Factors affecting adherence to physical training in the outpatient phase of rehabilitation, in patients after coronary artery bypass grafting.

Aim      To evaluate the outpatient physical exercise (PE) compliance and the affecting factors in patients after coronary bypass (CB).Material and methods  The study included 67 men with ischemic heart disease younger than 75 years who had had CB. All patients were randomized to 2 groups: group 1 exercised on a bicycle ergometer at the rehabilitation center, under the monitoring of medical staff; patients of group 2 performed home-based exercise (HBE) by dosed walking. In the preoperative period, at one month after CB, and after 3 months of exercise, the following was evaluated: clinical condition of patients in different groups, plasma concentrations of lipids, body weight index, waist circumference, echocardiography and bicycle ergometry data, and questionnaire data (SF-36, Bek's Depression Inventory). At 3 months of follow-up, the outpatient exercise compliance and the affecting factors were also evaluated.Results The study demonstrated the effectiveness of the proposed alternative 3-month program of home-based PE. Both the patients exercising on a bicycle and those performing HBE had increased exercise tolerance (ET) and improved blood lipid concentrations. The number of obese patients decreased. Also, depression severity decreased, quality of life (physical and psychological components) improved, and compliance with drug therapy increased in both groups. Analysis of the training attendance in the recommended period showed that patients who had undergone CB were insufficiently adherent to physical rehabilitation programs, regardless of the program type (home-based or monitored). The highest PE adherence was observed in men with the following characteristics: married, working urban residents, with a previous history of cardiovascular diseases, who had regularly taken medications in the preoperative period, and who also had higher quality of life.Conclusion      The proposed outpatient 3-month physical rehabilitation programs increase the effectiveness of CB, which is evident as improved adherence to modifying cardiovascular risk factors, increased ET, optimization of the psychological status and quality of life, and improved compliance with drug therapy. However, despite the proposed alternative, home-based 3-month physical rehabilitation programs aimed at increasing the treatment compliance, the level of ET remained low. This requires further improvement of methods for monitoring and motivation of patients to physical rehabilitation and psychological support that would start already at the preoperative stage.

[Prostate cancer and atherosclerosis].

Prostate cancer (PCa) remains a relevant public health concern and one of the main causes of morbidity and mortality worldwide. Coronary artery disease (CAD) with the underlying coronary artery atherosclerosis is the leading cause of global death. The interaction between modifiable and non-modifiable risk factors for these pathological conditions is discussed in the review. Elevated serum cholesterol, a known risk factor for CAD, can be associated with both development and progression of PCa. From this perspective, patients with atherosclerosis may represent a potential target group for PCa screening. Alternatively, patients with PCa should undergo examination for concomitant cardiovascular diseases as well as their risk factors. Statins are supposed to be potentially beneficial in treating atherosclerosis in men and reducing the risk of PCa development and progression.

[The personalized approach to the rehabilitation of a severely ill patient presenting with a cardio-surgical problem]. / Personifitsirovannyi podkhod k reabilitatsii tiazhelogo patsienta kardiokhirurgicheskogo profilia.

The ever increasing number of the patients presenting with the cardio-surgical problems referred for surgery emphasizes the importance of the treatment of the cases of post-operative complications based on the personalized approach. The present article was designed to report a clinical case of the successful surgical treatment and rehabilitation of a patient presenting with the dysfunction of the bioprosthetic mitral valve and complications of the post-operative course in the form of polyorgan insufficiency with the predominance of respiratory failure. Special attention is given to the post-operative complications among which the respiratory insufficiency prevailed that made necessary the long period of artificial pulmonary ventilation. The specific features of the intense personalized approach to the physical rehabilitation of the given severely ill patient based at the intensive care unit are considered, the description of the methods applied for the purpose is presented, and their effectiveness from the perspective of clinical and functional parameters is evaluated. The study has demonstrated that the application of the intensive personalized approach in the given case turned out to be a safe and effective method of rehabilitation. The use of the proposed approach allowed to shorten the duration of the post-operative rehabilitation period, facilitated the patient's transfer to autonomous breathing and expansion of the motor activity under conditions of the intensive care unit. In addition, the use of the continuity principle and continuation of rehabilitation measures based at the cardiac surgery department provided the opportunity for the further expansion of the motor activity.

[Exercise training and erectile dysfunction in patients after coronary artery bypass grafting].

