Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease.

Coronary artery disease carries a high morbidity and mortality worldwide, and exercise-based cardiac rehabilitation programmes play a large role in secondary prevention. Exercise-based rehabilitation programmes are expensive, and in certain subgroups uptake is poor. Yoga has been suggested to show improvements in cardiovascular health which would support its use in cardiac rehabilitation programmes. We carried out a review of current randomized controlled trials to determine if yoga-based cardiac rehabilitation leads to reduced cardiac risk factors, and improved physiological and psychological outcomes in patients with coronary artery disease compared to standard care. Six randomized controlled studies were identified after a medical database search, and meta-analysis was carried out for the different outcomes. Overall, the addition of yoga to standard care resulted in improved subjective feeling of cardiac health and quality of life. There was also a trend towards improvement in left ventricular systolic function. Improvement in cardiac risk factors, MACE and psychological health in this cohort has still to be proven, but was not inferior to standard or enhanced care, and the benefits became more pronounced at longer follow-up. Future studies with longer follow-up and larger patient numbers would aid in accurately assessing the long-term benefit of yoga-based rehabilitation.

Cost-effectiveness of Cardiac Telerehabilitation With Relapse Prevention for the Treatment of Patients With Coronary Artery Disease in the Netherlands.

Importance: Cardiac telerehabilitation (CTR) has been found to be a safe and beneficial alternative to traditional center-based cardiac rehabilitation (CR) and might be associated with higher participation rates by reducing barriers to CR use. However, implementation of CTR interventions remains low, which may be owing to a lack of cost-effectiveness analyses of data from large-scale randomized clinical trials. Objective: To assess the cost-effectiveness of CTR with relapse prevention compared with center-based CR among patients with coronary artery disease. Design, Setting, and Participants: This economic evaluation performed a cost-utility analysis of data from the SmartCare-CAD (Effects of Cardiac Telerehabilitation in Patients With Coronary Artery Disease Using a Personalized Patient-Centred ICT Platform) randomized clinical trial. The cost-effectiveness and utility of 3 months of cardiac telerehabilitation followed by 9 months of relapse prevention were compared with the cost-effectiveness of traditional center-based cardiac rehabilitation. The analysis included 300 patients with stable coronary artery disease who received care at a CR center serving 2 general hospitals in the Netherlands between May 23, 2016, and July 26, 2018. All patients were entering phase 2 of outpatient CR and were followed up for 1 year (until August 14, 2019). Data were analyzed from September 21, 2020, to September 24, 2021. Intervention: After baseline measurements were obtained, participants were randomly assigned on a 1:1 ratio to receive CTR (intervention group) or center-based CR (control group) using computerized block randomization. After 6 supervised center-based training sessions, patients in the intervention group continued training at home using a heart rate monitor and accelerometer. Patients uploaded heart rate and physical activity data and discussed their progress during a weekly video consultation with their physical therapist. After 3 months, weekly coaching was concluded, and on-demand coaching was initiated for relapse prevention; patients were instructed to continue using their wearable sensors and were contacted in cases of nonadherence to the intervention or reduced exercise or physical activity volumes. Main Outcomes and Measures: Quality-adjusted life-years were assessed using the EuroQol 5-Dimension 5-Level survey (EQ-5D-5L) and the EuroQol Visual Analogue Scale (EQ-VAS), and cardiac-associated health care costs and non-health care costs were measured by health care consumption, productivity, and informal care questionnaires (the Medical Consumption Questionnaire, the Productivity Cost Questionnaire, and the Valuation of Informal Care Questionnaire) designed by the Institute for Medical Technology Assessment. Costs were converted to 2020 price levels (in euros) using the Dutch consumer price index (to convert to US dollars, euro values were multiplied by 1.142, which was the mean exchange rate in 2020). Results: Among 300 patients (266 men [88.7%]), the mean (SD) age was 60.7 (9.5) years. The quality of life among patients receiving CTR vs center-based CR was comparable during the study according to the results of both utility measures (mean difference on EQ-5D-5L: -0.004; P = .82; mean difference on EQ-VAS: -0.001; P = .92). Intervention costs were significantly higher for CTR (mean [SE], €224 [€4] [$256 ($4)]) compared with center-based CR (mean [SE], €156 [€5] [$178 ($6)]; P < .001); however, no difference in overall cardiac health care costs was observed between CTR (mean [SE], €4787 [€503] [$5467 ($574)] and center-based CR (mean [SE], €5507 [€659] [$6289 ($753)]; P = .36). From a societal perspective, CTR was associated with lower costs compared with center-based CR (mean [SE], €20 495 [€ 2751] [$23 405 ($3142)] vs €24 381 [€3613] [$27 843 ($4126)], respectively), although this difference was not statistically significant (-€3887 [-$4439]; P = .34). Conclusions and Relevance: In this economic evaluation, a CTR intervention with relapse prevention was likely to be cost-effective compared with center-based CR, suggesting that CTR maybe used as an alternative intervention for the treatment of patients with coronary artery disease. These results add to the evidence base in favor of CTR and may increase the implementation of CTR interventions in clinical practice.

