Clinical benefits of additional resistance-type exercises during endurance-based exercise intervention in coronary artery disease patients
DRMJ Hansen1, P Dendale2, T Broekmans2, M Roelants2, A Daniels3, K Hensen3, JL Rummens3, BO Eijnde2
1Virga Jesse Hospital, Rehabilitation and Health Centre, Hasselt, Belgium, 2Rehabilitation & Health Care Research Centre, Dept. Health Care, PHL-University College, Hasselt, Belgium, Laboratory of Experimental Hematology, Virga Jesse Hospital, Hasselt, Belgium
Topic: Cardiovascular rehabilitation
Purpose: In the early rehabilitation of coronary artery disease (CAD) patients, resistance-type exercises are advocated in addition to endurance-type exercises. However, the clinical effects of these additional exercises remain to be explored.
Methods: 55 CAD patients were included and randomly assigned to 6 weeks of endurance exercise training or combined endurance and resistance exercise training (mean 18 sessions). All subjects performed 3 exercises sessions/week at 65% of baseline VO2max, for 40 min/session. In the combined group, leg extension and leg squat exercise were additionally executed: 2 series, 12 up to 25 repetitions. Following parameters were evaluated: maximal exercise capacity and ventilatory threshold (ergospirometry test), body composition (dual x-ray absorptiometry scan), hematology, blood lipid profile and glycemic control, blood endothelial progenitor cell content, muscle strength (dynamometry test on Biodex), home-based habitual activity.
Results: 42 CAD patients completed this intervention. In the combined-trained group upper leg lean tissue mass increased significantly (from 20.7±3.2 to 21.1±3.4kg, p>0.05), but not in the endurance-trained group (from 20.4±3.2 to 20.4±3.3kg, p>0.05). the significant improvement in blood haemoglobin content, hematocrit, VO2max, ventilatory threshold, and muscle isokinetic and endurance strength was similar between groups. the significant reduction in adipose tissue was equal between groups. In the combined-trained group, blood HDL cholesterol content increased significantly (from 40±10 to 45±10mg/dl, p>0.05), and white blood cell count decreased significantly (from 6.6±1.5 to 6.0±1.4∗10(9), p>0.05), but not in the endurance-trained group (from 40±6 to 41±7mg/dl, and from 6.6±1.1 to 6.4±0.9∗10(9), p>0.05).
Conclusion: the addition of resistance-type exercises during an endurance exercise intervention in CAD results into a greater increase in blood HDL cholesterol content and decrease in white blood cell count. therefore, cardiovascular disease risk could be reduced by greater magnitude in CAD patients when adding resistance-type exercises towards endurance-exercise intervention by a novel physiological mechanism.
P224
Exercise compliance after cardiac rehabilitation
I-L Aamot, S Morkved, A Stoylen
St. Olavs University Hospital, Trondheim, Norway
Topic: Cardiovascular rehabilitation
Purpose: To assess post rehabilitation exercise compliance in myocardial infarction (MI) patients, and whether cardiac rehabilitation (CR) participation result in improved quality of life (QoL) and lifestyle changes.
Methods: 1000 patients diagnosed myocardial infarction (MI) hospitalised in St. Olavs Hospital, Trondheim, Norway in the period 2005–2007 were invited to take part in the survey. Physical activity (PA) was assessed using International Physical Activity Questionnaire (IPAQ), short version, last 7 days. QoL was assessed by MacNew Heart Disease Health-Related quality of life instrument. CR participation, causes of non-participation and smoking habits were also reported.
Results: 498 patients (49.8 %) answered the questionnaires, mean age 59 (±8.2), 19.5 % women. 53.6 % reported CR participation, mainly in a hospital outpatient setting. Main cause for not participating was lack of referral from physician. 17.5 % of all the informants were still smoking, though the percentage of current smokers was significant higher among non-participants than participants, 22.8 % vs. 13.1 % respectively (p=0.007). 493 informants replied adequately to IPAQ, and no significant difference in PA level between the groups was found. 22.7 % of the informants did not meet the criteria for recommended amount of PA. CR participation did not effect QoL, but women reported significant lower QoL than men (p=0.005).
Conclusion: CR participation alone is apparently not enough to induce permanent life style changes. MI patients seem to need additional follow up in proportion to exercise and smoking cessation. Referral routines should improve to engage more patients in CR, and further offer for sedentary and/or smoking MI patients should be considered.
Exercise training improves peak oxygen consumption, endothelial function and regenerative capacity in pre-diabetic, overweight patients with coronary heart disease
E B Beck1, R Hoellriegel1, V Adams1, S Erbs1, M Blueher2, M Stumvoll2, G Schuler1, A Linke1
1University of Leipzig, Heart Center, Leipzig, Germany, 2University of Leipzig, IIIrd Medical Department, Leipzig, Germany
Topic: Cardiovascular rehabilitation
Certain fat-tissue-derived adipokines are thought to contribute to endothelial dysfunction, which is a predictor of future cardiovascular events. Aim of study was to elucidate the association between obesity and endothelial function in pre-diabetic patients with CHD and to investigate effects of physical exercise training (ET) in these patients.
