Effects of prehabilitation resistance training in mild to moderate clinically frail patients awaiting coronary artery bypass graft surgery.

Coronary artery disease is one of the main causes of mortality and morbidity among chronic heart diseases worldwide. Patients reported chronic chest pain as the primary symptom of coronary artery disease. Due to its progressive nature, it affects the health status and functional capacity of the patients. The current study was planned to compare the effects of prehabilitation resistance training in mild to moderate clinically frail patients awaiting coronary artery bypass graft (CABG). A randomized controlled trial was conducted on 74 patients awaiting CABG at the Faisalabad Institute of Cardiology, Faisalabad, Pakistan. A Modified Healthy Heart Questionnaire was used for screening of the patients. Interventions applied were resistance training by using cuff weights/dumbbells at light intensity (40%-50%) of a maximum of one repetition (10-15 repetitions for one to three times a day) per major muscle groups of upper and lower limbs of the body on weekly basis. The main outcome measures were the 6-minute walk test (6MWT), the New York Heart Association (NYHA) for heart failure, the clinical frailty score, and the essential frailty toolset. Significant differences between group A (resistance training group) and group B (conventional physical therapy group) patients were observed. The mean ranks for 6MWT in group A and group B were 1.70 and 1.55, respectively. The mean ranks of NYHA in group A and group B were 1.68 and 2.84, respectively. Clinical frailty scores in group A and group B were 2.68 and 2.74, respectively, with the essential frailty toolset in group A and group B were 1.14 and 1.11, respectively. There were significant (p < 0.05) differences within and between groups for prehabilitation resistance training after CABG. The study showed that the resistance training group had improved the clinical frailty score, strength, endurance, and functional capacity in patients who underwent elective CABG.

Combined Effects of Continuous Positive Airway Pressure and Cycle Ergometer in Early Rehabilitation of Coronary Artery Bypass Surgery Patients.

OBJECTIVE: To determine the combined effects of continuous positive airway pressure (C-PAP) and physical exercise rehabilitation on a cycle ergometer on postcoronary artery bypass surgery patients. STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Rawalpindi Institute of Cardiology, from December 2020 to May 2021. METHODOLOGY: Patients, who underwent coronary artery bypass graft surgery, were divided into two equal groups of each 51. The control group received standard physiotherapy from the 1st postoperative day which included breathing exercises, passive mobilisation in the sitting position, and ambulation. The interventional group also had standard physiotherapy from 1st postoperative day; but also the 2nd to 4th postoperative day had additional dynamic exercises on cycle ergometry in combination with CPAP (continuous positive airway pressure). RESULTS: There was a significant improvement in functional capacity measured by 6-minute walk test in the interventional group (p<0.001). Length of hospital and ICU stay mean rank (68.88 and 58) were also significantly decreased in the interventional group (p<0.001). There was no improvement in maximum inspiratory pressure and maximum expiratory pressure. One-minute sit-to-stand test was increased on 4th postoperative day in the interventional group. There was no significant difference observed in arterial blood gases between these two groups. CONCLUSION: Cycle ergometry combined with continuous positive airway pressure (C-PAP) applied earlier on patients undergoing coronary artery bypass grafting improves the functional capacity, decreases the ICU and hospital length of stay and also improves lower limb muscle strength. But no difference in respiratory muscle strength and arterial blood gases was observed between the control and interventional groups. KEY WORDS: Aerobic exercise, Coronary artery bypass graft surgery, Continuous positive airway pressure.

Home-based cardiac rehabilitation: development, implementation and outcome evaluation in patients with coronary artery diseases in Lahore, Pakistan - a mixed-methods study protocol.