Immersive Virtual Reality Therapy as a Support for Cardiac Rehabilitation: A Pilot Randomized-Controlled Trial.

Depression and anxiety can significantly reduce the effectiveness of cardiac rehabilitation (CR). Several studies have assessed the effectiveness of virtual reality (VR)-based interventions for symptoms of anxiety and depression; however, they do not relate to patients with heart disease. The aim of this study was to assess the effects of VR therapy on the mental state of patients with coronary artery disease (CAD). Thirty-four CAD patients with elevated anxiety or depression symptoms were recruited. After randomization, 17 participants were assigned to the intervention group, and 17 to the control group. Both groups underwent standard CR for outpatients. In the intervention group, eight VR therapy sessions were applied. In the control group, eight sessions of Schultz' Autogenic Training were applied. To assess patient mental states, Hospital Anxiety and Depression Scale (HADS) and Perception of Stress Questionnaire (PSQ) were used, before and after 4 weeks of CR. In the intervention group, a significant decrease in HADS score was observed (19.46 pretreatment vs. 15.73 post-treatment, p = 0.003), HADS-Anxiety subscale decreased by 16.0 percent (p = 0.01) and HADS-Depression by 23.0 percent (p = 0.003). Similarly, a significant decrease in PSQ was recorded at 12.8 percent (64.73 vs. 56.47, p = 0.03). In the control group, HADS and PSQ data did not change. VR therapy significantly reduced the severity of depressive symptoms, anxiety, and stress levels in CAD patients undergoing CR. Immersive VR therapy effectively supports the CR of individuals with anxiety-depressive symptoms. ClinicalTrials.gov (NCT04045977).

Effects of peripheral and different inspiratory muscle training methods in coronary artery disease patients with metabolic syndrome: A randomized-controlled trial.

Background OBJECTIVE: To investigate the effects of peripheral muscle training (PMT) and different inspiratory muscle training (IMT) methods on respiratory functions, exercise capacity, and biochemistry parameters in coronary artery disease patients with metabolic syndrome. METHODS: This prospective, single-blind, randomized-controlled study included 60 patients of stable coronary artery disease with metabolic syndrome (New York Heart Association [NYHA] Class I-II, left ventricular ejection fraction >40%). Patients were randomly divided into three groups: neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group (PMT group, n = 20). Treatment continued for six weeks for all groups. The NMES was applied to rectus abdominis, IMT was applied with 30% of maximal inspiratory pressures, and PMT was applied at home. Spirometry, maximal inspiratory and expiratory pressure, dyspnea scores, exercise stress test, and biochemistry parameters were measured before and after training. RESULTS: There were significant improvements in spirometric tests, respiratory muscle strength, dyspnea scores, exercise capacity, fasting blood glucose, and antistreptolysin O after treatment in all groups (p < 0.05). Significant improvements in C-reactive protein and erythrocyte sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p < 0.05). Among the groups, there was a significant difference in maximal inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p = 0.037) in favor of NMES + PMT group (p < 0.05). CONCLUSION: Our study results showed significant improvements in respiratory functions, exercise capacity, and biochemistry markers in all groups. Different IMT methods can be used in cardiopulmonary rehabilitation to improve exercise intolerance in coronary artery disease patients with metabolic syndrome. CLINICAL TRIAL REGISTRATION NUMBER: NCT03523026.

