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Affiliation(s)
- Victor Dayan
- Cátedra de Cirugía Cardiaca, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
| | - Roberto Ricca
- Cátedra de Cardiología, Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Abstract
BACKGROUND Heart rate recovery (HRR) after exercise cessation is thought to reflect the rate of reestablishment of parasympathetic tone. Relatively little research has focused on improved HRR in women after completing cardiac rehabilitation (CR) exercise training. OBJECTIVE We examined the influence of exercise training on HRR in women completing a traditional CR program and in women completing a CR program tailored for women. METHODS A 2-group randomized clinical trial compared HRR between 99 women completing a traditional 12-week CR program and 137 women completing a tailored CR program. Immediately upon completion of a symptom-limited graded exercise test, HRR was measured at 1 through 6 minutes. RESULTS Compared with baseline, improvement in 1-minute HRR (HRR1) was similar (P = 0.777) between the tailored (mean [SD], 17.5 [11] to 19.1 [12]) and the traditional CR program (15.7 [9.0] to 16.9 [9.5]). The amount of change in the 2-minute HRR (HRR2) for the tailored (30 [13] to 32.8 [14.6]) and traditional programs (28.3 [12.8] to 31.2 [13.7]) also was not different (P = 0.391). Similar results were observed for HRR at 3 through 6 minutes. Given these comparable improvements of the 2 programs, in the full cohort, the factors independently predictive of post-CR HRR1, in rank order, were baseline HRR1 (part correlation, 0.35; P < 0.001); peak exercise capacity, estimated as metabolic equivalents (METs; 0.24, P < 0.001); anxiety (-0.17, P = 0.001); and age (-0.13, P = 0.016). The factors independently associated with post-CR HRR2 were baseline HRR2 (0.44, P < 0.001), peak METs (0.21, P < 0.001), and insulin use (-0.10, P = 0.041). CONCLUSIONS One to 6 minutes after exercise cessation, HRR was significantly improved among the women completing both CR programs. The modifiable factors positively associated with HRR1 included peak METs and lower anxiety, whereas HRR2 was associated with insulin administration and peak METs. Additional research on HRR after exercise training in women is warranted.
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The influence of endurance training intensity on dynamics of post-exertional heart rate recovery adaptation in patients with ischemic heart disease. Adv Med Sci 2014; 58:50-7. [PMID: 23729585 DOI: 10.2478/v10039-012-0073-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The intensity of post-exertion heart rate recovery, evaluated in the first minute of the recovery period (HRR₆₀), is considered to be a strong predictor of risk for cardiac death. Intensification of physical activity performed as part of cardiac rehabilitation (CR) increases the HRR₆₀ value in ischemic heart disease (IHD) patients. In this context, the impact of endurance training intensity (ETI) on change in HRR₆₀ intensity seems to be an interesting issue. MATERIAL/METHODS The study group consisted of 251 patients who were subjected to a CR cycle. 45 patients of this group participated in CR twice. The control group consisted of 35 patients who were not subjected to any CR. ETI was estimated by the training work. In all patients an exertion test on a treadmill was performed twice within six months, analyzing the initial and final HRR₆₀ value and ΔHRR₆₀. RESULTS After a six-month observation, there was a statistically significant increase in the HRR₆₀ value (17.98±8.33/min vs. 22.72±7.72/min, p<0.01) in the test group, which was not observed in the control group. Mean ΔHRR₆₀ value in the test group was statistically significantly greater than in the control group. In the subgroup subjected to the two CR cycles, only the first cycle led to a statistically significant increase in the mean HRR₆₀ value. CONCLUSIONS A six-month CR cycle significantly increased the HRR₆₀ value, while cardiac training intensity did not affect the exertion-evoked change in its intensity. Continuation of the CR cycle beyond 6 months no longer significantly affected the change in the HRR₆₀ value.
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Snoek JA, van Berkel S, van Meeteren N, Backx FJG, Daanen HAM. Effect of aerobic training on heart rate recovery in patients with established heart disease; a systematic review. PLoS One 2013; 8:e83907. [PMID: 24367618 PMCID: PMC3867471 DOI: 10.1371/journal.pone.0083907] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/10/2013] [Indexed: 12/26/2022] Open
Abstract
Background Although a delayed decrease in heart rate during the first minute after graded exercise has been identified as a powerful predictor of overall mortality in cardiac patients, the potential to influence this risk factor by aerobic training remains to be proven. Objective The aim was to study the relationship between aerobic training and Heart Rate Recovery (HRR) in patients with established heart disease. Methods (Quasi) randomized clinical trials on aerobic exercise training in adults with established heart disease were identified through electronic database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Methodological validity was evaluated using an adapted version of the Cochrane Collaboration’s tool for assessing risk of bias and the therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (CONTENT). Scores range from 0 to 9 (score ≥ 6 reflecting therapeutic validity). Results Of the 384 articles retrieved, 8 studies (449 patients) were included. Three of the included studies demonstrated adequate therapeutic validity and five demonstrated low risk of bias. Two studies showed both adequate therapeutic validity and a low risk of bias. For cardiac patients aerobic exercise training was associated with more improvement in HRR compared to usual care. Conclusion The present systematic review shows a level 1A evidence that aerobic training increases HRR in patients with established heart disease.