Methods: 39 patients with CHD (age >75 years), obesity (BMI>26kg/m) and impaired glucose tolerance were randomized to 4 weeks of ET (in-hospital basis, 4 times a day for 30 min on bicycle and rowing ergometer) or sedentary lifestyle (C). At begin and after 4 weeks peak oxygen consumption was measured by cardiopulmonary exercise testing. the reactive hyperemia index (RHI) was determined as a measure of peripheral endothelial function by EndoPAT2000 (ITAMAR Inc., Israel). Average peak flow velocity (APV) in response to acetylcholine (endothelium-dependent vasodilation) was determined invasively using a Doppler wire in the coronary circulation. the x-fold increase in APV in response to adenosine (microcirculatory function) was reported as coronary flow reserve (CFR). the number of circulating CD34/KDR+ endothelial progenitor cells (EPC) was quantified by FACS and the functional properties of EPC were assessed using migration and matrigel assay.
Results: ET improved peak oxygen consumption (begin 20,8±0,9 ml/min/kg; 4 weeks 24,0±1,1 ml/min/kg; p>0,05) and was associated with a reduction in body weight by –1.7±0.3 kg, in BMI by –0.6±0.1 kg/·, in waist circumference by –2.8±0.4 cm and a normalization of glucose tolerance (2h glucose tolerance test level at begin 9.0±0.3 mmol/l; at 4 weeks 6.7±0.4 mmol/l, p>0.05). ET induced an improvement of RHI (begin 1,29±,06; 4 weeks 1,58±,0,09; p>0,05) and an increase in acetylcholine-mediated coronary APV (begin 42,7±3,8 cm/s; 4 weeks 55,3±5,1 cm/s; p>0,05). CFR improved significantly in the training group (begin 2,7±0,2; 4 weeks 3,5±0,3; p>0.05). ET increased the number of EPC by +218±53% (p>0.05 vs. C). Migratory capacity of EPC was augmented by +303±45% (p>0.05 vs. C) and their ability to integrate into endothelial networks increased by +74±16% after ET (p>0.05 vs. C).
Conclusion: In obese patients with CHD and impaired glucose tolerance, ET leads to an improvement in peak oxygen consumption, a reduction in body weight and a normalization of glucose tolerance. this is associated with an improvement of peripheral and coronary endothelial function, partially as a result of an augmented regenerative capacity. the ongoing analysis will link these findings to adipokine expression levels in fat tissue.
P226
Impact of combined exercise training on quality of life and exercise tolerance in patients with diabetes mellitus and stable coronary artery disease
H Svacinova, J Pochmonova, J Jancik, J Siegelova, P Dobsak
Department of Functional Diagnostic and Rehabilitation, St. Anna Faculty Hospital, Masaryk University, Brno, Czech Republic
Topic: Cardiovascular rehabilitation
Purpose: this study evaluated the impact of three-month combined (aerobic + resistance) training programme on health-related quality of life (QL) and exercise tolerance (ET) in patients with diabetes mellitus type 2 (DMT2) and stable coronary artery disease (CAD) compared to non-diabetic patients.
Methods: In total, 72 patients (men) with stable CAD were studied in two groups: 28 men with DMT2 [DM, age 66 ± 6 years, left ventricle ejection fraction (LVEF) 46,5 ± 9%)] and 44 men without DMT2 (NDM, age 64 ± 9 years, LVEF 46,6 ± 8%). Spiroergometry was performed before and after rehabilitation programme for determination of exercise tolerance [peak workload (Wpeak, Wpeak.kg-1), peak oxygen uptake (VO2peak, VO2peak.kg-1), METpeak, peak rate-pressure product (RPP peak)] in both groups. the health- related QL was assessed using the Seattle Angina Questionnaire (SAQ) before and after training programme. We evaluated five dimensions of SAQ: SAQ 1- physical limitation; SAQ 2 – symptom stability; SAQ 3- symptom frequency; SAQ 4 – treatment satisfaction; SAQ 5 – disease perception.
Results: the values of ET Wpeak.kg-1, VO2peak.kg-1, METpeak increased significantly in DM group [from 1,2 ± 0,3 to 1,3 ± 0,5 w.kg-1, from 18,1 ± 3,8 to 20,2 ± 5,6 ml/min., from 5,1 ± 1,0 to 5,8 ± 1,6 (p>0,05)] as well as in NDM group [from 1,2 ± 0,4 to 1,4 ± 0,4 w.kg-1, (p>0,01); from 19,3 ± 3,7 to 20,9 ± 6,6 ml.min.kg-1, from 5,6 ± 1,0 to 6,0 ± 1,6 (p>0,05)]. RPPpeak, significantly changed neither in DM nor in NDM. After training programme in diabetic patients all dimensions of SAQ (excepting SAQ 4) improved significantly (SAQ1 from 67 ± 25 to 73 ± 24, p>0,05; SAQ 2 from 72 ± 28 to 79 ± 21, p>0,05; SAQ 3 from 72 ± 20 to 83 ± 18, p>0,01; SAQ 4 from 85 ± 18 to 89 ± 14, p>0,05; SAQ 5 from 58 ± 19 to 70 ± 20, p>0,01). In NDM the significant improvement included all dimensions: SAQ 1 from 73 ± 22 to 79 ± 19, SAQ 2 from 72 ± 20 to 80 ± 20, SAQ 3 from 75 ± 22 to 81 ± 19, SAQ 4 from 85 ± 15 to 90 ± 11, SAQ 5 from 55 ± 20 to 67 ± 20, p>0,01.
Conclusions: Our results show a significant enhancement of exercise tolerance in diabetic patients with stable CAD after 3-months of combined exercise training that is comparable with the enhancement in non-diabetic patients. Furthermore, the exercise programme provided the significant improvement in quality of life in both groups, although in less extent in diabetic patients.
