Comparing Different Frequency Cardiac Rehabilitation Programs in Stable Ischemic Heart Disease Patients

Abstract

Summary T he term cardiac rehabilitation (CR) refers to coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality. Recent meta-analyses of randomized studies on the effects of exercise-based CR in patients with CAD have demonstrated a statistically significant reduction in total and cardiac mortality ranging from 20% to 32% in patients undergoing CR compared with those receiving standard medical care. The aim of this study was to compare the effects of short term (6 weeks) twice weekly cardiac rehabilitation program to the once weekly (12 weeks) program in patients with stable coronary artery disease (CAD) after total revascularization by PCI regarding symptomatology, effort tolerance, laboratory changes, anthropometric parameters and echocardiographic measurements. This study included sixty consecutive patients presented to the cardiac rehabilitation unit at Ain Shams University hospital. With history of myocardial infarction (MI) who performed total revascularization by Percutaneous Coronary Intervention (PCI) and who were recruited during the period between may, 2015, and may, 2016. The whole cohort was subdivided into two equal groups: Group I consisted of 30 patients who were involved into a twice weekly cardiac rehabilitation program for six weeks, Group II consists also of 30 patients who were involved into a once weekly cardiac rehabilitation program for twelve weeks. All patients underwent treadmill exercise training for a total of twelve sessions targeting 60% - 80 % of maximal heart rate (MHR) achieved during a pre-rehabilitation modified Bruce protocol symptom limited exercise stress test. There was statistically significant difference regarding percentage of change in most variables after CR between the 2 groups as follows; BMI decreased more in group I Vs group II (P value = <0.0001) ; LVEF increased more in group I Vs group II (P value = <0.0001) ; PASP decreased more in group I Vs group II (P value = <0.0001) ; S.HDL level increased more in group I Vs group II (P value = 0.034) ; S.TGs level decreased more in group I Vs group II (P value = 0.007) ; HBA1C level decreased more in group I Vs group II (P value = 0.002) ; resting HR value decreased more in group I Vs group II (P value = <0.0001) ; METs achieved increased more in group I Vs group II (P value = <0.0001) ; resting systolic BP decreased more in group I Vs group II (P value = <0.0001) and finally resting diastolic BP decreased more in group I Vs group II (P value = 0.026) There were no statistically significant differences regarding percentage of change in rest of variables through the CR program between the 2 groups. Cardiac rehabilitation programs post PCI for MI patients have beneficial effects on improvement of patients’ anthro-pometric, symptomatic, clinical, effort tolerance, echocardio-graphic and laboratory parameters. A 12-sessions exercise rehabilitation program in post-MI patients is useful for improving both blood pressure and exercise capacity (being more evident in higher frequency and intensity ones) and it should be encouraged more commonly. A 12-sessions early (within 1 month post-discharge) structured “individually tailored” exercise training could significantly improve LVEF in post-event CAD patients and post PCI (being more evident in higher frequency and intensity ones).