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Affiliation(s)
- Johan A. Snoek
- Sports Medicine Department, Isala, Zwolle, The Netherlands
- * E-mail:
| | | | - Nico van Meeteren
- TNO Healthy Living, Leiden, The Netherlands
- Centre for Care Technology Research, Maastricht, The Netherlands
| | - Frank J. G. Backx
- Rehabilitation, Nursing science and Sports Department, UMC Utrecht, Utrecht, The Netherlands
| | - Hein A. M. Daanen
- TNO Healthy Living, Leiden, The Netherlands
- MOVE Research Institute Amsterdam & Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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Currie KD, Rosen LM, Millar PJ, McKelvie RS, MacDonald MJ. Heart rate recovery and heart rate variability are unchanged in patients with coronary artery disease following 12 weeks of high-intensity interval and moderate-intensity endurance exercise training. Appl Physiol Nutr Metab 2013; 38:644-50. [PMID: 23724882 DOI: 10.1139/apnm-2012-0354] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decreased heart rate variability and attenuated heart rate recovery following exercise are associated with an increased risk of mortality in cardiac patients. This study investigated the effects of 12 weeks of moderate-intensity endurance exercise (END) and a novel low-volume high-intensity interval exercise protocol (HIT) on measures of heart rate recovery and heart rate variability in patients with coronary artery disease (CAD). Fourteen males with CAD participated in 12 weeks of END or HIT training, each consisting of 2 supervised exercise sessions per week. END consisted of 30-50 min of continuous cycling at 60% peak power output (PPO). HIT involved ten 1-min intervals at 88% PPO separated by 1-min intervals at 10% PPO. Heart rate recovery at 1 min and 2 min was measured before and after training (pre- and post-training, respectively) using a submaximal exercise bout. Resting time and spectral and nonlinear domain measures of heart rate variability were calculated. Following 12 weeks of END and HIT, there was no change in heart rate recovery at 1 min (END, 40 ± 12 beats·min(-1) vs. 37 ± 19 beats·min(-1); HIT, 31 ± 8 beats·min(-1) vs. 35 ± 8 beats·min(-1); p ≥ 0.05 for pre- vs. post-training) or 2 min (END, 44 ± 18 beats·min(-1) vs. 43 ± 19 beats·min(-1); HIT, 42 ± 10 beats·min(-1) vs. 50 ± 6 beats·min(-1); p ≥ 0.05 for pre- vs. post-training). All heart rate variability indices were unchanged following END and HIT training. In conclusion, neither END nor HIT exercise programs elicited training-induced improvements in cardiac autonomic function in patients with CAD. The absence of improvements with training may be attributed to the optimal medical management and normative pretraining state of our sample.
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Affiliation(s)
- Katharine D Currie
- Department of Kinesiology, McMaster University, Ivor Wynne Centre, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Okutucu S, Karakulak UN, Aytemir K, Oto A. Heart rate recovery: a practical clinical indicator of abnormal cardiac autonomic function. Expert Rev Cardiovasc Ther 2012; 9:1417-30. [PMID: 22059791 DOI: 10.1586/erc.11.149] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The autonomic nervous system (ANS) and cardiovascular function are intricately and closely related. One of the most frequently used diagnostic and prognostic tools for evaluating cardiovascular function is the exercise stress test. Exercise is associated with increased sympathetic and decreased parasympathetic activity and the period of recovery after maximum exercise is characterized by a combination of sympathetic withdrawal and parasympathetic reactivation, which are the two main arms of the ANS. Heart rate recovery after graded exercise is one of the commonly used techniques that reflects autonomic activity and predicts cardiovascular events and mortality, not only in cardiovascular system disorders, but also in various systemic disorders. In this article, the definition, applications and protocols of heart rate recovery and its value in various diseases, in addition to exercise physiology, the ANS and their relationship, will be discussed.