AIM: to estimate the effects of exercise training on erectile function after coronary artery bypass grafting. MATERIALS AND METHODS: 114 men with stable coronary artery disease undergoing on - pump coronary artery bypass grafting were examined. Patients with ED were randomized into two groups comparable in the main demographic, clinical and baseline parameters: a group of patients undergoing supervised exercise trainings at the outpatient rehabilitation center (n=53) and a group of patients without any exercise trainings at the outpatient hospital (n=61). Patients were assessed 1, 6 and 12 months after CABG. All patients underwent echocardiography (ECHO-CG), bicycle ergometer test without discontinuation of the drug therapy, measurement of nocturnal penile tumescence (NPT), ultrasound assessment of the cavernous arteries with the further estimation of their endothelial function. RESULTS: In addition to the expected improvements in exercise tolerance, regular cycling exercises led to a significant recovery of erectile function (number and duration of NTP, increased penile blood flow volume, estimated during NTP measurement), improved endothelial function of the cavernous arteries, compared to patients without exercise trainings. However, the obtained effects in the group with exercise trainings were short - term. One year after CABG, the number of NTP and penile blood flow volume were superior in patients undergoing exercise trainings. Differences in other parameters became less reliable between the groups. CONCLUSION: Aerobic exercise trainings appeared to be effective for optimizing exercise tolerance, erectile and endothelial function, and allow improving the prognosis of these patients and, therefore, are needed to be included in the rehabilitation programs for patients undergoing CABG.

[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.

[Cognitive dysfunction after coronary artery bypass grafting]. / Kognitivnaia disfunktsiia posle koronarnogo shuntirovaniia.

Despite the advances in surgical and anesthetic techniques for coronary artery bypass grafting (CABG), the incidence of neurological complications, including postoperative cognitive dysfunction (POCD), remains high. CABG is performed more often in elderly patients with severe comorbidities. However, comprehensive prevention measures and POCD rehabilitation have not yet been developed. Physical training is an effective and safe method for correcting endothelial dysfunction, severe systemic inflammatory response syndrome, lipid peroxidation, i.e. mechanisms contributing to the development and severity of POCD.

[Problems of Determination of Degree of Disability After Coronary Artery Bypass Surgery].

The review contains data on rates of permanent loss of working ability (disability) after coronary artery bypass grafting (CABG) in Russia and in European populations of patients with ischemic heart disease. According to domestic studies determination of disability status is not based on assessment of objective characteristics of functional reserve of cardiovascular system. Most patients after surgery retain disability status. CABG is not a rehabilitating factor but on the contrary results in increase of number of officially disabled people.

[Adherence to Therapy as a Factor Determining Prognosis of Coronary Artery Bypass Grafting].

AIM: to study the influence of the patients adherence to the recommended therapy after coronary artery bypass grafting (CABG) on prognosis of postoperative period. MATERIAL: We examined 197 consecutive patients with stable coronary artery disease (CAD) who had undergone CABG. Age of patients was 38-75 years. RESULTS: Assessment of modifiable cardiovascular risk factors showed that about half of patients had smoked before CABG and only a few gave up smoking after surgery. Number of patients with abdominal obesity increased by 8% after surgery. Number of patients involved in physical trainings remained unchanged. Adherence to drug therapy before CABG was low. Less than half of the patients took antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors, only 25% took statins. One year after CABG number of patients taking appropriate medications significantly increased. However, only half of patients managed to achieve the main objectives of secondary prevention.

[Analysis of approaches to assessment of persistent loss of capacity to work in patients who had undergone coronary bypass surgery].

Aim of the study was to assess factors influencing decisions about persistent disability of patients after coronary bypass surgery (CBS). By method of continuous sampling (registry study) we examined 427 working age patients who had undergone CBS. Although surgical treatment was effective rehabilitating factor most patients after CBS at inspection in institutions of medical social expertise were unreasonably classified as having low degree of restoration of ability to work. Possible explanations of this were incomplete volume of conducted tests, lack of relation between presence of functional class of angina and real clinical picture of this syndrome, absence of objective criteria of the presence of myocardial ischemia and tolerance to physical exercise, ill-timed referral to medical social inspection.

[Potentials for the correction of endothelial and erectile dysfunction in patients after coronary artery bypass grafting].

The study was aimed to the evaluation the effect of NO- synthase inducer impaza on endothelial function and erectile function in patients undergoing coronary artery bypass grafting (CABG). The study involved 127 men with stable coronary artery disease (CAD), aged 55.8 +/- 5.3 years, which were planned on CABG. The survey included assessment of IIEF score and blood lipid levels, registration of nocturnal penile tumescences, postcompression tests on the shoulder and cavernous arteries. Endothelial function was assessed as the plasma levels of nitric oxide (NO) and endothelin-1 (ET-1). The comparison group of patients (n = 67) were treated with standard rehabilitation program, and the study group (n = 67) additionally has received impaza 1 tablet a day for 24 weeks. It is shown that in patients with erectile dysfunction (ED) undergoing CABG, the use of impaza for 24 weeks facilitates optimal dynamic expression of the ED. But a year after the operation, there were marked deterioration in erectile function, indicating a short-term effect of action of impaza that may require its longer use. In addition, 6 months after CABG, patients receiving impaza had better indicators of functional activity of the endothelium in shoulder and cavernous arteries compared with patients who received conventional rehabilitation; one year after surgery, however, there were no significant differences in these parameters. Restorative treatment using impaza in CAD patients after myocardial revascularization operations has positive influence on the NO, ET-1 levels, which is reflected in the functional state of the endothelium and characterized by an increase in vasodilator properties and decrease in vasoconstrictor properties.