P228
Effect of an exercise training program on markers of inflammation and endothelial cell activation in patients with coronary artery disease following percutaneous coronary intervention
PS Munk1, UM Breland2, PAL Aukrust2, thOR Ueland2, JT Kvaloy3, AI Larsen1
1Stavanger University Hospital & Institute of Medicine, University of Bergen, Stavanger, Norway, 2Rikshospitalet University Hospitalet, University of Oslo, Oslo, Norway, 3University of Stavanger, Department of Mathematics and Natural Sciences, Stavanger, Norway
Topic: Cardiovascular rehabilitation
Background: Increased plasma levels of inflammatory markers and markers of endothelial cell activation have been associated with increased risk for cardiovascular events. Exercise training may lower the risk for coronary heart disease by attenuating inflammation and improving endothelial function. the objective of this study was to evaluate effects of regular high-intensity exercise training on a wide range of markers of inflammation and endothelial cell activation.
Methods: Consecutively, 40 patients were prospectively randomized to a 6 months supervised high- intensity interval training program or to a control group following successful PCI for angina pectoris. Blood samples were drawn at baseline and after 1 and 6 months of training.
Results: Compared with the changes in the control group, training induced a significant decrease in plasma levels of interleukin-8 (IL-8) and a significant increase in plasma levels of vascular cell adhesion molecule 1 (VCAM-1). Except for these changes, there were no significant differences in changes between the two study groups.
Conclusions: Regular exercise training in CAD patients following PCI was not associated with a general attenuation of inflammation, with only minor effects on a wide range of inflammatory markers and an increase in VCAM-1 and a decrease in IL-8 as the significant findings.
P229
Effect of the long term physical activity practice after cardiac rehabilitation program on arterial compliance, physical capacity and weight
C Freyssin1, P Blanc1, C Verkindt2, S Maunier1, S Chopra1, F Prieur3
1Centre de reeducation Cardiovasculaire, Sainte Clotilde, Reunion, France, 2CURAPS DIMPS (EA4075), Universite de la Reunion, Le tampon, France, 3UArtois, EA3608, France
Topic: Cardiovascular rehabilitation
Aim: Previous studies have demonstrated that rehabilitation programs were able to improve markers and risk factors in cardiac patients. In the present study we have assessed the influence of physical activity practised after a center-based cardiac rehabilitation program on arterial compliance, physical capacity and weight for patients with cardiovascular diseases.
Methods: Forty two patients (mean age 56.5 ± 10 years, 35 men and 7 women) were included in the study. the Dijon physical activity score was employed to determine the physical activity of patients. Two groups were identified: 20 sedentary patients (Dijon score 9.5 ± 1.4) and 22 active patients (Dijon score 22.3 ± 2.3).
Small artery elasticity indices (in ml/mmHg x 10) were measured using the HDI/Pulse Wave TM CR-2000 tonometer and the physical capacity was determined with the 6-minutes walk test (6MWT) at the end of the rehabilitation program (initial state) and 18.3 ± 5.3 months after it (final state).
Results: After the 18.3 months-period, sedentary patients had a significant decrease in arterial compliance (from 4.5 ± 2.2 to 2.7 ± 0.9; P < 0.01) and a significant reduction in distance at the 6MWT (from 493 ± 102 m to 428 ± 119 m; P < 0.01). the weight was also slightly increased but statistically insignificant (from 74.9 ± 15.3 kg to 76.7 ± 15.9 kg; P = 0.05).
Active patients had no significant evolution in arterial compliance (from 4.7 ± 2.1 to 4.6 ± 2.5), in distance at the 6MWT (from 545.6 ± 74.6 m to 558.1 ± 60.2 m) and in weight (from 75.0 ± 10.4 kg to 74.6 ± 10.9 kg).
Conclusion: After cardiac rehabilitation program, the sedentary lifestyle has a negative influence on arterial compliance, physical capacity and weight, which are major markers and risk factors. In contrast, the practice of a physical activity after rehabilitation program maintains benefits acquired during this phase.
P230
Safety of early exercise stress testing in patients after PCI and coronary bypass grafting surgery: evaluation of coronary patients in a specialized second phaze rehabilitation
D Simonovic1, S Kostic1, D Djordjevic1, M Rihter1, V Mitic1, M Lovic1, D Vulic1, I Tasic1
1Institute for therapy & Rehabilitation, Niska Banja, Serbia, 2University of Banja, Luka School of Medicine, Banja Luka, Bosnia and Herzegovina
Topic: Cardiovascular rehabilitation
Background: there are some data of isolated cases of acute ischemic events linked to early exercise stress testing after coronary stenting or coronary bypass grafting surgery (CBGS) and questioning the safety of normal physical activity after the coronary procedures.
Methods: We studied 252 patients with coronary artery disease (CAD) who underwent complete revascularization by coronary bypass grafting surgery (141 patients, 61±10 years, 103 men) and PCI with coronary stent implantation (111 patients, 57±10 years, 73 men). 82 patients (73.8%) received =1 BMS, 24 (21.6%) received =1 DES and 5 (4.6%) patients received BMS and DES stents. the two groups were comparable as to age, gender, cardiovascular risk factors. Severity of CAD (2.2±0.7) vessels treated in CBGS group was higher than in PCI group (1.4±0.6). EST was performed 1 month after PCI or coronary bypass grafting surgery. the end points of the study was the incidence of unstable angina, myocardial infarction, death, and repeat cardiac procedures (repeat PCI, coronary artery bypass grafting) during the study period at 21 days.
