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.

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.

Use of the six-minute walk test in exercise prescription in male patients after coronary artery bypass surgery.

INTRODUCTION: It is unclear whether it is possible to determine the training load on the basis of the 6-minute walk test (6-MWT) in patients after cardiac surgery with low tolerance of physical exercise. AIM: Use of the 6-MWT to determine an individual initial training load in walking training on a treadmill in the early phase of cardiac rehabilitation in men after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS: Twenty-two men aged 54 to 74 years, up to 3 months after CABG surgery participated in walking training on a treadmill (12-15 sessions). Patients underwent the initial and final treadmill exercise stress test (TEST) and the 6-MWT. Based on 6-MWT results, the initial training load was prescribed. Before the 6-MWT and 3 minutes after its completion, lactate concentration was determined. RESULTS: The 6-MWT distance increased from 420 ±80 m to 519 ±61 m (p < 0.001), and the energy expenditure from 4.4 ±1.4 MET to 6.3 ±1.3 MET (p < 0.001). There was a positive correlation between 6-MWT distance and energy expenditure in the TEST before rehabilitation (r = 0.60, p = 0.005), and after rehabilitation (r = 0.75, p < 0.001). A negative correlation was found between the baseline 6-MWT distance and distance increment in the final 6-MWT (r = -0.66, p = 0.002). The 6-MWT did not induce hyperlactatemia. CONCLUSIONS: The 6-MWT can be used in exercise intensity prescription, especially for determining the individual initial training load, load progression, as well as its correction during follow-up tests.

Effects of Nordic walking training on exercise capacity and fitness in men participating in early, short-term inpatient cardiac rehabilitation after an acute coronary syndrome--a controlled trial.

OBJECTIVE: To investigate the effects of Nordic Walking training supplemental to a standard, early rehabilitation programme on exercise capacity and physical fitness in men after an acute coronary syndrome. DESIGN: A controlled trial. SETTING: Cardiac rehabilitation service of a provincial hospital. SUBJECTS: Eighty men 2-3 weeks after an acute coronary syndrome, with good exercise tolerance. INTERVENTIONS: Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group). MAIN MEASURES: Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test. RESULTS: Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 +/- 1.8 versus 9.2 +/- 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 +/- 1.5 versus 0.7 +/- 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group. CONCLUSIONS: Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.

Why patients after acute coronary syndromes do not participate in an early outpatient rehabilitation programme?

BACKGROUND: The value of cardiac rehabilitation in patients with coronary artery disease has been well established. The main problem is a low attendance of patients qualified for rehabilitation. AIM: To assess differences between subjects attending outpatient cardiac rehabilitation (OutCR) after completing an early inpatient programme (InCR), and patients refusing participation in OutCR; to investigate factors determining patients' decisions. METHODS: Seventy-two patients (mean age 57 +/- 9.4 years; 53 men) 2-3 weeks after an acute coronary syndrome (ACS) treated with primary PCI were enrolled. On admission to the cardiac rehabilitation ward, the following parameters were assessed: quality of life (EuroQol-5D questionnaire), psychological status (Beck's, SOPER and STAI questionnaires), marital status, education, economic status, employment, place of living, smoking status, and comorbidities (a questionnaire prepared by the authors). Additionally, patients' opinions on outpatient and inpatient cardiac rehabilitation were noted. The inpatient programme lasted 2-3 weeks. At discharge, the assessment was repeated, and patients were proposed to enrol in a 12-week outpatient programme. In the case of refusal, patients were asked to give the reason. RESULTS: Two men failed to complete the inpatient program. Of the remaining 70 subjects, 16 attended and completed the outpatient programme. In the group participating in OutCR, there were fewer patients with depression before InCR (12 vs. 39% in the group without OutCR, p = 0.0484). Subjects in the OutCR group had a higher score for mood after InCR (7.7 +/- 1.25 vs. 6.7 +/- 1.69, p = 0.0365), lower score for emotional stress before and after InCR (before InCR: 4.4 +/- 1.09 vs. 5.3 +/- 1.34, p = 0.0188; after InCR: 3.8 +/- 1.51 vs. 4.8 +/- 1.4, p = 0.0262), and lower score for anxiety before InCR (3.1 +/- 1.75 vs. 4.4 +/- 2.12, p = 0.0426). Patients in the two groups differed with regard to employment (p = 0.0256) and smoking status (p = 0.0517). In both groups, most patients (l 80%) preferred inpatient rehabilitation. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation. CONCLUSIONS: Only a small proportion of patients after an ACS decides to participate in outpatient rehabilitation after completing a short-term inpatient programme. Psychological status, employment and smoking status are among the factors that differentiate OutCR attenders and non-attenders. Continuous medical care, lack of commuting problems, and convenience were the most frequently given advantages of inpatient rehabilitation, while commuting problems and conflict with job were the most frequently perceived barriers to outpatient rehabilitation.

