Can Inspiratory Muscle Training Improve Exercise Tolerance and Lower Limb Function After Myocardial Infarction?

BACKGROUND Respiratory therapy is an integral part of treatment of cardiac patients. The aim of this study was to evaluate the effect of addition of inspiratory muscle training (IMT) to second-stage cardiac rehabilitation on exercise tolerance and function of lower extremities in patients following myocardial infarction (MI). MATERIAL AND METHODS This study included 90 patients (mean age 65 years) with MI who took part in the second stage of an 8-week cycle of cardiac rehabilitation (CR). They were divided into 3 groups: group I underwent CR and IMT, group II only underwent CR, and group III only underwent IMT. Groups I and II were allocated randomly according sealed opaque envelopes. The third group consisted of patients who could not participate in standard rehabilitation for various reasons. Before and after the 8-week program, participants were assessed for maximal inspiratory and expiratory pressure (PImax and PEmax) values, exercise tolerance, and knee muscle strength. RESULTS In groups I and II, a significant increase in the PImax parameters and exercise tolerance parameters (MET) were observed. Group I had increased PEmax parameters. In group III, the same changes in the parameter values that reflect respiratory muscle function were observed. All of the examined strength parameters of the knee joint muscles demonstrated improvement in all of the investigated groups, but the biggest differences were observed in group I. CONCLUSIONS Use of IMT in the ambulatory rehabilitation program of MI patients resulted in improved rehabilitation efficacy, leading to a significant improvement in physical condition.

The influence of physical training on endothelial function in patients with stable coronary artery disease.

BACKGROUND: Endothelial damage is the key factor in the pathophysiology of atherosclerosis. Regular physical activity exerts beneficial direct and indirect effects on, among others, cardiovascular system, locomotor system, lipids, carbohydrate and hormonal balance, maintenance of a proper body weight as well as immunological system. OBJECTIVES: The aim of the study included evaluating the effect of a regular, two-month physical training on endothelial function parameters in patients with stable coronary artery disease. MATERIAL AND METHODS: The study involved 61 patients after coronary angioplasty, 13 women and 48 men aged 62.8 ± 8.7 years. The control group included 21 subjects aged 63.2 ± 9.7 years, 17 of whom had hypertension which was well controlled pharmacologically. Blood for VCAM-1 and ICAM-1 was collected with the subjects remaining for 30 min in supine position, through a venous access inserted in the basilica vein. In the patients' group the blood was collected twice, prior to and after a physical training cycle. In controls the blood was collected once. RESULTS: The investigated groups differ slightly but not in a statistically significant way with regard to the hemodynamic parameters BP 124.4/75.9 vs. 123.4/76.3 mm Hg, p = ns., HR 66.2 ± 6.8 vs. 68.8 ± 6.3 bpm, p = ns., left ventricular ejection fraction - EF 60.1 ± 7.6 vs. 63.7 ± 5.2 %, p < 0.05 and did not differ with regard to the incidence of hypertension or BMI value. The level of soluble ICAM-1 prior to physical training was higher in the investigated group (289.0 ± 97.1 vs. 230.2 ± 47.1 ng/mL, p < 0.01) and after the training it decreased but remained higher than in control group (252.4 ± 100.8 ng/mL, p < 0.05. vs. control group). The level of soluble VCAM-1 did not differ initially between the groups, nor did it change significantly after the training. CONCLUSIONS: Moderately intense physical training only slightly affects the investigated parameters of the endothelial function in patients with coronary artery disease. A beneficial effect of training on endothelial function was observed as a decrease of the level of soluble ICAM-1. 8-week, moderately intense physical training is sufficient to cause a clinically significant decrease in arterial blood pressure.