IMPACT OF EARLY EXERCISE-BASED CARDIAC REHABILITATION ON HOSTILITY, ITS BEHAVIORAL COMPONENTS AND DISEASE PERCEPTION IN PATIENTS AFTER MYOCARDIAL INFARCTION.

OBJECTIVE: Aim: Hostility and its behavioral components, anger and aggression are psychosocial risk factors for coronary heart disease. The purpose of the study was to evaluate the effectiveness of physical training on the level of negative emotions, the cognitive aspect of adaptation to disease and physical capacity in patients after MI who participated in cardiac rehabilitation. PATIENTS AND METHODS: Materials and Methods: We enrolled 60 post-MI men and women in the study. They underwent an 8-week training program. Before and after completion of trainings patients underwent exercise test and a psychological examination.The Buss-Perry Aggression Questionnaire and the Brief Illness Perception Questionnaire were performed with results analysis in the entire group and in subgroups of men, women, patients under 60 years of age (younger) and over 60 years of age (older). RESULTS: Results: After rehabilitation a significant reduction in the general level of negative emotions was found in younger: 67.8±4.6 vs 63.9±3.7 points (p< 0.01). Similarly, a significant reduction in the sense of the impact of the disease on life was found only in younger 6.96±0.5 vs 5.48±0.5 points (p<0.01). There was a significant improvement in overall adaptation to the disease in women from 40.6±2.2 to 35.7±1.9 points (p < 0.05).Moreover,patients with higher levels of negative emotions had more difficulty adapting to the disease r=0.361, p<0.01. Physical capacity increased significantly in all groups. CONCLUSION: Conclusions: Participating in cardiac rehabilitation improved physical capacity, beneficially contributed to a decrease in negative emotions and had a positive effect on disease adaptation but only in younger post -MI patients.

Influence of warm­up ischemia on the effects of exercise training in patients with stable angina.

INTRODUCTION:  It is still unknown whether ischemia­inducing training in patients with stable angina is superior to the training conducted below the ischemic threshold (IT) according to the current guidelines. OBJECTIVES:  The aim of the study was to assess the influence of warm­up ischemia prior to training on the effects of training conducted either at or below the IT in patients with stable angina. PATIENTS AND METHODS:  Thirty male patients aged 56 ±8 years, after myocardial infarction, with stable angina and positive exercise test (ET1) were divided into 2 groups: group A included 18 patients with the warm­up effect, group B - 12 patients without this effect. All patients followed an 8­week interval training program (TP). The intensity of training was planned to reach the heart rate at the IT. Successive ETs were performed immediately after the TP (ET2), at day 3 (ET3), day 10 (ET4), and at 1 month (ET5).   RESULTS:  After the TP, there was a statistically significant improvement in group A in all analyzed variables except maximum ST depression (max STD). Maximal workload increased by 28%, walking distance by 24%, duration by 20%, and time to 1­mm STD by 28%. Max STD reduction amounted to 14% (P =0.13). The beneficial effect of training on exercise­induced ischemia was maintained for up to 10 days (ET4) and on physical capacity for up to 1 month (ET5). In group B, the TP did not affect time to 1­mm STD, but physical capacity improved significantly and was maintained for up to 1 month (ET5). CONCLUSIONS:  The warm­up effect appears to be necessary to attenuate myocardial ischemia after training. 

Two models of early cardiac rehabilitation in male patients after myocardial infarction with preserved left ventricular function: comparison of standard out-patient versus hybrid training programmes.

BACKGROUND: The key to increase the percentage of cardiac patients undergoing cardiac rehabilitation is to follow a well designed exercise programme at home. To maximise the benefits while minimising the risks of aggravating health status, home-based exercise should be tele-monitored. AIM: To compare the effects on physical capacity and sympatho-vagal balance of two types of early cardiac rehabilitation in post-myocardial infarction (MI) male patients: the hybrid model, partly out-patient and partly home-based and tele-monitored vs standard rehabilitation performed only in the out-patient setting. METHODS: Sixty two male patients aged 54.7 ± 6.9 years, mean 27.3 ± 13.5 days after MI with preserved left ventricular systolic function (EF > 50%) underwent an eight-week training programme consisting of 24 training sessions. After performing the first ten interval trainings on a cycloergometer, 30 patients (the hybrid group) exercised at home while being monitored via TeleECG, while 32 patients (the out-patient group) continued their rehabilitation in the out-patient clinic. At entry and after completion of the rehabilitation programme, all patients underwent a symptom-limited treadmill stress test. The following parameters were analysed: maximal workload (METs), exercise duration (ED, min), heart rate (HR, bpm), blood pressure (BP, mm Hg), double product i.e. product of HR and systolic BP at rest and at peak exercise (DP, mm Hg/min, HR × systolic BP), and HR recovery (HRR) in the first and second minute of the recovery period. RESULTS: Maximal workload (out-patient: 7.3 ± 1.4 vs 7.8 ± 1.2, p < 0.05; hybrid: 8.5 ± 1.8 vs 9.9 ± 2.2, p < 0.01) and ED (out-patient: 10.1 ± 2.0 vs 13.5 ± 1.4, p < 0.001; hybrid: 10.9 ± 3.6 vs 12.5 ± 4.1, p < 0.05) increased significantly in both study groups. The remaining parameters did not change significantly, except for HRR1 (22.1 ± 8.7 vs 29.5 ± 10.7, p < 0.01) and HRR2 (37.9 ± 9.5 vs 43.8 ± 10.7, p < 0.01), which improved in the hybrid group only. Moreover, there were no significant differences between the study groups when comparing the training-induced percentage changes in the analysed parameters. CONCLUSIONS: 1. Hybrid rehabilitation improved physical capacity and positively influenced the sympatho-vagal balance in post-MI male patients with preserved left ventricular systolic function. 2. The hybrid model was effective and comparable with standard out-patient-based programme.