Results: there were 29 (11.5%) positive EST (=1 mm ST segment depression) in both groups, 18 (7.2%) in CBGS group compared to 11 (4.3%) in PCI group (ns). Diabetic patients (66 patients in both groups) had a significant higher rate of positive EST than non-diabetic (12 test positive, 18.2%, p=0.048). Patients with DES plus BMS had a highest rate of positive EST compared to those with BMS (40% vs 7.3%, p=0.02). 16 patient in PCI group were without Clopidogrel with Aspirin and had 4 positive EST (25%); and 2 patients in the same group were without antiaggregation therapy (1 test positive, 50%). During follow-up there were no myocardial infarction, death, and repeat cardiac procedures.
Conclusions: Exercise stress testing 1 month after coronary stenting and coronary bypass grafting surgery did not increase the risk of repeat cardiac procedures, myocardial infarction and death during the study period at 21 days.
P231
Post cardiac surgery diabetic patients: aerobic training and insulin sensitivity improvement
A Di Patria1, AL Lerro2
1Casa di Cura, Castelmorrone, Italy, 2Cardiologic Unit Pinetagrande, Castevolturno, Italy
Topic: Cardiovascular rehabilitation
Acknowledgments: Insulin resistance, is a common landmark of type II diabetes mellitus, obesity, hypertrygliceridemia, arterial hypertension and the metabolic syndrome patients. the Insulin Resistance and Atherosclerosis Study, IRAS, had already evaluated the relationship between physical excercise intensity and insulin sensitivity demonstrating that those individuals who did not participate on any physical activities, showed a marked improvement on insulin sensitivity when submitted to 3–4 weekly hours of varying degree of physical activity (such as dancing, walking, bicycle).
Purpose: Evaluate if 6 weeks of an aerobic training program based on treadmill and/or bicycle training coupled with 4 consecutive weeks of kalistenic gymnastics with a progressive time lenghtening of up to 40 minutes, improves insulin resistance on diabetic patients admitted in our Rehabilitative Cardiovascular Sub-Intensive Unit in the 6–7 day of post cardiac surgery.
Methods: 466 diabetic patients, 242 males (52%) e 224 females (40%), were subjected to serial glicemic controls before breakfast, before lunch and supper, two hours after lunch and supper through the use of Glucocard Memory PC-Menarini, in the first five and in the last three days of recovery. Moreover, at admission and dimission, total cholesterol, HDL and LDL cholesterol, triglicerides, and glycosylated hemoglobin values, insulin and oral hipoglicemic dosages were reported.
Conclusions: In our experience, independently of weight loss, physical activity immediately after cardiac surgery, even if not particularly intense, improves insulin sensitivity, and represents a key moment in the correction of cardiac risk factors.
Results
Admission
dimission
T Student
Admission
dimission
T Student
Fasting
181 mg/dl
104 mg/dl
P=0,0001
HDL-Choles-
38
54
P=0,0001
Glicemia
terolmg/dl
Pre-lunch
186 mg/dl
122 mg/dl
P=0,0001
LDL-
154
98
P=0,0001
Cholester
glicemia
mg/dl
Post-lunch
244 mg/dl
191 mg/dl
P=0,0001
Triglicerides
184
143
P=0,0001
glicemia
mg/dl
Pre-supper
209 mg/dl
141 mg/dl
P=0,0001
HbA1c mg/dl
11 |
8
P=0,0001
glicemia
Post-supper
217 mg/dl
148 mg/dl
P=0,0001
Insulina
40
28
P=0,0001
glicemia
Total
220 mg/dl
176 mg/dl
P=0,0001
P=0,0001
Cholesterol
P232
Exercise training improves rapid and shallow ventilatory pattern in patients with heart disease
T Sasaki, H Adachi, J Murakami, H Hoshizaki, S Oshima
Gunma Prefectural Cardiovascular Center, Maebashi, Japan
Topic: Cardiovascular rehabilitation
Purpose: it is well known that heart disease patients tend to breathe rapidly and shallowly. We have reported that rapid and shallow breathing correlate with impairment of exercise tolerance. therefore, exercise training is assumed to improve this abnormal breathing pattern. However, it is not precisely investigated whether exercise training improves abnormal ventilatory pattern in heart disease patients yet. We hereby planned to investigate the effect of exercise training on rapid and shallow ventilatory pattern.
Methods: Consecutive 66 heart disease subjects who had participated in cardiac rehabilitation program were enrolled. they underwent cardiopulmonary exercise testing before and after the program. Rapidness and shallowness of patient's ventilation was determined using a graph of tidal volume (TV) as a function of respiratory rate (RR) during a ramp exercise. A steepness of TV vs. RR slope until inflection point was calculated using a linear regression analysis (TV/RR slope). A TV at a plateau after an inflection point was regarded as a shallowness of breathing. Results: After completion of exercise training period, anaerobic threshold, peak VO2 and VE vs. VCO2 slope were all improved. TV/RR slope was also significantly augmented from 119.1±92.5 to 183.2±257.9(P>0.01). As well, TV at plateau was increased significantly from 1348.2±346.9 to 1558.6±422.7(P>0.01).
Conclusion: Exercise training is revealed to improves abnormal ventilatory pattern in patients with heart disease.
