[A home exercise training program after acute coronary syndrome and/or endovascular coronary intervention: efficiency and a patient motivation problem].

AIM: To analyze the impact of a home exercise training (ET) program on quality of life, motor activity (MA), dietary habit, functional and biochemical parameters, and clinical course of the disease in patients who have experienced acute coronary syndrome (ACS) and/or endovascular coronary intervention (ECI). SUBJECTS AND METHOD: The trial included 100 patients after ECL who were randomized into 2 groups: those who had gone through Patient School (PS) and received a 6-week course of controlled ET (a study group (Group S)) and those who had gone through PS only (a control group (Group C). The patients of both groups were recommended a home ET program and, according to its implementation, they formed 2 subgroups: Subgroup A (home ET+) comprising 51 patients who had trained themselves at home) and Subgroup B (home ET-) consisting of 46 patients who had not. The follow-up lasted 1 year. Quality of life, risk factors, lifestyle and clinical parameters were assessed. RESULTS: As time elapsed, the patients' motivation to perform home ET; and, accordingly, the proportion of those who had trained themselves decreased in Group S to 67 and 61% and in Group C to 39 and 40% after 6 and 12 months, respectively. Among the reasons for refusal to perform home ET, disease was reported by only 5.6% of the patients (by all from Group C). The comprehensive physical rehabilitation program (RP) (controlled ET in combination with home ET) produced the best effect in raising the level of daily MA, exercise performance with a 21.3-fold increase in cardiac performance (p < 0.05) and a 14.3-fold decrease in heart rate increment in response to exercises. Group C patients who had refused the home ET program, as compared to those in the same group who had trained themselves at home, showed the worst daily MA levels, none body mass index reduction, and a rise in the low-density lipoprotein cholesterol (by 20.3%; p < 0.05) and in the number of angina attacks (by 1.9 times; p < 0.05). CONCLUSION: RP in the early-stage, which encompasses an educational program (PS), a short-term course of controlled ET and home ET used in patients with ACS, including in those after ECI, has clear clinical benefits. The participation of patients with coronary heart disease (CHD) in the home ET programs increases their motivation and, hence, the proportion of those who participate in therapeutic and rehabilitation measures. Home patient physical rehabilitation is one of the important components of different rehabilitation and prevention programs in patients with CHD after ACS and ECI.

[The use of a short program of physical training in patients with ischemic heart disease after endovascular (coronary) interventions in complex program of rehabilitation and secondary prevention at dispensary-ambulatory stage].

Aim of the study was to assess efficacy of a short program of medium intensity physical training of patients with ischemic heart disease (IHD) after endovascular intervention (EVI) in conditions of practical health care of Russia. Patients (n=100) were randomized into 2 groups - intervention (main group "M", n=50) and control (group "C", n=50) during weeks 2-8 after EVI. Efficacy of undertaken measures was assessed by results of laboratory (lipids), instrumental (electrocardiogram - ECG, exercise test on veloergometer - VEM-test, echocardiography - EchoCG) and clinical investigations. Patients of group M exercised for 45-60 min 3 times/week using work loads 50-60% of those achieved during VEMtest. All patients received therapy standard for EVI treatment IHD as well as lipid lowering drugs when indicated. The use of short program of physical training in this contingent of patients led to significant increase of duration of exercise compared with initial value (by 38% after 1 year, p<0.001) and with control group (p<0.05), increase of efficiency of heart work during VEM-test which differed from that in group "C" at points 1.5 and 6 months (p<0.05). According to EchoCG data parameters of left ventricular (LV) contractility in group "M" significantly improved. With that systolic LV volume diminished 3.1% in 6 months (p<0.05) while its ejection fraction (EF) increased 2.4% (p<0.01). In group "M" at the background of conducted from the very beginning therapy with statins blood concentrations of atherogenic fractions of lipids in blood did not change. At the same time in group "C"their values significantly rose (in 1 year level of total cholesterol - by 12.1%, level of low density lipoprotein cholesterol - by 18.6%, p<0.01 for all comparisons) and at points 4 months and 1 year differences in dynamics of these parameters at intergroup comparison were also significant. In the group of physical training compared with control group according to overall results of 1 year observation more favorable course of disease was registered with more cases of improvement of clinical state (p<0.01) and less cases of its worsening (p<0.01). The obtained results evidence for sufficient efficacy of the short program of physical training and feasibility of its introduction into ambulatory practice for rehabilitation of patients with IHD subjected to EVI on coronary arteries especially in acute coronary syndrome. In combination with the School for IHD patients subjected EVI it can be considered as method of secondary prevention because the study demonstrated its positive effect of risk factors and clinical course of the disease.

[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)].

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeak rose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.

[Rehabilitation of patients with ischemic heart disease at outpatient stage.].

