The importance of combined rehabilitation programme in patients with chronic ischaemic heart disease


Authors: L. Elbl 1;  V. Chaloupka 1;  S. Nehyba 1;  I. Tomášková 1;  P. Kala 2;  J. Schildberger 2;  M. Poloczek 2;  O. Boček 2;  R. Lábrová 2;  M. Šišáková 2;  J. Špinar 2
Authors‘ workplace: Oddělení funkčního vyšetřování FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Václav Chaloupka, CSc. 1;  Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC 2
Published in: Vnitř Lék 2005; 51(9): 957-964
Category: Original Contributions

Overview

Research objective:
Research objective was to assess, if controlled rehabilitation programme can influence an extent of stressinduced myocardial ischaemia, clinical status and prognosis of patients with chronic ischaemic heart disease with significant coronary stenosis on 1 or more arteries and with manifestations of myocardial ischaemia, which was indicated to conservative treatment.

Patients’ population:
69 patients with chronic ischaemic heart disease (IHD) (14 women/55 men) in the age of 62 ± 8 (62) years were enrolled in the study. In 23 patients 8-week ambulatory controlled rehabilitation programme (RHB) with aerobic exercise to 60–80 % pVO2, which was completed with power training, was performed. 46 patients constituted the control group. Patients were examined by means of rest and stress echocardiography, spiroergometry, short-term RR interval variability measurements were performed (HRV) as admission tests, following rehabilitation and after one year.

Results:
Rehabilitation programme significantly increased stress tolerance (p < 0.004), pVO2 (p < 0.04) and MET (p < 0.05). Significant changes persist even after one year. Further it slightly influenced values of rest (p < 0.05) and stress ejection fraction (p < 0.01). Values of left ventricular wall motion index (LVWMI) in rest were unchanged, stress values reflecting the extent of induced ischaemia were improved only after one year elapsed (p < 0.05). These findings are accompanied with changes of HRV indicators reflecting vagus branch activity. In the control group there was no improvement of capacity indicators, ejection fraction, stress LVWMI were actually significantly worse (p < 0.05) during one-year control. Autonomous nervous system (ANS) activity was unchanged. During one-year control it was found that 91 % patients following RHB programme devoted themselves to occasional or regular physical activity in further period of time. This finding is statistically significant (p < 0.001) compared to the control group. There was significantly more patients with destabilisation of angina pectoris and rehospitalisation (p < 0.001) in the control group, nitrate (p < 0.001) and trimetazidine (p < 0.01) proportions in the treatment were significantly increased.

Conclusion:
Combined aerobic training with power exercise significantly improved stress tolerance, peak oxygen intake and slightly even LV ejection fraction values. Following one-year training there was significant decrease of the extent of stress-induced myocardial ischaemia. These changes are accompanied with the increase of ANS vagus branch tension. Training led to the decrease of patients' symptomatology and to the stabilisation of pharmacotherapy of IHD.

Key words:
rehabilitation – chronic ischaemic heart disease – myocardial ischaemia


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