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.

Impact of exercise-based cardiac rehabilitation on attitude to the therapy, aims in life and professional work in patients after myocardial infarction.

BACKGROUND: Comprehensive cardiac rehabilitation aims to restore pathophysiological and psychosocial consequences of myocardial infarction (MI). The aim of the study was to assess how exercise-only-based cardiac rehabilitation (ECR) influences the attitude to the therapy (ATT), to the aims in life and professional work (AAL) amongst men and women after MI. MATERIAL AND METHODS: The study comprised 44 post-MI patients: 28 men and 16 women, mean age 58±10 years old, referred to ECR. Patients underwent 24 interval cycle ergometer trainings 3 times a week. At the beginning and after the training program (TP) each patient underwent exercise stress test (EST) and was scored to ATT and ALL based on the Psychological Effects of Rehabilitation Score Scale (PERSS) according to Tylka and Makowska. The analysis covered: 1) EST findings: maximal workload and test duration (min), 2) ATT and AAL based on PERSS, 3) resuming professional work. RESULTS: Exercise capacity improved significantly after TP. Attitude to the aims in life and professional work significantly increased in the whole group (4.4±2.8 vs. 5.1±2.4, p < 0.01) and separately in men (4.5±2.9 vs. 5.1±2.5, p < 0.05) and women (4.3±2.6 vs. 5.0±2.0, p < 0.05). Attitude to the therapy did not change significantly in the whole group (5.6±2.8 vs. 6.0±2.8) and in men (5.9±2.9 vs. 6.0±2.9), but increased significantly in women (5.0±2.5 vs. 6.1±2.7, p < 0.05). Professional work was resumed, averagely by 86.4% of all patients (85.7% men and 87.5% women). CONCLUSIONS: Physical training beneficially influenced post-MI men's and women's attitude to the aims in life, professional work and attitude to the therapy in women. Med Pr. 2019;70(1):1-7.

Electrocardiographic exercise testing in adults: performance and interpretation. An expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology.

Electrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk strati- fication in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.

The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction.

AIM: The aim of the study was to assess the effectiveness of exercise training on depression, anxiety, physical capacity and sympatho-vagal balance in patients after myocardial infarction and compare differences between men and women. METHODS: Thirty-two men aged 56.3±7.6 years and 30 women aged 59.2±8.1 years following myocardial infarction underwent an 8-week training programme consisting of 24 interval trainings on cycloergometer, three times a week. Before and after completing the training programme, patients underwent: depression intensity assessment with the Beck depression inventory; anxiety assessment with the state-trait anxiety inventory; a symptom-limited exercise test during which were analysed: maximal workload, duration, double product. RESULTS: In women the initial depression intensity was higher than in men, and decreased significantly after the training programme (14.8±8.7 vs. 10.5±8.8; P<0.01). The anxiety manifestation for state anxiety in women was higher than in men and decreased significantly after the training programme (45.7±9.7 vs. 40.8±0.3; P<0.01). Of note, no depression and anxiety manifestation was found in men. Physical capacity improved significantly after the training programme in all groups, and separately in men and in women. Moreover, an 8-week training programme favourably modified the parasympathetic tone. CONCLUSIONS: Participating in the exercise training programme contributed beneficially to a decrease in depression and anxiety manifestations in women post-myocardial infarction. Neither depression nor anxiety changed significantly in men. The impact of exercise training on physical capacity and autonomic balance was beneficial and comparable between men and women.

The influence of water-based training on arrhythmia in patients with stable coronary artery disease and preserved left ventricular function.

BACKGROUND: Water immersion may cause adverse cardiovascular events, including arrhythmias in patients with damaged cardiac muscle, e.g. with cardiac failure. So far, there have been rather few reports on arrhythmia induced by water training in patients with coronary artery disease (CAD). The aim of the study was to assess the influence of exercise training in moderately cold water (28-30°C) on arrhythmia and physical capacity in stable CAD patients with preserved left ventricular (LV) function. METHODS: Sixty-two post-myocardial infarction male patients, mean age 50.9 ± 7.9 years, participated in 16 water-based trainings (WBT), which lasted 55-min, twice a week in water at 28-30°C. Each subject underwent 24 h Holter on-land monitoring (Holter-24) once during the study and twice in-water Holter monitoring (Holter-W) during WBT. Before and after WBT cardiopulmonary exercise test (CPET) was performed. The following parameters were analyzed: peak oxygen consumption (peak VO2), mean number of ventricular ectopic beats (VEBs) and supraventricular ectopic beats (SVEBs) during Holter-24 and Holter-W, the percentage of men who developed arrhythmia during CPET vs. Holter-24 and vs. Holter-W. RESULTS: WBT significantly improved patients' physical capacity, and more often provoked arrhythmia, mainly SVEBs, than CPET or daily activity assessed during Holter-24. During WBT 58% men developed VEBs and 62% SVEBs. CONCLUSIONS: 1. WBT provoked arrhythmias significantly more often than did CPET and normal daily activity. 2. Owing to WBT patients improved their physical capacity which was still maintained at 1-year follow-up.

Hybrid model of cardiac rehabilitation in men and women after myocardial infarction.