[Relationship between endothelial and erectile functions in patients with coronary heart disease].

The study included 92 men with stable coronary heart disease (CHD) aged 39-61 (mean 55 +/- 5.3) years. Groups 1 and 2 were comprised of 63 patients with erectile dysfunction (ED) and 29 ones without it respectively. It was shown that most patients with CHD suffer ED (68.5%). The probability of ED increases in the presence of such risk factors as diabetes mellitus, multifocal atherosclerosis, disturbances of lipid metabolism. Severity of ED grows with CHD duration and body mass. Parameters of endothelium-dependent dilation of brachial and cavernous arteries were impaired in ED patients which suggests the compromised ability of these vessels to respond to mechanical deformation. ED is a marker not only of functional disturbances of the vascular tone but also of severity of atherosclerotic lesions. Correlation analysis revealed the relationship between mean endothelium-dependent dilation of brachial artery and severity of ED; the latter also correlated with such markers of cardiovascular risk as multifactor atherosclerosis, obesity, and disturbances of lipid metabolism.

[Predictors of non-fulfillment of reperfusion therapy in patients with ST-elevation acute coronary syndrome].

At present reperfusion therapy in ST-elevation (STE) acute coronary syndrome (ACS) is carried out in majority of countries not more than in 70% of cases. We analyzed predictors of non-fulfillment of reperfusion therapy in patients with STEACS included into ACS registry conducted in the Kemerovo cardiological dispensary. Reperfusion therapy was not carried out in 154 patients with STEACS (36.2%). Main predictors of non-fulfillment of reperfusion were age older than 75 years (odds ratio [OR] 47.97, 95% confidence interval [CI] 19.47-118.21), admission later than in 12 hours after onset of disease (OR 4.29, 95%CI 1.52-12.13), history of myocardial infarction (OR 2.68, 95%CI 1.11-6.48). Thus there are factors including subjective ones which preclude full-fledged use of contemporary recommendations on the management of patients with STEACS.

[Weekly rhythms of general and cardiovascular mortality].

The aim of the study was to elucidate 7-day rhythms of general and cardiovascular mortality among the residents of Kemerovo. We analysed all registered cases of death in Kemerovo over the period from 01.01.98 to 31.12.01. The sample included 28 761 persons (15 454 men and 13 307 women). Cardiovascular mortality was distinguished from other causes of death. Analysis of distribution of lethal cases regardless of the cause by days of the weak showed that most of them fell on Fridays when their number was by 5.2% higher than on Thursdays when the mortality rate was minimal (p=0.02). Monday was the most unfavourable day in terms of mortality from cardiovascular diseases that was minimal on Sundays, the difference between the two days being 8% (p=0.02). The study revealed weekly rhythms of general and cardiovascular mortality most of which occurred on Fridays whereas the largest number of cardiovascular death fell on Mondays.

[Cardiovascular diseases and erectile dysfunction].

Until recently, erectile dysfunction (ED) has been considered to be psychogenic in nature in most cases. Advances in our knowledge about the physiology of erection and the pathophysiology of ED have clarified that it is due to organic causes in most cases. Atherosclerosis-associated intraorgan lesion is most frequently encountered. ED is closely related to common cardiovascular risk factors, such as diabetes mellitus, arterial hypertension, dyslipidemia, smoking, physical inactivity. Endothelial dysfunction is of great and universal importance for the genesis of cardiovascular diseases (CVD) and ED. As a manifestation of endothelial dysfunction, ED is an independent risk factor for CVD since vascular endothelial damage is one of the first stages of atherosclerotic plaque formation. ED is an early symptom that is suggestive of atherosclerotic lesion of arterial vessels, coronary arteries in particular. The first manifestation of atherosclerosis in the large arteries is frequently the life-threatening complications myocardial infarction or stroke, which underlines the importance of timely detection of early-stage vascular system lesions. Understanding ED of arteriogenic origin as an early sign of vascular lesion gives a clinician the unique chance to take preventive measures that can prevent complications of CVD.