Effect of voluntary breathing exercises on stable coronary artery disease in heart rate variability and rate-pressure product: a study protocol for a single-blind, prospective, randomized controlled trial.

BACKGROUND: At present, China has more than 11 million patients with stable coronary heart disease and this is becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of the cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation for patients with stable coronary artery disease (SCAD), in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time-domain index of heart rate variability, reduce the burden on the heart, and relieve patients' anxiety and other negative emotions. METHODS: This is a 6-month single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. A total of 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises (VBE)-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcomes will be measured heart rate variability and RPP. Secondary outcomes will include changes in Self-rating Anxiety Scale, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, weight, and body mass index. DISCUSSION: This trial will carry out scientific respiratory exercise for patients with SCAD, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate and is not limited by time and place. It is important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. TRIAL REGISTRATION: Chinese Clinical Trials Registry, 1900024043 . Registered on 23 June 2019.

High-Intensity Interval Training in Cardiac Rehabilitation.

Recently, high-intensity interval training (HIIT) has been recognized as a safe and effective alternative to moderate-intensity continuous training for older patients with cardiovascular disease (CVD) in cardiac rehabilitation settings in an effort to improve health outcomes. This brief review considers general principles and suggestions for prescription of HIIT for older patients with CVD, specific challenges pertaining to older adults, the physiologic mechanisms by which HIIT contributes to improvements in peak Vo2, and the effects of HIIT on cardiovascular health in older patients with coronary artery disease and heart failure.

Obstructive Sleep Apnea in Cardiac Rehabilitation Patients.

STUDY OBJECTIVES: Although regular physical activity improves obstructive sleep apnea (OSA) in the general population, this finding has not been assessed in postmyocardial infarction (MI) patients in a rehabilitation setting (coronary artery disease, CAD). We aimed to determine whether cardiac rehabilitation may benefit post-MI patients in terms of OSA disease and associated autonomic nervous system (ANS) activity. METHODS: Consecutive post-MI patients participating in the ambulatory cardiac rehabilitation program of St-Etienne University Hospital were included in this study. The apnea-hypopnea index calculated from electrocardiogram (ECG)-derived respiration (AHIEDR) was obtained through nocturnal Holter ECG recordings. According to AHIEDR, patients were classified as normal, mild, moderate, or severe OSA (< 5, 5-14, 15-29, ≥ 30, respectively). Physiological performance (peak VO2) was established via cardiopulmonary exercise testing. ANS activity was evaluated through spontaneous baroreflex sensibility as well as heart rate variability analysis. RESULTS: Of the 105 patients with CAD and OSA included (95 men, 55.2 ± 12.4 years), 100 had at least 1 cardiovascular risk factor (98%) and 52 patients (50%) had an ANS dysfunction. Surprisingly, 68 of these patients with OSA (65%) were free of classical diurnal symptoms usually associated with sleep apnea. In response to cardiac rehabilitation, AHIEDR decreased significantly (-9.3 ± 9.5, P < .0001) only in patients with severe OSA, and the decrease was even greater when peak VO2 and baroreflex sensibility improved beyond 20% compared to basal values (-11.6 ± 9.1, P < .001). CONCLUSIONS: Severe OSA in patients with CAD is significantly improved after 2 months of cardiopulmonary rehabilitation. Reviving ANS activity through physical activity might be a target for complementary therapy of OSA in patients with CAD.