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Affiliation(s)
- Sercan Okutucu
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Mendes RG, Simões RP, Costa FDSM, Pantoni CBF, Di Thommazo L, Luzzi S, Catai AM, Arena R, Borghi-Silva A. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery – a randomised controlled trial. Disabil Rehabil 2010; 32:1320-7. [DOI: 10.3109/09638280903483893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moholdt TT, Amundsen BH, Rustad LA, Wahba A, Løvø KT, Gullikstad LR, Bye A, Skogvoll E, Wisløff U, Slørdahl SA. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J 2009; 158:1031-7. [PMID: 19958872 DOI: 10.1016/j.ahj.2009.10.003] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 10/05/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Peak oxygen uptake (Vo(2peak)) strongly predicts mortality in cardiac patients. We compared the effects of aerobic interval training (AIT) versus moderate continuous training (MCT) on Vo(2peak) and quality of life after coronary artery bypass grafting (CABG). METHODS Fifty-nine CABG patients were randomized to either AIT at 90% of maximum heart rate or MCT at 70% of maximum heart rate, 5 d/wk, for 4 weeks at a rehabilitation center. Primary outcome was Vo(2peak), at baseline, after rehabilitation (4 weeks), and after 6 months of home-based exercise (6 months). RESULTS Vo(2peak) increased between baseline and 4 weeks in AIT (27.1 +/- 4.5 vs 30.4 +/- 5.5 mL.kg(-1).min(-1), P < .001) and MCT (26.2 +/- 5.2 vs 28.5 +/- 5.6 mL.kg(-1).min(-1), P < .001; group difference, not significant). Aerobic interval training increased Vo(2peak) between 4 weeks and 6 months (30.4 +/- 5.5 vs 32.2 +/- 7.0 mL.kg(-1).min(-1), P < .001), with no significant change in MCT (28.5 +/- 5.6 vs 29.5 +/- 5.7 mL.kg(-1).min(-1)). Quality of life improved in both groups from baseline to 4 weeks, remaining improved at 6 months. There were no changes in echocardiographic systolic and diastolic left ventricular function. Adiponectin increased between 4 weeks and 6 months in both groups (group differences, not significant). CONCLUSIONS Four weeks of intense training increased Vo(2peak) significantly after both AIT and MCT. Six months later, the AIT group had a significantly higher Vo(2peak) than MCT. The results indicate that AIT and MCT increase Vo(2peak) similarly in the short term, but with better long-term effect of AIT after CABG.
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Abstract
To evaluate the effects of a cardiac rehabilitation program on heart rate recovery after percutaneous transluminal coronary angioplasty, a historical cohort study was performed on 436 patients of whom 285 were grouped on completion of 5, 10, or 24 training sessions. All 3 groups showed significant improvements in heart rate recovery, peak heart rate during treadmill testing, and end-training heart rate, from baseline to follow-up. Heart rate recovery on follow-up correlated significantly with the number of completed exercise sessions. The number of sessions, baseline ejection fraction, and age were independent predictors of mean post-training heart rate recovery. The cardiac rehabilitation program had a significant effect on peak heart rate and heart rate recovery, regardless of the underlying characteristics of the patients.
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Abstract
This study determines the effects of 15 potential predictors on cardiac rehabilitation (CR) initiation: demographic information, measures of perceived severity, perceived susceptibility, perceived cardiac threat, social support, depression, comorbid conditions, left ventricular ejection fraction, strength of physician recommendation, and benefits and barriers. Results showed that greater strength of physician recommendation and less disease severity were significant predictors of higher levels of CR initiation; female gender was a marginally significant predictor of less CR initiation. The strength of the associations for these predictors varied. Strength of physician recommendation was the strongest predictor. This information can be used to increase the number of patients starting CR through programs designed to increase physician awareness of the importance of their recommendation, the continuing need to refer women to CR, and the need to design programs that meet women's needs.
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Dewland TA, Androne AS, Lee FA, Lampert RJ, Katz SD. Effect of acetylcholinesterase inhibition with pyridostigmine on cardiac parasympathetic function in sedentary adults and trained athletes. Am J Physiol Heart Circ Physiol 2007; 293:H86-92. [PMID: 17322413 DOI: 10.1152/ajpheart.01339.2006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Heart rate variability and postexercise heart rate recovery are used to assess cardiac parasympathetic tone in human studies, but in some cases these indexes appear to yield discordant information. We utilized pyridostigmine, an acetylcholinesterase inhibitor that selectively augments the parasympathetic efferent signal, to further characterize parasympathetic regulation of rest and postexercise heart rate. We measured time- and frequency-domain indexes of resting heart rate variability and postexercise heart rate recovery in 10 sedentary adults and 10 aerobically trained athletes after a single oral dose of pyridostigmine (30 mg) and matching placebo in randomized, double-blind, crossover trial. In sedentary adults, pyridostigmine decreased resting heart rate [from 66.7 (SD 12.6) to 58.1 beats/min (SD 7.6), P = 0.005 vs. placebo] and increased postexercise heart rate recovery at 1 min [from 40.7 (SD 10.9) to 45.1 beats/min (SD 8.8), P = 0.02 vs. placebo]. In trained athletes, pyridostigmine did not change resting heart rate or postexercise heart rate recovery when compared with placebo. Time- and frequency-domain indexes of resting heart rate variability did not differ after pyridostigmine versus placebo in either cohort and were not significantly associated with postexercise heart rate recovery in either cohort. The divergent effects of pyridostigmine on resting and postexercise measures of cardiac parasympathetic function in sedentary subjects confirm that these measures characterize distinct aspects of cardiac parasympathetic regulation. The lesser effect of pyridostigmine on either measure of cardiac parasympathetic tone in the trained athletes indicates that the enhanced parasympathetic tone associated with exercise training is at least partially attributable to adaptations in the efferent parasympathetic pathway.
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Affiliation(s)
- Thomas A Dewland
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, 135 College Street, New Haven, CT 06511, USA
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