[Knowledge of cardiovascular risk factors and recommended lifestyle modifications in patients after an acute coronary syndrome. The influence of short-term, stationary rehabilitation. Preliminary results]. / Poziom wiedzy o czynnikach ryzyka chorób ukladu krazenia i zalecanych modyfikacjach stylu zycia wsród chorych po leczonym interwencyjnie ostrym zespole wiencowym. Wplyw krótkotrwalej, stacjonarnej rehabilitacji kardiologicznej. Badanie pilotazowe.

BACKGROUND: Education on behavioural risk factors and lifestyle modification is one of the core components of comprehensive cardiac rehabilitation. AIM: To assess the level of knowledge of cardiovascular risk factors and recommended lifestyle changes in patients rehabilitated after an acute coronary syndrome (ACS). METHODS: The study group consisted of 31 consecutive patients (22 males, 56.6+/-10.9 years) participating in short-term, early, comprehensive cardiac rehabilitation. On admission, at discharge and 3 months after discharge patients' knowledge was assessed with a questionnaire worked out by the authors. RESULTS: On admission, patients had poor knowledge of cardiovascular risk factors and recommended lifestyle modifications, especially concerning diabetes, hypertension, and diet. After completing the rehabilitation programme, significantly higher percentage of patients gave correct answers to questions concerning diabetes and cholesterol-rich diet as cardiovascular risk factors, and substitution of vegetable fat for animal fat as a lifestyle modification, and significantly higher proportion of patients gave the correct value for elevated systolic blood pressure. CONCLUSIONS: Patients after ACS have poor knowledge of cardiovascular risk factors and recommended lifestyle modifications. The level of knowledge improves after short-term, stationary cardiac rehabilitation; however, the degree of this improvement is not completely satisfactory.

The application of walking training in the rehabilitation of patients after coronary artery bypass grafting.

Walking is regarded as one of the most common and utilitarian activities of everyday life. Rehabilitation programs developed on the basis of this form of activity often constitute the primary method of rehabilitating patients after coronary artery bypass grafting. This paper provides a review of literature concerning various forms of walking training, discussing their impact on the parameters of exercise capacity and verifying the training methods with regard to the current guidelines. Attention is drawn to the diversity of the exercise protocols applied during the early and late stages of rehabilitation and pre-rehabilitation programs including: treadmill walking, walking down the corridor, treadmill walking enriched with virtual reality, and walking as an element of training sessions consisting of many different forms of activities. Exercise protocols were also analyzed in terms of their safety, especially in the case of high-intensity interval training. Despite the variety of the available rehabilitation programs, the training methodology requires constant improvement, particularly in terms of load dosage and the supervision of training sessions.

Short-term endurance training after coronary artery bypass grafting improves insulin resistance parameters in patients with hypertension.