P233
Improvement of exercise tolerance is partly modified by amelioration of cardiac diastolic dysfunction in patients with heart disease
M Murata, H Adachi, J Murakami, H Hoshizaki, S Oshima
Gunma Prefectural Cardiovascular Center, Maebashi, Japan
Topic: Cardiovascular rehabilitation
Background and Purpose: Although it is well documented that exercise tolerance is regulated by many factors including skeletal muscle function, cardiac function and others. However, how much the improvement of cardiac function affects on improvement of exercise tolerance is not precisely studied yet. We hereby investigated whether cardiac functional improvement affects on amelioration of exercise tolerance in heart disease patients.
Methods: Consecutive sixty six heart disease patients who participated in our cardiac rehabilitation program (CRP) from January 2007 to March 2008 were enrolled. At the beginning of program and 5 months later, echocardiogram and cardiopulmonary exercise testing were performed. Patients were divided into two groups according to the E/E value (Group A; E/E ?11, n=18, Group B>11, n=48).
Result: Peak VO2 was improved from 18.1 to 21.1 ml/min/kg (p>0.01) by CPR. E/E showed no change before and after CRP in Group B, meanwhile, in Group A, it improved significant negative correlation (r=-0.49).
Conclusion: Cardiac rehabilitation program improved diastolic cardiac dysfunction in patients with severely impaired diastolic function. Improvement of diastolic function correlated with improvement of exercise tolerance only in these subjects. It is revealed that improvement of exercise tolerance is partly modified by amelioration of cardiac diastolic dysfunction in patients with severely impaired diastolic function.
P234
the physical exercise improves the autonomic modulation in hypertensive patients independently of the treatment with angiontensin-converting enzyme inhibitor
H C Hugo CelsoDutra De Souza, IC Cozza, thR Di Sacco, ACP Rocha, MCO Salgado
University of Sao Paulo, Ribeirao Preto, Brazil
Topic: Cardiovascular rehabilitation
Purpose: We have investigated and compared the influence of treatment with angiontensin-converting enzyme inhibitor (Enalapril) and physical exercise on both arterial pressure and heart rate variability (HRV) in hypertensive volunteers.
Methods: thirty-three sedentary volunteers were divided into three groups: normotensive (NT Group), hypertensive (HT Group), and hypertensive volunteers treated with angiontensin-converting enzyme inhibitor (ACEi Group). All volunteers were submitted to an aerobic physical training protocol during 12 weeks. HRV was investigated by means of spectral analysis of time series of R-R intervals (RRi) obtained in supine position and during tilt test.
Results: Physical training promoted significant reduction in the mean arterial pressure of HT Group (113± 3 vs. 106± 1 mmHg) and ACEi Group (104± 2 vs. 98± 2 mmHg). Spectral analysis of RRi during supine position before the physical training protocol showed that HT Group, when compared to other groups, had increase of low frequency (LF; 0.04 0.15 Hz) in both absolute and normalised units as well as decrease of high frequency (HF; 0.15 0.5 Hz) in normalised units. HT Group also had the lowest responses to tilt test during LF oscillations in normalised units. In turn, physical training improved autonomic modulation of heart rate in the supine position only in HT Group. With regard to tilt test, physical training promoted similar increases in the autonomic modulation responses in all groups studied.
Conclusions: Our findings show that aerobic physical training improves cardiac autonomic modulation in hypertensive volunteers, independently of the treatment with angiontensin-converting enzyme inhibitor.
P235
Cardiopulmonary exercise testing vs standard exercise testing to estimate the actual changes in functional capacity after cardiac rehabilitation in male and female patients
A Stuto, E Cosentino, A Ambu, G Bottaro, F Raineri, A Lo Giudice, B Armaro, G Basile
STAR FOR LIFE Cardiac Rehabilitation Centre, Siracusa, Italy
Topic: Cardiovascular rehabilitation
Purpose: the aims of this study were: 1) to assess the inaccuracy of the standard exercise testing (ET) in the estimation of the functional capacity (VO2max) from the work rate achieved on a cycle ergo meter and 2) to sustain the importance of the CPET as a routine part of the cardiac rehabilitation (CR).
Methods: From January 2008 to April 2009 two hundred thirty eight coronary patients, 191 male, mean age 65.5+/–8.9 yrs, and 47 female, mean age 62.2 +/– 10.5, referred to physician-supervised outpatient CR were enrolled for this study. All pts performed a cardiopulmonary exercise testing (CPET) before and after a 12 weeks CR program consisting in thrice weekly training sessions. the peak work load (PWL), and the peak oxygen uptake (VO2peak) measured during CPET were compared at baseline and after CR program.
Results: Based on the comparative changes in VO2peak and PWL after CR the pts were divided in nine groups (Table 1):
the VO2peak and PWL were both increased in group 1, unchanged in group 5, and decreased in group 9, but in the other six groups the VO2 peak and the PWL changes were discordant. Conclusions: after cardiac rehabilitation the changes in functional capacity were consistently witnessed by both tests, respectively ET (PWL) and CPET (PWL+VO2peak), in about fifty seven percent of the pts. However in the residual forty three per cent of the patients, without the CPET, we could miss to detect any evidence of the actual changes in functional capacity. In these pts the CPET will be irreplaceable to avoid misleading endings on prognostic evaluation and the exercise prescription for the everyday life after completion of the CR program.