Acute Effects of Low-Level Laser Therapy on Patients' Functional Capacity in the Postoperative Period of Coronary Artery Bypass Graft Surgery: A Randomized, Crossover, Placebo-Controlled Trial.

OBJECTIVE: The aim of this study was to evaluate the acute effects of low-level laser therapy (LLLT) on the functional capacity to exercise tested by incremental shuttle walking test (ISWT) after coronary artery bypass graft (CABG) surgery. METHODS: Fifteen male patients (60 ± 9 years) were crossed over during the experiment, to compare the outcomes after active LLLT and placebo LLLT treatments. LLLT (850 nm, 200 mW, 30 J to each point, resulting in a total of 240 J per quadriceps muscle), using a multidiode cluster (five spots; 6 J/spot) in eight points per leg was performed 3 min before the ISWT. We analyzed distance walked, Borg scale of perceived exertion, heart rate, and brachial arterial blood pressure. Markers of tissue damage [lactate dehydrogenase (LDH)] and oxidative stress [lipid peroxidation, total thiol levels, and antioxidant enzyme activity of superoxide dismutase (SOD) and catalase (CAT)] were also measured in peripheral blood. RESULTS: Comparison of the distances walked revealed no significant differences between the LLLT and placebo LLLT groups (p = 0.779). Regarding the Borg scale (p = 0.567), heart rate (p = 0.506) as well as systolic and diastolic blood pressure (p = 0.164 and p = 0.140, respectively), no differences were observed between LLLT and placebo LLLT groups. Application of LLLT was not able to change levels of LDH (p = 0.214), oxidative lipid damage (p = 0.733), total thiol levels (p = 0.925), SOD (p = 0.202), and CAT (p = 0.825) enzyme activities. CONCLUSIONS: Acute LLLT improved neither functional capacity to exercise nor the markers of oxidation after CABG. TRIAL REGISTRATION: Registered as a clinical trial (NCT02688426).

Effect of Chronic Kidney Disease and Supplemental Polyunsaturated Fatty Acid Use on Exercise Levels During Cardiac Rehabilitation in Patients With Coronary Artery Disease.

PURPOSE: The correlation between chronic kidney disease (CKD) and increased cardiovascular disease-related mortality is well established. Cardiac rehabilitation (CR) improves exercise capacity, quality of life, and risk factors in patients with coronary artery disease (CAD). Data on the benefits of CR in patients with CKD are sparse. The purpose of this study was to compare outcomes after CR in patients with CAD but normal renal function, versus those with CAD and CKD. METHODS: We studied 804 patients with CAD entering an exercise-based CR program. Demographics, risk factors, exercise capacity in metabolic equivalent levels (METs), and estimated glomerular filtration rate (GFR) were recorded before and after the 3-month CR program. Use of polyunsaturated fatty acid (PUFA) was determined by medical records review. Stage III-V CKD (GFR <60 mL/min/1.73 m) was present in 170 patients at baseline. RESULTS: After CR, METs improved in all patients, although increases in patients with a GFR 30 to 59 mL/min/1.73 m (Δ1.6) and a GFR <30 (Δ1.2) were smaller than those in patients with a GFR ≥60 (Δ2.6, P < .05 vs GFR 30-59 and GFR <30). In patients with a GFR ≥60 mL/min/1.73 m, PUFA use was associated with a 20% greater increase in MET levels compared with nonusers (Δ3.0 vs Δ2.5, P = .02); and in patients with a GFR 30 to 59, PUFA use was associated with 30% increase in MET level compared with nonusers (Δ2.0 vs Δ1.4, P = .03). These observations persisted after multivariable adjustment for baseline MET level, demographics, and risk factors. CONCLUSIONS: Potential mitigation by PUFA of the smaller improvement in exercise capacity with decreasing GFR requires confirmation in prospective randomized trials.