BACKGROUND: It has been shown that short-term exercise training improves insulin resistance parameters in patients with ischaemic heart disease. The effects of such a rehabilitation programme in patients with hypertension have not been well established. AIM: To assess whether short-term endurance training after coronary artery bypass grafting (CABG) may improve metabolic parameters and reduce blood pressure in patients with hypertension. METHODS: The study group consisted of 30 male patients (15 with hypertension and 15 normotensive) aged 55+/-2.1 years who underwent CABG 1 to 6 months before the initiation of a 3-week endurance training. Glucose, insulin and C-peptide blood levels as well as binding and degradation of 125I-insulin by erythrocyte receptors were assessed before and after the training programme. The effects of training on blood pressure values were also evaluated. RESULTS: A significant improvement (p<0.01) in the insulin resistance parameters, i.e. binding and degradation of labelled insulin was noted only in patients with hypertension. This was accompanied by a significant (p<0.05) increase in the HDL-cholesterol level. In the subgroup with hypertension, both the exercise systolic and diastolic pressures decreased significantly (p<0.05 and p<0.01, respectively), and similar changes were noted in the resting systolic and diastolic blood pressures values (p<0.05). CONCLUSIONS: Rehabilitation after CABG based on the endurance training was especially effective in patients with hypertension in whom beneficial changes in some metabolic risk factors of ischaemic heart disease as well as the reduction in the blood pressure values were observed.

Effects of social intervention on detection and efficacy of treatment for arterial hypertension. Main results of the Polish Four Cities Programme.

BACKGROUND: Cardiovascular diseases are the main cause of death in the adult Polish population. Beside lipid disorders and cigarette smoking, hypertension represents the most important risk factor leading to cardiovascular complications. Representative studies conducted in Poland in 1994-2002 showed that in 2002 the number of respondents in the survey who stated they knew their own blood pressure values dropped by 3.5 million, compared with 1994. This decrease was predominantly seen in small towns and in the countryside. Preventive programmes should therefore be addressed mainly to the most vulnerable communities. Modern methods of social marketing may play a substantial role in the creation of a healthy lifestyle. AIM: The aim of the Polish Four Cities Programme (PP4M), conducted in 2000-2001, was to develop the most effective methods of detection of and improvement in treatment for hypertension among the residents of small towns and rural areas. One of the programme tasks was to compare the effectiveness of a standard medical screening intervention with a similar approach combined with the use of social marketing methods.Methods. The programme was conducted by an interdisciplinary team in three small Polish towns -- Kartuzy, Oborniki Wlkp. and Braniewo, as well as in one of the districts of a large city Lódz -- Olechów. Medical intervention combined with social marketing (community intervention) took place in Oborniki Wlkp. whereas the residents of Kartuzy and Lódz were subjected only to the traditional medical intervention. Braniewo served as a control location -- neither medical nor community intervention was implemented. Community intervention with elements of social marketing consisted of a three-month, intensive education and information campaign, initiated four weeks prior to the start of medical intervention. Epidemiological situation was assessed in all the four cities before and after the completion of the preventive interventions (screening), using representative surveys, with the objective to assess the changes in the awareness of one's own blood pressure values, detection of hypertension and knowledge concerning cardiovascular risk factors.Results. In two survey locations -- Kartuzy and Lódz - awareness of one's own blood pressure values after the medical intervention did not significantly change (61% and 67.6% at baseline versus 62.1% and 71.6% after the intervention, respectively). In contrast, social marketing activities conducted in Oborniki significantly increased this parameter from 61.5% to 79.8% (p<0.01). While medical intervention did not change the proportion of non-diagnosed hypertension in a small town (a non-significant decrease from 49% to 45% in Kartuzy), its effect in a large city was clearly visible (a decrease from 46% to 28% in Lódz). In Oborniki Wlkp. (medical intervention combined with social marketing) the effects were the most noticeable -- a reduction from 50% to 27% was achieved. The efficacy of hypertension treatment at baseline was low (4.7% in Kartuzy, 6.6% in Oborniki, and 6.5% in Lódz), but it then improved significantly (a twofold increase in Kartuzy and Oborniki, and more than twofold increase in Lódz). When the target value of blood pressure was set at 160/95 mmHg, the highest efficacy of hypotensive therapy was observed directly after the completion of medical and community intervention in Oborniki (an almost twofold increase in treatment efficacy). CONCLUSIONS: 1. Medical intervention combined with a community intervention and marketing campaign leads to a statistically significant improvement in self-awareness of blood pressure values among residents of small towns. 2. Medical intervention combined with community intervention brings the detection rate of hypertension in small towns up to the level observed in large cities. 3. Medical intervention, especially when combined with community intervention, improves the efficacy of the treatment of hypertension, regardless of the size of agglomeration.