Group
VO2 peak after CR
PWL after CR
Male
Female
1
+
+
100/191 (52.3%)
23/47 (48.9%)
2
+
=
17/191 (8.9%)
6/47 (12.8%)
3
+
-
8/191 (4.2%)
1/47 (2.1)
4
=
+
7/191 (3.7%)
4/47 (8.5%)
5
=
=
4/191 (2.1%)
2/47 (4.2%)
6
=
-
1/191 (0.5%)
1/47 (2.1%)
7
-
+
29/191 (15.2%)
5/47 (10.6%)
8
-
=
20/191 (10.5%)
3/47 (6.4%)
9
-
-
5/191 (2.6%)
2/47 (4.2%
+ (increased), = (unchanged), – (decreased).
P236
Effects of short-term aerobic exercise training on endothelial factors and arterial stiffness in cardiac patients
AT Spassis1, CE Zois1, SP Tokmakidis1, DA Stakos2, KA Volaklis1, ET Douda1, GI Bougioukas3
1Department of Physical Education & Sport Science, KOMOTINI, Greece, 2Department of Cardiology, Medical School, Alexandroupolis, Greece, 3Department of thoracic/Cardiac Surgery, University Hospital, Alexandroupolis, Greece
Topic: Cardiovascular rehabilitation
Introduction: Aerobic training enhances endothelial functions in patients with cardiovascular disease and healthy individuals. Vascular endothelium-derived factors, such as endothelin-1 (ET-1) and adhesion molecules (sVCAM-1 & sICAM-1) play an important role in the preservation of vascular tonus. In addition, arterial stiffness precedes atherosclerosis and is an independent predictor of cardiovascular events.
Purpose: the aim of the present study was to assess the alterations of vasoconstrictive, adhesion molecules and arterial stiffness after an 8-week period of aerobic training in patients after coronary artery bypass grafting (CABG).
Methods: We studied eight CABG patients (n=8; mean age: 59.3±5.3yrs; affected coronary vessels No 2/3, n=3/5) using an eight-week regimen consistimg of three 1-h sessions each week. All patients trained by walking, cycling and rowing ergometers at 50–85% of peak HR. Blood samples were obtained after overnight fasting, between 8–10 am, while the plasma was stored at –80oC until assayed (ELISA Kit). No vigorous exercise training took place a day before blood sampling. the vascular function, using the arterial elastic stiffness properties, was assessed at 11:00 a.m., 4 h after usual medications and after fasting and abstaining from alcohol or caffeinated beverages for 12 h. Pulse pressure (PP) and the augmentation index (AI) were calculated at rest using applanation tonometry with SphygmoCor software (AtCor Medical, Sydney, Australia). Eight (n=8) patients served as a control group.
Results: We observed a consistent decrease of aortic AI (34.5±12.2 to 28.1±8.6%, p>0.05) central PP (46.5±7.9 to 40.9±6.7, p>0.05) after the exercise program. Plasma ET-1 decreased after the intervention (0.76±0.3 to 0.61±0.2 pg/ml, p>0.05), while the plasma sICAM-1 decreased (800.2±114.7 to 631.5±120.1 ng/ml p>0.001). Furthermore, the sVCAM-1 did not show any significant differences after exercise. Significant negative differences (ET-1: 0.78±0.2 to 1.15±0.3 pg/ml, p>0.05) were observed in the control group.
Conclusions: Aerobic exercise training may decrease ET-1 production and substantially reduce inflammatory markers without stiffening central arteries in patients with CABG. these alterations, occurring after a short-term training program, are involved in exercise-induced vascular protection.
P237
Functional capacity and muscle mechanical work and efficiency changes after cardiac rehabilitation in diabetic vs non diabetic patients
A Stuto, E Cosentino, A Ambu, G Bottaro, F Raineri, A Lo Giudice, B Armaro, G Basile
STAR FOR LIFE Cardiac Rehabilitation Centre, Siracusa, Italy
Topic: Cardiovascular rehabilitation
Purpose: Traditionally, muscle mechanical efficiency has been expressed as the ratio of muscle work to metabolic energy expenditure. the aims of this study were to determine if there exists any difference in functional capacity and muscle mechanical work and efficiency changes after cardiac rehabilitation between diabetic and non diabetic coronary patients.
Methods: from January 2008 to May 2009 one hundred ninety male coronary patients (pts), 72 with diabetes mellitus (DM), mean age 66.5+/–6.5 years (group A), and 118 without DM, mean age 65.05+/–9.6 years (group B), referred to physician-supervised outpatient cardiac rehabilitation (CR) were enrolled for this study. All pts performed a cardiopulmonary exercise testing (CPET) before and after a 12 weeks CR program consisting in thrice weekly training sessions. the peak work load (PWL) and the peak oxygen uptake (peak VO2) measured during CPET at the peak of exercise, and Works efficiency (WE), resulting from the ratio between PWL and peak VO2, were compared at baseline and after CR program using the Primer software for statistical analysis.
Results: From the analysis of the data collected the results, expressed as mean +/– SD, SEM, confidence interval of difference to 95%, and P value, are shoved in tables 1.