BACKGROUND: A relatively new alternative for post-myocardial infarction (MI) patients' care is the hybrid cardiac rehabilitation (CR) consisting of ambulatory and home-based parts. The aim of the study was to compare the influence of CR on physical capacity, safety, adherence and return to work in post-MI male and female patients with preserved left ventricular systolic function, and to assess who benefited more from this model of trainings. METHODS: The study comprised 57 men aged 54.5 ± 7.5 years and 30 women aged 52.2 ± 6.7 years after MI. All subjects underwent an 8-week training program consisting of 24 interval trainings. The first 10 trainings were conducted in an out-patient clinic, then both groups did their training at home with TeleECG monitoring. At the beginning and after trainings all patients underwent a symptom-limited exercise stress test. Assessment included results of exercise tests. Moreover, a comparative analysis of adherence and returning to work in post MI female and male patients was performed. RESULTS: We found that trainings led to a significant improvement in physical capacity in all patients based on exercise test. When the training effects were compared between men and women, no significant differences were observed. The percentage of patients returning to work was higher in men than in women (78.9% vs. 50%, p < 0.01). CONCLUSIONS: 1. Hybrid rehabilitation resulted in a comparable improvement in physical capacity in post-MI low-risk male and female patients. 2. Although hybrid rehabilitation facilitated patients' adherence to the training program, their return to work was significantly greater only in post-MI men.

Feasibility of home-based cardiac telerehabilitation: Results of TeleInterMed study.

BACKGROUND: Cardiac rehabilitation (CR) is recommended as an important component of a comprehensive approach to cardiovascular disease (CVD) patients. Data have shown that a small percentage of eligible patients participate in CR despite their well established benefits. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR. The purpose of the study was to evaluate a wide implementation and feasibility of home-based cardiac telerehabilitation (HTCR) in patients suffering from CVD and to assessits safety, patients' acceptance of and adherence to HTCR. METHODS: The study included 365 patients (left ventricular ejection fraction 56 ± 8%; aged 58 ± 10 years). They participated in 4-week HTCR based on walking, nordic walking or cycloergometer training. HTCR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with CR. The influence on physical capacity was assessed by comparing changes - in time of exercise test, functional capacity, 6-min walking test distance from the beginning and the end of HTCR. At the end of the study, patients filled in a questionnaire in order to assess their acceptance of HTCR. RESULTS: HTCR resulted in a significant improvement in all parameters. There were neither deaths nor adverse events during HTCR. Patients accepted HTCR, including the need for interactive everyday collaboration with the monitoring center. There were only 0.8% non-adherent patients. CONCLUSIONS: HTCR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high and promising.

Comparison between hybrid and standard centre-based cardiac rehabilitation in female patients after myocardial infarction: a pilot study.

BACKGROUND: Despite the known benefits of cardiac rehabilitation (CR) for patients with stable coronary artery disease, it is neglected, especially in women. Home-based programmes may increase adherence to CR. AIM: To compare the effectiveness of centre-based CR with a hybrid model of training, partly out-patient and partly home-based and tele-monitored, in terms of physical capacity and adherence in post-myocardial infarction (MI) women with preserved left ventricular function. METHODS: 53 post-MI female patients, aged 51.3 ± 7.6 years underwent an eight-week training programme (TP) consisting of 24 interval trainings. The first ten trainings were performed in a hospital, then 33 patients (Gruop A) continued them in the centre, the remaining 20 (Group B) did tele-monitored walking training at home (hybrid model). Before and after completing CR, all patients underwent a symptom-limited treadmill exercise stress test during which the analysis included: workload (METs), duration (min), heart rate (HR, bpm), double product (mm Hg/min) at rest and during effort, and HR recovery in the first minute after test. Adherence was reported as the number of trainings completed and the number of dropouts in two CR models. RESULTS: After CR, only workload (Group A: 6.5 ± 1.1 vs. 7.0 ± 1.4, p < 0.05; Group B: 7.4 ± 1.1 vs. 8.3 ± 1.4, p < 0.01) and duration (Group A: 4.7 ± 1.1 vs. 5.1 ± 1.2, p < 0.01; Group B: 8.1 ± 3.9 vs. 9.3 ± 4.2, p < 0.01) improved significantly in both groups. Comparing CR effects between both groups, no significant differences were observed. All patients completed TP. CONCLUSIONS: In post-MI women, a hybrid model of training improved physical capacity and was a similarly effective form of CR as a centre-based approach. A home-based tele-monitored programme facilitated our patients' adherence to CR.

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. 

[Physical training as an effective way to protect the heart against ischaemia]. / Trening fizyczny jako skuteczny sposób ochrony serca przed niedokrwieniem.

The findings from experimental animal studies show that regular physical trainings can protect via preconditioning the heart against the ischaemia-reperfusion (IR) injury. It is not clear if the cellular mechanism is the same as in the case of ischaemic preconditioning, but the final effect is the same, i.e. a stress stimulus, in this case a repeated effort leaves the heart with the 'memory', which translates into an increased resistance to ischaemia. At present, the precise mechanism responsible for training-induced cardioprotection is not clear. Candidate factors responsible for this cardioprotection are numerous and include collateral circulation development, enhanced ER stress proteins, increased COX-2 activity, increased heat shock protein (HSP-72) levels, increased activity of mitoK-ATP and sarcoK-ATP channels, and increased myocardial antioxidative capacity. The studies performed so far have suggested that MnSOD activity and increased sarcoK-ATP expression did play a role in exercise-induced cardioprotection. There may exist some other mechanisms responsible for this type of cardioprotection, but finding them will be possible only through further relevant studies. The paper presents the up-to-date knowledge in this field.