Nontraditional Cardiac Rehabilitation in Korean Patients with Coronary Artery Disease.

PURPOSE: This pilot investigation sought to compare outcomes including depression, anxiety, stress, mindful awareness, and exercise capacity between exercise-focused cardiac rehabilitation (ECR) and meditation-focused cardiac rehabilitation (MCR) programs for patients with coronary artery disease (CAD) who had percutaneous coronary intervention (PCI). DESIGN: A nonrandomized pretest-posttest design was employed. METHODS: Two different interventions (ECR vs. MCR) were implemented with participants of each group for 12 weeks. Questionnaires assessing depression, anxiety, stress, and mindful awareness and measures of peak VO2 were completed before and after the 12-week interventions. FINDINGS: Thirteen patients completed the cardiac rehabilitation (CR) programs. Meditation-focused cardiac rehabilitation was associated with significantly greater reductions in depression as compared to ECR; there were no significant differences between the two groups on other outcomes. CONCLUSIONS: The MCR program has similar effects to improve the physical and psychological outcomes, compared with the ECR program. CLINICAL RELEVANCE: There is potential for patients with CAD to participate in and benefit from nontraditional CR programs, and such CR could play a role in secondary prevention of CAD.

Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis.

BACKGROUND: Cardiac rehabilitation (CR) is an evidence-based recommendation for patients with coronary artery disease (CAD). However, CR is dramatically underutilized. Telehealth interventions have the potential to overcome barriers and may be an innovative model of delivering CR. This review aimed to determine the effectiveness of telehealth intervention delivered CR compared with center-based supervised CR. METHOD: Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library and the Chinese BioMedical Literature Database (CBM), were searched to April 2014, without language restriction. Existing randomized controlled trials, reviews, relevant conference lists and gray literature were checked. Randomized controlled trials that compared telehealth intervention delivered CR with traditional center-based supervised CR in adults with CAD were included. Two reviewers selected studies and extracted data independently. Main clinical outcomes including clinical events, modifiable risk factors or other endpoints were measured. RESULTS: Fifteen articles reporting nine trials were reviewed, most of which recruited patients with myocardial infarction or revascularization. No statistically significant difference was found between telehealth interventions delivered and center-based supervised CR in exercise capacity (standardized mean difference (SMD) -0.01; 95% confidence interval (CI) -0.12-0.10), weight (SMD -0.13; 95% CI -0.30-0.05), systolic and diastolic blood pressure (mean difference (MD) -1.27; 95% CI -3.67-1.13 and MD 1.00; 95% CI -0.42-2.43, respectively), lipid profile, smoking (risk ratio (RR) 1.03; 95% CI 0.78-1.38), mortality (RR 1.15; 95% CI 0.61-2.19), quality of life and psychosocial state. CONCLUSIONS: Telehealth intervention delivered cardiac rehabilitation does not have significantly inferior outcomes compared to center-based supervised program in low to moderate risk CAD patients. Telehealth intervention offers an alternative deliver model of CR for individuals less able to access center-based cardiac rehabilitation. Choices should reflect preferences, anticipation, risk profile, funding, and accessibility to health service.

Comparison of cardiorespiratory responses during aquatic and land treadmill exercise in patients with coronary artery disease.