The article is assigned to general practitioners and devoted to the outpatient combined rehabilitation of coronary heart disease patients, including those after myocardial infarction. In the part concerning the physical rehabilitation there is given the classification of patients by functional classes, the exercise programs of middle intensity for sport and home training. The formula of selection of the walking training temp according to the results of exercise stress test is given. There are presented the psychodiagnostic methods that evaluate the psychological reactions of patients on the disease, and the methods of psychological rehabilitation with use of psychopharmacotherapy. Special part is devoted to the educational program for patients.

[Cooperative study "posthospital rehabilitation of patients with coronary heart disease after acute coronary incidents" conducted in moscow region.]. / Moskovskoe oblastnoe kooperativnoe issledovanie "Poststatsionarnaia reabilitatsiia bol'nykh ishemicheskoi bolezn'iu serdtsa posle ostrykh koronarnykh intsidentov"

Effect of physical training, therapy with extended-release nicotinic acid (enduracin) or their combination on clinical course of the disease, physical working capacity, hemodynamics and blood lipids was studied in 136 patients. Patients were recruited 8-12 weeks after onset of acute coronary incident in several hospitals of Moscow region and followed up for 1 year. Type of intervention implemented in a given hospital was determined by randomization of the hospitals. Combined use of training and nicotinic acid resulted in increased physical working capacity, improved hemodynamics both at rest and during exercise, improved systolodiastolic left ventricular function and lipid profile. Combined use of interventions produced better effect than each one alone. However positive significant effect of enduracin on physical working capacity, blood pressure and frequency of angina was also demonstrated. The data obtained were used for creation of recommendations on out of hospital physical rehabilitation of this group of patients.

[Clinical efficacy of tianeptine in patients with ischemic heart disease and comorbid depression]. / Klinicheskaia éffektivnost' tianeptina u bol'nykh ishemicheskoi bolezn'iu serdtsa s komorbidnoi depressiei.

Ischemic heart disease patients (20 men, 20 women, age 36-72 years) with class II-III effort angina and depression (Beck Depression Inventory -- BDI -- score > or = 19) were randomized to standard therapy were treatment of stable ischemic heart disease (control group) or standard therapy plus tianeptine 37.5 mg/day. After 6 weeks 52% decrease of BDI score occurred in tianeptine treated patients (from 24.9+/-1.2 to 11.9+/-1.5, p<0.001). This was associated with decrease of number and severity of cardialgias, better blood pressure control in patients with hypertension, lengthening of exercise time during exercise test (by 3.3+/-0.9 min, p<0.05), and increase of overall index of quality of life (by 2.6+/-0.9 points, p<0.01). No dynamics of these parameters occurred in control group.

[Exercise and nicotinic acid delayed action drug Enduracin: application in outpatient rehabilitation of patients with ischemic heart disease]. / Primenenie fizicheskikh trenirovok i preparata nikotinovoi kisloty dlitel'nogo vysvobozhdeniia énduratsina na poliklinicheskom étape reabilitatsii bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To evaluate efficacy of combined use of moderate exercise and nicotinic acid drug enduracin in patients with coronary heart disease (CHD) with moderate dyslipidemia (DE). MATERIAL AND METHODS: The effects of exercise therapy alone, enduracin alone and their combination on physical performance (PP), hemodynamics, blood lipid spectrum and clinical course of CHD were studied in 93 CHD patients with moderate DE. The results were evaluated clinically after 1-year treatment. RESULTS: Combined used of exercise and enduracin in CHD patients showed its efficacy manifesting in improvement of PP, hemodynamics at rest and exercise test, left ventricular systolic function, clinical course, reduction of DE. Enduracin + exercise appeared more efficient than their use in monotherapy. Enduracin monotherapy had a positive action on PP, arterial pressure and anginal attacks frequency. CONCLUSION: Enduracin is recommended as monotherapy and in combination with moderate exercise in outpatient rehabilitation and secondary prophylaxis of CHD patients with moderate dyslipidemia and angina pectoris to relieve myocardial ischemia under exercise, to raise PP, improve lipid composition of blood and prevent maladaptive left ventricular remodeling.

[Effect of a compound preparation pumpan on exercise tolerance and clinical course of ischemic heart disease]. / Vliianie kompleksnogo preparata "Pumpan" na perenosimost' fizicheskikh nagruzok i klinicheskoe techenie ishemicheskoi bolezni serdtsa.

AIM: To study effects of the drug pumpan on exercise tolerance and myocardial ischemia induced by exercise in patients with ischemic heart disease of functional class II-III. MATERIAL AND METHODS: The study included 30 patients with various forms of ischemic heart disease (myocardial infarction, coronary artery bypass grafting) having stable effort angina of functional class II-III. RESULTS: The addition of a compound drug pumpan to a standard antianginal therapy reduced the number of anginal attacks and ST depression at bicycle exercise test. CONCLUSION: Pumpan is an adjuvant medication in conduction of antianginal therapy in ischemic heart disease patients with stable angina of effort of functional class II-III.