[Efficacy of Home-Based Exercise Training and Adherence to Therapy in Patients After Coronary Artery Bypass Grafting].

AIM: to assess efficacy of home-based exercise training (HBET) at outpatient stage of cardiac rehabilitation and its impact on adherence to treatment in patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: In 1 month after CABG 112 male patients (after completion of rehabilitation program in the sanatorium) were distributed to 3 groups with comparable demographic, clinical, and functional parameters: group 1 - patients fulfilling supervised cycling training program (SCTP), group 2 - patients subjected to home-based exercise training (HBET) with defined walking sessions (WS), and the control group of usual care without exercise training. Patients were examined 1, 4 months and 1 year after CABG. RESULTS: Three months SCTP was most efficient relative to improvement of exercise tolerance (ET), modification of cardiovascular risk factors (smoking, obesity, dyslipidemia), and of adherence to medical therapy. Lowest ET and worst adherence to medical and non-medical therapies were found in the group of usual care without exercise training. The intermediate position was occupied by patients subjected to HBET and WS. Effects of 3 months of HBET diminished by 1 year of follow-up. CONCLUSION: HBET of moderate intensity appeared to be safe, easily workable and affordable training program for patients after CABG. However, it was less effective, compared with SCTP. Moreover, effects of this rehabilitation program were transitory.

[The comparative analysis of the influence of the supervised exercise training and home-based exercise training on the psychological status of the following coronary artery bypass grafting].

This article was designed to report the results of the comparative analysis of the influence of the home-based exercise training (HBT) and the supervised exercise training in the form of the controlled training (CVT) under conditions of outpatient rehabilitative treatment on the patients' quality of life (QoL) and psychological status (including manifestations of anxiety and depression) following coronary artery bypass grafting (CABG). AIM: The objective of the present study was to evaluate the consequences of the application of different programs of physical rehabilitation under the outpatient conditions on the psychoemotional status and quality of life of the patients who had undergone coronary artery bypass grafting. MATERIALS AND METHODS: A total of 114 male patients suffering from coronary artery disease (CAD) who had undergone CABG were available for the examination. All the patients were allocated to three groups. Group 1 was comprised of the patients (n=36) treated with the use of the supervised cycling training (SCT) while group 2 consisted of the patients who had to perform home-based walking training (HBWT) (n=36). The group of comparison included 42 patients. The psychophysiological assessment was carried out based on the Beck Depression Inventory (BDI) and the Spielberger-Hanin Personal and Reactive Anxiety Scale. The quality of life (QoL) was assessed with the use of the SF-36 questionnaire. All the patients were examined prior to surgery, 1.4 months and 1 year after CABG. RESULTS: The study has demonstrated the most pronounced improvement in the quality of life of the patients following the 3-month supervised cycling training after CABG that was manifested as the decrease of anxiety and depression. The minimal changes in the psychological and emotional status were documented in the absence of any exercise training integrated into the postoperative rehabilitation program. Only the moderate improvement of QoL was observed in the patients treated with the application of the 3-month home-based walking training program after CABG. The positive effects of the three-month exercise training were evened out within 1 year after its initiation. DISCUSSION: It has been shown that the effectiveness of HBT is somewhat lower than that of CVT in terms of the influence on the psychoemotional status of the patients following CABG. This finding is at variance with the results reported by the foreign authors and should provide a basis for the enhancement of the effectiveness of the post-CABG rehabilitation programs to be implemented under conditions of the medical facilities, their principal objective being the education of the patients in safe and efficient methods for the pots-surgical self-rehabilitation with the emphasis placed on the measures intended for the improvement of the approaches to monitoring the compliance of the patients with the prescribed recommendations and for increasing their motivation to observe as long as possible the advices given by the health care professionals. CONCLUSION: The home-based walking training of moderate intensity provides a safe, easy to perform, and readily available tool for a large number of patients who underwent coronary artery bypass grafting even though it is somewhat less effective than the supervised cycling training. The effects of both rehabilitation modalities are rather short-term.