PURPOSE: To investigate cardiorespiratory responses during exercise stress tests using an aquatic treadmill and a land-based treadmill in patients with coronary artery disease (CAD). METHODS: Twenty-one stable CAD patients were enrolled. All patients participated in 2 symptom-limited incremental exercise tests, using both an aquatic and a land treadmill. For the aquatic treadmill protocol, patients were submerged to the upper waist in 28°C water. The treadmill speed started at 2.0 km/h and increased 0.5 km/h every minute thereafter. For the land treadmill protocol, the speed and gradient were started at 2.4 km/h and 1.5%, respectively. The speed was increased by 0.3 km/h and grade by 1% every minute thereafter. Oxygen consumption ((Equation is included in full-text article.)O2), heart rate (HR), and respiratory exchange ratio were measured continuously and peak values recorded. Rating of perceived exertion, percentage of age-predicted maximal HR, and total exercise duration were also recorded. RESULTS: Peak cardiorespiratory responses during both protocols were compared. The peak (Equation is included in full-text article.)O2 and peak HR did not show any significant differences. The peak respiratory exchange ratio was significantly greater using the land treadmill than the aquatic treadmill protocol. Rating of perceived exertion, age-predicted maximal HR percentage, and total exercise duration were similar for both protocols. There was a significant linear relationship between HR and (Equation is included in full-text article.)O2 with both protocols. CONCLUSIONS: This study demonstrated that aquatic treadmill exercise elicits similar peak cardiorespiratory responses compared with land treadmill exercise, suggesting that aquatic treadmill exercise may be effective for CAD patients in cardiac rehabilitation.

Biofeedback on heart rate variability in cardiac rehabilitation: practical feasibility and psycho-physiological effects.

OBJECTIVE: Biofeedback is a self-regulation therapy by which the patient learns how to optimize the functioning of his autonomic nervous system. It has been applied to patients with various cardiovascular disorders. The purpose of this study was to investigate the practical feasibility and the psychophysiological effects of biofeedback applied to heart rate variability (HRV biofeedback) in order to increase cardiac coherence in coronary artery disease (CAD) patients participating in a cardiac rehabilitation programme. METHODS AND RESULTS: In this randomised and controlled study, 31 CAD patients were randomly assigned to an experimental or to a control group. The experimental group participated in a programme of 10 sessions of cardiac coherence biofeedback training, in addition to the rehabilitation programme. The control group participated in the usual cardiac rehabilitation programme only. Physiological variables (systolic and diastolic blood pressure, SDNN) and psychosocial variables (anxiety, depression, type D personality) were measured at the start and at the end of the programme in both groups. Statistical comparisons assessed the inter and intra group differences. The small sample size precludes any firm conclusions concerning the effect of cardiac coherence biofeedback on physiological or psychological variables. However, we observed a significant increase of the percentage of cardiac coherence, in relation with an increased SDNN index. CONCLUSIONS: Our study demonstrated the practical feasibility of cardiac coherence biofeedback training in CAD patients. Further research is desirable to investigate the potential benefit of cardiac coherence biofeedback as an adjunct to stress management in cardiac rehabilitation.

Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease / Tai Chi Chuan como Reabilitação Cardíaca na Doença Arterial Coronária: Revisão Sistemática

Background: Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective: To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods: We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results: The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion: Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard. .

Fundamento: Alguns estudos têm mostrado que o Tai Chi Chuan pode melhorar a função cardiorrespiratória de pacientes com doenças cardíacas. Objetivo: Realizar uma revisão sistemática da literatura para avaliar os efeitos do Tai Chi Chuan na reabilitação cardíaca de pacientes com doença arterial coronária. Métodos: Foi realizada uma pesquisa nas seguintes bases de dados: MEDLINE, EMBASE, LILACS e Registro Cochrane de Ensaios Controlados. Foram feitas buscas por estudos publicados em inglês, português e espanhol. Os dados foram extraídos de forma padronizada, por três investigadores independentes, que foram responsáveis pela avaliação da qualidade metodológica dos manuscritos. Resultados: A busca inicial detectou 201 estudos que, após revisão de títulos e resumos, resultou na seleção de 12 manuscritos. Os mesmos foram analisados na íntegra e, destes, nove foram excluídos. Ao final, restaram três ensaios clínicos randomizados. Os estudos incluídos nessa revisão sistemática foram compostos por amostra de pacientes com diagnóstico comprovado de doença arterial coronária, todos estáveis clinicamente e capazes de se exercitar. Os três experimentos contaram com a presença de um grupo controle praticante de qualquer categoria de treinamento físico estruturado ou receberam aconselhamento para exercício físico. O tempo de acompanhamento variou de 2 a 12 meses. Conclusão: Evidências preliminares sugerem que o Tai Chi Chuan possa ser uma forma não convencional de reabilitação cardíaca, podendo ser terapêutica adjuvante no tratamento de pacientes com doença arterial coronária estável. No entanto, a qualidade metodológica dos artigos incluídos e as amostras de tamanho reduzido ...