The impact of short-term cardiac rehabilitation on changing dietary habits in patients after acute coronary syndrome.

PURPOSE: The aim of this study was to determine whether short-term cardiac rehabilitation (CR), including dietary counseling, had an impact on changing eating habits in patients after acute coronary syndrome (ACS), treated with primary percutaneous coronary intervention (PCI). METHODS: The controlled, prospective, nonrandomized study was performed on 44 patients, early following ACS/PCI, who underwent 2- to 3-week inpatient CR with dietary counseling and compared to 18 patients who did not participate in CR. An analysis of the daily diet composition was performed at baseline, at 3 months post-ACS, and at 1 year post-ACS. RESULTS: In the CR group, comparing baseline with 3 months post-ACS, daily calorie intake was significantly reduced from a mean ± SD of 2260 ± 525 kcal to 2037 ± 514 kcal (P < .05), and daily cholesterol intake from 509 ± 237 to 394 ± 199 mg (P < .05). The daily energy intake of saturated fatty acids was also significantly reduced from 13.6% at baseline to 12.2 ± 4.5% at 3 months and further reduced at 1 year post-ACS to 10.2 ± 4.3% (P < .05). Although both groups exhibited increased body mass index, the increase was significantly greater in the nonrehabilitation group than in the CR group at 1 year post-ACS (2.61 ± 2.23 vs 0.86 ± 1.67 kg/m, respectively, P < .001). CONCLUSIONS: The analysis suggests that a short-term CR program following ACS, which includes educational meetings on dietary prevention of atherosclerosis, may result in some favorable and lasting modifications of eating habits of post-ACS patients.

Early phase 2 inpatient rehabilitation after acute coronary syndrome treated with primary percutaneous coronary intervention: short- and long-term effects on blood pressure and metabolic parameters.

OBJECTIVE: The aim of this study was to assess the 1-yr follow-up effects of inpatient rehabilitation and its prolongation with an ambulatory training program on blood pressure and metabolic risk factors in patients after an acute coronary syndrome. DESIGN: A controlled (n = 20) prospective study was undertaken. The study group consisted of 54 consecutive patients participating in a 3-wk inpatient rehabilitation. Of these, 14 chose to continue the training for 3 mos (CR_In+Amb group) and 40 declined (CR_In group). RESULTS: Body mass index increased in the CR_In and control groups. The magnitude of change was greater in controls (2.2 ± 2.14 vs. 0.7 ± 1.70 kg/m; P < 0.05). Waist circumference increased only in the control group, and at 12 mos, it was higher than in the CR_In and CR_In+Amb groups (P < 0.05). Mean systolic and diastolic blood pressure increased in the CR_In (from 121/76 to 130/82 mm Hg; P < 0.01) and control (from 122/74 to 139/87 mm Hg; P < 0.01) groups. At 12 mos, blood pressure in the CR_In group was lower than in the control group but higher than in the CR_In+Amb group (119/77 mm Hg; P < 0.05). Total cholesterol, low-density lipoprotein cholesterol level, and triglyceride level at 12 mos were higher in the control group than in the CR_In and CR_In+Amb groups (P < 0.05). C-reactive protein decreased in the CR_In and CR_In+Amb groups (P < 0.01). CONCLUSIONS: Inpatient rehabilitation was associated with beneficial effects on blood lipids and C-reactive protein in coronary patients and attenuated the rise in blood pressure and adiposity indices observed in nonparticipants. Prolongation of rehabilitation with an ambulatory program improved blood pressure control.