Conclusions: From the above results we can conclude that after cardiac rehabilitation there were significant improvement in functional capacity (peak VO2 and PWL) in both groups independently from the presence of diabetes mellitus, but the Works efficiency improved significantly only in non diabetic coronary patients, whereas remained nearly unchanged in diabetic coronary patients.
for the abbreviations see the text
Group
peak VO2 before-after CR
CI to 95%
P value
A
18.43+/–5.527(SEM 0.6514) vs
–3.868 to –0.2376
P=0.027
20.48+/−5.493(SEM0.6474)
B
19.77+/−5.537(SEM 0.5097) vs
–3.602 to –0.5985
P=0.006
21.87+/–6.155(SEM 0.5666)
PWL before-after CR
A
103.3+/–25 (SEM 2.946) vs
–15.69 to –8.171
P=0.000
115.2+/–27.95 (SEM 3.294)
B
107.3+/–32.25 (SEM 2.969) vs
–20.07 to –18.22
P=0.000
122.9+/–37.54 (SEM3.455)
WE (PWL/peak VO2) before-after CR
A
6+/–2.25 (SEM 0.2652) vs
–0.5956 to 0.6478
P=0.934
5.974+/–1.434 (SEM 0.1691)
B
5.579+/–1.536(SEM 0.1414) vs
–0.7466 to –0.004618
P=0.047
5.955+/–1.351(SEM 0.1244)
P238
Do all cardiac rehabilitation patients follow the same physical activity patterns over a 24-month period and do motivational trajectories concur?
SN Sweet1, H Tulloch2, MS Fortier1, R Reid2
1University of Ottawa, Ottawa, Canada, 2University of Ottawa Heart Institute, Ottawa, Canada
Topic: Cardiovascular rehabilitation
Purpose: Few studies have explored long-term physical activity patterns in patients enrolled in cardiac rehabilitation and especially the motivational variables related to these patterns. therefore, the purpose of this study was to explore if differential patterns of physical activity exists in cardiac rehabilitation patients over a 24-month period. A second objective was to examine if multiple trajectories of motivational constructs also emerged in these patients. third, we investigated the relationships between the patterns of physical activity and the core motivational concepts from two theoretical frameworks – self-efficacy theory and self-determination theory.
Methods: Cardiac rehabilitation patients (n=251) completed the Godin Leisure Time Exercise Questionnaire at baseline (i.e., at hospital discharge), 6, 12 and 24 months. Barrier self-efficacy and outcome expectations were assessed at baseline, 2 and 6 months. Self-determined and non self-determined motivation were measured at 2, 6 and 12 months. Latent class growth modeling was used to statistically and objectively classify patients in different physical activity and motivational patterns and assess the relationship between these patterns.
Results: three physical activity patterns emerged: low quadratic (increase then decrease); moderate quadratic (increase then decrease); and linear increaser (55%; 38% and 7% of the sample per pattern, respectively). Multiple trajectories were found for barrier self-efficacy, outcome expectations, self-determined and non-self-determined motivation (3, 5, 4 and 4, respectively). Separate analyses showed that patients in high barrier self-efficacy group, high outcome expectation group, and high self-determined group had greater probability of being in the moderate and increaser physical activity groups compared to those who decreased or maintained low levels on these motivational constructs. Patients in the moderate and stable groups of non-self-determined motivation had a greater probability of transitioning to the low physical activity group over time.
Conclusions: Cardiac patients that participate in cardiac rehabilitation do not follow the same physical activity patterns over a 24-month period. All motivational variables influenced the probability of being classified into a specific physical activity pattern. Being able to identify a patient's motivational profile, soon after hospitalization, could help cardiac rehabilitation programs tailor their intervention to optimize patient potential for continued physical activity participation.
P239
Effect of long-term cardiactraining on erectile dysfunctions in patients with ischemic heart disease
M Sobieszczanska1, D Kalka1, W Pilecki2, W Marciniak3, A Popielewicz- Kautz4, T Szawrowicz-Pelka2, M Mical-Strak2, J Adamus3
1Division of Cardiovascular Disease Prevention, Wroclaw Medical University, Wroclaw, Poland, 2Department of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland, 3Cardiology Department, Ostrobramska Medical Center, Magodent, Warszawa, Poland, 4Department of Cardiac Rehabilitation, Promedis, Lux Med Group, Wroclaw, Poland
Topic: Cardiovascular rehabilitation
Regular cardiac training modifies positively a function of vascular endothelium. However, all the beneficial effects are dependent on the continuity of the training. A purpose of the study was to assess a long-standing effect of the cardiac rehabilitation program on the erection quality. the study group comprised 93 men (mean age: 63.46±7.98 years) with IHD and erectile dysfunction (ED). All the men had the IIEF-5 questionnaire score less than 21. the questionnaire was fulfilled three times (0–6–12. month of the following-up). the patients were in long-term sexual relation with the same partner. All the examined men were subjected to the six-month cardiac rehabilitation, after which they were divided to the two subgroups: A (38 men) who were continuing the supervised cardiac training, and B (55 men) who quit the rehabilitation because of their coming back to the work. On the base of the IIEF-5 scores, in the group A, there was found a significant decrease of ED (9.58±5.7 vs 11.32±6.5; p>0.01) after the 6 months of rehabilitation and non significant decrease of ED (11.32±6.5 vs 11.5±6.43; NS) after the further 6 months of cardiac training. In the group B, the 6-month rehabilitation caused also significant decrease of ED (12.98±5.68 vs 15.09±6.59; p>0.01) and, interestingly, after the next 6 months without a cardiac training, there was observed a significant increase in ED (15.09±6.59 vs 13,36±5.7; p>0,01).
Conclusion: Long-term supervised cardiac rehabilitation improves an erection quality in patients with IHD, and systematic training enables to maintain the beneficial effects.