Tai Chi Chuan for cardiac rehabilitation in patients with coronary arterial disease.

BACKGROUND: Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. OBJECTIVE: To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. METHODS: We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. RESULTS: The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. CONCLUSION: Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard.

Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: a randomized controlled trial.

In this study 258 patients from the Department of Cardiology in Chhatrapati Shahuji Maharaj Medical University, Lucknow were selected to participate. All had been diagnosed with coronary artery disease. They were randomly divided into 2 groups, the yoga group and the non-yoga group, 129 in each group; 208 completed the study protocol. The yogic intervention consisted of 35-40 min/day, 5 days a week over a period of 18 months in the Department of Physiology. Autonomic function testing was done in both the groups at zero time and after 18 months. We observed a statistically significant reduction in body mass index, waist circumference, systolic and diastolic blood pressure, and heart rate (P < 0.05), i.e., a significant positive effect was observed when yoga therapy was used as an adjunct in patients with coronary artery disease.

A warm footbath improves coronary flow reserve in patients with mild-to-moderate coronary artery disease.

BACKGROUNDS: Recent studies have shown that thermal therapy by means of warm waterbaths and sauna has beneficial effects in chronic heart failure. However, a comprehensive investigation of the hemodynamic effects of thermal vasodilation on coronary arteries has not been previously undertaken. In this study, we studied the effect of a warm footbath (WFB) on coronary arteries in patients with coronary artery disease (CAD), as well as any adverse effect. METHODS: We studied 21 patients (33.3% men, mean age 60.8 ± 13.5 years) with CAD. Coronary flow Doppler examination of the left anterior descending coronary artery and coronary flow reserve (CFR) were performed and measured using adenosine before and after a WFB. RESULTS: Systolic and diastolic blood pressure and heart rate did not change with the WFB. Mean velocity of diastolic coronary flow significantly increased (diastolic mean flow velocity: 18.3 ± 7.1 cm/sec initial, 21.5 ± 8.0 cm/sec follow-up, P = 0.002) and CFR significantly improved (1.6 ± 0.4 vs. 2.2 ± 0.5, P < 0.001) after WFB. The WFB was well accepted and no relevant adverse effects were observed. The change of CFR after WFB correlated well with diastolic function (E', r = 0.51, P = 0.031; E/E', r =-0.675, P = 0.002). CONCLUSIONS: A WFB significantly improved CFR without any adverse effects in patients with mild-to-moderate CAD and can be applied with little risk of a coronary artery event if appropriately performed.

Foot reflexology can increase vagal modulation, decrease sympathetic modulation, and lower blood pressure in healthy subjects and patients with coronary artery disease.