INTRODUCTION: Cardiac rehabilitation (CR) is an important strategy to bring cardiac patients back to a normal life after a cardiac event. The benefits of CR as part of secondary prevention are widely known among people who have undergone myocardial infarction or revascularisation. As evidenced by several systematic reviews and meta-analyses, home-based CR (HBCR) has similar or greater effects on health-related quality of life, health outcomes, physical activity, anxiety and unplanned visits to the emergency department as compared with centre-based CR. The purpose of this study is to develop a contextual HBCR intervention and evaluate its effects on quality of life, health behaviours, bio-physiological parameters and emergency hospital visits of patients with coronary artery diseases in Lahore, Pakistan. METHODS AND ANALYSIS: This study will employ a mixed-method exploratory sequential research design. The researchers will invite 15-20 cardiac patients and 12-15 healthcare providers for semi-structured interviews in the qualitative phase of the study. Once the intervention is developed and validated through the qualitative phase, the outcomes will be evaluated through a single-blinded randomised control trial in the quantitative phase. A total of 118 patients with acute coronary syndrome will be recruited through a screening checklist and randomly allocated into the control and intervention groups (59 patients in each group). The inductive coding approach will be used for the thematic analysis of qualitative data, whereas the quantitative data will be analysed through descriptive and inferential statistics using SPSS to see the difference within the groups, between groups and between three intervals. ETHICS AND DISSEMINATION: The Ethical Review Committee of Aga Khan University and Mayo Hospital Lahore under the registration number 2023-8282-24191 and No/75749MH have approved this study protocol, respectively. The results of this study will be disseminated to participating patients (in the Urdu language), healthcare professionals and the public by publishing the manuscript in an open-access peer-reviewed journal and presenting it at different conferences. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trial Registry (ACTRN12623000049673p).

Effectiveness of the Graston Technique on Pain and General Foot Health in Patients with Chronic Plantar Fasciitis: A Randomized Clinical Trial.

Background: Chronic plantar fasciitis has been historically treated with conventional physical therapy. The use of the Garston Technique® (GT) is a new intervention for the management of chronic plantar fascitis, but there is lack of evidence in the literature regarding its efficacy. Study Objective: To evaluate the effectiveness of the GT on pain, foot function and general foot health in patients with plantar fasciitis. Methods: This was a randomized clinical trial conducted from November 2020 to March 2021. The non-probability purposive sampling technique was used to select 30 patients. Setting: Madinah Teaching Hospital, Faisalabad, Pakistan. Participants: A total of 30 patients of both genders with a 6-week history of planter fasciitis and the presence of a calcaneus everted ≥2° were included in this study and randomly assigned to one of two groups. Intervention: Both groups received conventional physical therapy (CPT) for 4 weeks and the experimental group in addition received GT. Primary outcome measures: The primary outcome measures were pain, measured at baseline, after the second week and after the end of treatment (ie, the fourth week) on the visual analog scale (VAS); and general foot health and foot function, measured at baseline and after the end of treatment with the Modified Foot Health Status Questionnaire (FHSQ). Results: The mean age of the study patients was 34.1 ± 6.67 years. There was significant improvement in pain in the GT group compared with the CPT group after the second (P = .005; partial η2 = 0.263) and the 4th (P = .000; partial η2 = 0.535) week of intervention. Foot function was also significantly improved (P < .05) in the GT group compared with the CPT group with a large effect size (Cohen's d = 0.080). But in the case of general foot health, no significant difference was observed between the groups at the end of the fourth week. Conclusion: The use of the GT combined with CPT shows significant results compared with CPT alone; ie, GT speeds up the recovery from heel pain and foot function in patients with chronic plantar fasciitis.

Effectiveness of Pre-operative Respiratory Muscle Training versus Conventional Treatment for Improving Post operative Pulmonary Health after Coronary Artery Bypass Grafting.

OBJECTIVE: To evaluate the Effectiveness of Pre-operative Respiratory Muscle Training versus Conventional Treatment for Improving post-operative pulmonary health after Coronary Artery Bypass Graft Surgery (CABG). METHODS: A Prospective Randomized clinical trial was performed on sixty patients who underwent elective CABG at Faisalabad Institute of Cardiology. At the time of admission all patients were subjected to 6-minutes' walk test (6MWT) as baseline. The subjects were then divided into two groups. The Group-I was subjected to respiratory muscle training whereas the Group-2 received the routine preoperative care. The 6-minute walk test (6MWT) was then repeated a day before surgery (pre-operative) and before discharge (post-operatively). Duration of post-operative mechanical ventilation, oxygen therapy and hospital stay were also noted as outcome measures of this study. RESULTS: The pre-operative and post-operative readings showed that the patients in the interventional group performed better than the control group in their 6MWT with P-value of less than 0.05. Similarly the interventional group had shorter duration of mechanical ventilation, dependence on oxygen therapy and postoperative hospital stay as compared with the control group showing P-values below 0.05. CONCLUSION: The results showed that respiratory muscle training results in improved postoperative functional capacity and reduces of hospital stay.