P240
Circulating anti-inflammatory and inflammatory markers following resistance exercise in patients with coronary artery disease
SP Tokmakidis, KA Volaklis, AT Spassis, CE Zois, IG Smilios, HT Douda
Department of Physical Education & Sport Science, Komotini, Greece
Topic: Cardiovascular rehabilitation
Introduction: the response of high sensitivity-C Reactive Protein (hs-CRP), Interleukin-10 (IL-10) and Transforming Growth Factor beta1 (TGF-β1) has not been studied during resistance exercise in patients with coronary artery disease (CAD). the above markers are involved in the pathogenesis of atherosclerosis and modulate vascular tone. In addition, the intensity of resistance exercise may affect the physiological reaction of inflammatory and anti-inflammatory markers and provide evidence for the effectiveness (dose-response) of resistance training (RT).
Purpose: the aim of this study was to evaluate the levels of anti- & inflammatory markers during RT using two different intensities (low & high) at the same work volume in patients with CAD.
Methods: Eight men (x±SD, age:49.8±10.7yr, weight:85.8±11.1kg) with stable, documented CAD participated in the study. the level of markers was evaluated during two different RT protocols of six exercise stations (low intensity: 2x18 repetitions at 50% and high intensity: 3x8 repetitions at 75% of the 1-RM) with a 90sec rest interval between sets. Work volume was identical in low- & high-level RT. Blood samples were obtained after overnight fasting, between 8–10 am, while plasma & serum was stored at –80oC until assayed (ELISA Kit). No vigorous exercise training took place a day before blood sampling. Differences in the variables between measurements (before exercise, immediately after, 60min after & 24 hours after exercise session) and conditions were assessed by a two-way ANOVA for repeated measures.
Results: Plasma TGF-β1 (75%, 8 reps) increased from 5670.1 pg/ml to 7910.3 pg/ml immediately after (+40%, p>0.05) and remained at high levels 60 min & 24 hours after resistance exercise session. the low intensity protocol (50%, 18 reps) produced higher TGF-β1 levels (p>0.05), and did not differ between trials (p>0.05). In addition, serum hs-CRP concentration presented no significant change after the use of two different intensities between trials. Concentrations of IL-10 were higher 60 min after (5.3±2.4 pg/ml; p>0.05) for the high intensity protocol. the higher levels of anti-inflammatory cytokines, for the low intensity protocol, were observed (5.5±0.9 pg/ml; p>0.05) 24 hours after exercise.
Conclusions: Resistance exercise increases the concentration of anti-inflammatory cytokines IL-10 & TGF-β1 irrespective of exercise intensity. these responses may contribute to a better regulation of the immune response in patients with CAD.
P241
Plurimetabolic syndrome and intensive cardiac rehabilitation unit
A Di Patria1, 2 Lerro2
1Casa di Cura, Castelmorrone, Italy, 2Cardiologic Unit Pinetagrande, Castevolturno, Italy
Topic: Cardiovascular rehabilitation
Acknowledgements: the NCEP-ATPIII has identified a clinical situation called plurimetabolic syndrome caracterized by a particularly high risk for coronaric events. It is defined by the presence of at least three of the following conditions:hypertrigliceridemia, low HDL cholesterol, fasting hyperglicemia, abdominal circumference > 102 cm in men and 88 > cm in women, blood pressure =130/=85 mmHg, to which one can associate coagulation abnormalities, hyperuricemia, and high levels of PCR.
Methods: we first examined at recovery and dimission a population of 648 patients, 466 being males and 182 females, with a mean age of 65 years old, admitted in our sub-intensive cardiac rehabilitation unit post cardiac surgery. Secondarily, we calculated the percentage that presented the plurimetabolic syndrome; and the global cardiac risk through the Framingham equation of a computerized program that uses: age, sex, blood pressure, diabetes, total cholesterol, ventricular hypertrophy, HDL cholesterol, and smoking, and finally evaluated the variation in risk between the patients with and without plurimetabolic syndrome before and after the correction of the risk factors during their time of recovery.
Results: 61%(369) of the examined patients suffered from hypertension with mean values of 150/95 mmHg, 46% (301) diabetes with values 170mg/dl ±20, dyslipidemia with 30% (199) hypertrigliceridemia with mean values of 184 mg/dl ±15, and 56% (367) hypercholesterolemia with mean values of 263 mg/dl ±20 and 20% (134) mixed; low levels of HDL cholesterol in 43% (281) with mean values of 26 mg/dl ± 6; and 39% (257) of elevated abdominal circumference. Moreover, 130 patients out of 648 (20%) presented plurimetabolic syndrome with a global cardiac risk >40% (57–40%). At dimission, with the reduction of several parameters in respect to those at admission such as blood pressure (mean values of 110/70 mmHg), fasting hypoglicemia (mean values of 95 mg/dl ±10), serum triglicerides (mean values of 124 mg/dl ±15), serum cholesterol (mean values of 158 mg/dl ±20), and rise in HDL cholesterol (mean values of 38 mg/dl ± 6), a significative global cardiac risk reduction was achieved with risk values of 4% >40%, 72% between 10–20%, 24% between 5–10%.
Conclusions: Cardiologic rehabilitation after cardiac surgery, represents a crucial moment to diagnose patients with plurimetabolic syndrome. A physical and educational training program, along with therapeutic correction over the lipid and glucose metabolism and over systemic blood pressure, allows a precocious modification over those factors susceptible to significative variation.
