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

Česká verzia

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 place of work: 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 the journal: Vnitř Lék 2005; 51(9): 957-964
Category: Original Contributions

Summary

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

Zdroje

1. Beraldinelli R, Georgiou D, Ginzton L et al. Effects of moderate exercise training on thalium uptake and contractile response to low-dose dobutamine on dysfunctional myocardium in patients with ischemic cardiomyopathy. Circulation 1998; 97: 553-561.

2. Bigger JT, Fleiss JL, Rolnitzki LM et al. Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol 1993; 21: 729-736.

3. Cohen MV, Yipintsoi T, Scheuer J. Coronary colateral stimulation by exercise in dogs with stenotic coronary arteries. J Appl Physiol 1982; 52: 664-671.

4. European guidelines on CVD prevention. Eur J Cardiovas Prev Rehab 2003; 10: S62-S63.

5. Franklin BA, Swain DP, Shephard R. New insights in the prescription of exercise for coronary patients. J Cardiovasc Nurs 2003; 18: 116-123.

6. Froelicher V, Jensen D, Genter F et al. A randomized trial of exercise training in patients with coronary heart disease. JAMA 1984; 252: 1291-1297.

7. Giannuzzi P, Saner H, Bjornstad H et al. Secondary Prevention Trough Cardiac Rehabilitation. Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. Eur Herat J 2003; 24: 1273-1278.

8. Gielen S, Schuler G, Hambrecht R. Exercise training in coronary artery disease and coronary vasomotion. Circulation 2001; 103: 1-6.

9. Hambrecht R, Adams V, Erbs S et al. Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 2003; 107: 3152-3158.

10. Hambrecht R, Walther C, Mobius-Winkler S et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease. Circulation 2004; 109: 1371-1378.

11. Haskell WL, Alderman EL, Fair JM et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease: the Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994; 89: 975-990.

12. Chaloupka V, Elbl L. Zátěžová echokardiografie. Praha: Maxdorf Jesenius 1997.

13. Chaloupka V, Elbl L, Nehyba S. Silový trénink u nemocných po infarktu myokardu. Vnitř Lék 2000; 46(12): 829-834.

14. Malik M et al. Heart rate variablity. Standards of measurement, physiological interpretation, and clinical use. Task force of The European society of Cardiology and The American Society of Pacing and Electrophysiology. Eur J Cardiol 1996; 17: 354-381.

15. Meluzín J, Jančík J, Siegelová J et al. Vliv tělesného tréninku na velikost ischemické dysfunkce levé komory srdeční u nemocných s chronickou ischemickou chorobou srdeční. Vnitř Lék 2001; 47(2): 87-91.

16. Myers J, Ahnve S, Froelicher V et al. A randomized trial of the effects of 1 year of exercise training on computer-measured ST segment displacement in patients with coronary artery disease. J Am Coll Cardiol 1984; 4: 1094-1102.

17. Nehyba S, Chaloupka V, Elbl L. Rehabilitační péče o nemocné po prodělaném srdečním infarktu. Praktický lékař 1995; 6: 272-273.

18. Niebauer J, Hambrecht R, Marburger C et al. Impact of intensive physical exercise and low-fat diet on collateral vessel formation in stable angina pectoris and angiographically confirmed coronary artery disease. Am J Cardiol 1995; 76: 771-775.

19. Niebauer J, Hambrecht R, Velich T et al. Attenuaed progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96; 2534-2541.

20. Ornish D, Scherwitz LW, Billings JH et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280: 2001-2007.

21. Otto MC. The Practice of Clinical Echocardiography. New York: W.B. Saunders 1997.

22. Prisco D, Francalanci I, Filippini M et al. Physical exercise and hemostasis. Int J Clin Lab Res 1994; 24: 125-131.

23. Reinhart WH, Dziekan G, Goebbels U et al. Influence of exercise training on blood viskosity in patients with coronary artery disease and impaired left ventricular function. Am Heart J 1998; 135: 379-382.

24. Semrád B, Honzíková N, Fišer B. Metody určení rizika náhlé srdeční smrti u nemocných po infarktu myokardu. Cor Vasa 1994; 36: 295-298.

25. Schachinger V, Britten MB, Zeiher A. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000; 101: 1899-1906.

26. Schuler G, Hambrecht R, Schlierf G et al. Myocardial perfusion and regression of coronary artery disease in patients on a regime of intensive physical exercise and low fat diet. J Am Coll Cardiol 1992; 19: 34-42.

27. Špinar J, Vítovec J et al. Ischemická choroba srdeční. Praha: Grada 2003.

28. Suwadi JA, Hamasaki S, Higano ST et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 2000; 101: 948-954.

29. Todd IC, Bradnam MS, Cooke MB et al. Effects of daily high-intensity exercise on myocardial perfusion in angina pectoris. Am J Cardiol 1991; 68: 1593-1599.

30. Verani MS, Hartung GH, Hoepfel-Haris J et al. Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease. Am J Cardiol 1981; 47: 797-803.