OBJECTIVE: Complementary and alternative medicine (CAM) has long been used by people to postpone the aging process and to reverse disease progression. Reflexology is a CAM method that involves massage to reflex areas in the feet and hands. This study investigated the effect of foot reflexology (FR) on the autonomic nervous modulation in patients with coronary artery disease (CAD) by using heart rate variability analysis. STUDY METHODS: Seventeen people with angiographically patent coronary arteries and 20 patients with CAD scheduled for coronary artery bypass graft surgery were recruited as the control and CAD groups, respectively. The normalized high-frequency power (nHFP) was used as the index of vagal modulation and the normalized very low-frequency power (nVLFP) as the index of vagal withdrawal and renin-angiotensin modulation. RESULTS: In both control and CAD groups, the nHFP was increased significantly whereas the nVLFP was decreased significantly 30 and 60 minutes after FR, as compared with those before FR. The systolic, diastolic, mean arterial, and pulse pressures were significantly decreased after FR in both groups of participants. In the CAD group, the percentage change in heart rate 30 and 60 minutes after FR was smaller than that in the control, and the percentage change in nVLFP 60 minutes after FR was smaller than that in the control. In conclusion, a higher vagal modulation, lower sympathetic modulation, and lower blood pressure can be observed following 60 minutes of FR in both controls and CAD patients. The magnitude of change in the autonomic nervous modulation in CAD patients was slightly smaller than that in the controls. CONCLUSION: FR may be used as an efficient adjunct to the therapeutic regimen to increase the vagal modulation and decrease blood pressure in both healthy people and CAD patients.

Effect of creatine supplementation as a potential adjuvant therapy to exercise training in cardiac patients: a randomized controlled trial.

OBJECTIVE: To investigate the effect of oral creatine supplementation in conjunction with an exercise programme on physical fitness in patients with coronary artery disease or chronic heart failure. DESIGN: Single centre double-blind randomized placebo controlled trial. SETTING: Cardiac rehabilitation centre. SUBJECTS AND INTERVENTION: 70 (4 women) cardiac patients (age 57.5 (8.4) years) were randomized to a placebo (n = 37) or creatine (n = 33) treatment for three months. Combined aerobic endurance and resistance training (three sessions/ week) was performed during supplementation. MAIN MEASURES: Aerobic power was determined during graded bicycle testing, knee extensor peak isometric and isokinetic strength, endurance and recovery were assessed by an isokinetic dynamometer, and health related quality of life was evaluated with the SF-36 and MacNew Heart Disease questionnaires. In addition, blood samples were taken after an overnight fast and 24 hour urinary collection was performed. RESULTS: At baseline there were no significant differences between both groups. We observed main time effects for aerobic power, muscle performance, health related quality of life, high density lipoprotein cholesterol and triglycerides (pre vs post; P<0.05 for all). However, changes after training were similar between placebo group and creatine group (P>0.05). Further, no detrimental effect on renal or liver function was observed nor were there any reports of side effects. CONCLUSION: Oral creatine supplementation in combination with exercise training does not exert any additional effect on the improvement in physical performance, health related quality of life, lipid profile in patients with coronary artery disease or chronic heart failure than exercise training alone.

Effects of Tai Chi rehabilitation on heart rate responses in patients with coronary artery disease.

The objective of the present study was to evaluate the effect of a six-month Tai Chi (TC) exercise cardiac rehabilitation program on two prognostic factors of cardiac events, rate-pressure product and rate-pressure product reserve, in patients with coronary artery disease (CAD). Patients (N = 54) with CAD were recruited from the clinics of cardiology and cardiovascular surgery at a regional hospital in Taiwan. Twenty-two of them enrolled in the TC rehabilitation program which consisted of weekly 90-min sessions of Yang's style TC for six months in addition to receiving usual care. The remaining 32 patients received usual care only. Modified Bruce treadmill exercise test was performed to evaluate their exercise test responses at baseline and at six months. The change over time was significantly different between the TC and control group in peak rate-pressure product (RPP) (interaction between group and time, p = 0.029) and in RPP reserve (interaction between group and time p = 0.009) over the six-month period, there was a decrease in peak RPP of 32.0 mmHg x bpm x 10(-2) and in RPP reserve of 37.4 mmHg x bpm x 10(-2) in the TC group. In conclusion, participating in a six-month TC exercise-based cardiac rehabilitation program was associated with improved peak RPP and RPP reserve during exercise testing in patients with CAD. TC exercise program may lead to a better prognosis for cardiac events in patients with CAD.