Exercise capacity improvement after cardiac rehabilitation following myocardial infarction and its association with long-term cardiovascular events

Abstract

Aims Cardiovascular rehabilitation (CR) improves aerobic capacity and quality of life in patients after myocardial infarction (MI). The aim was to examine the associations between exercise capacity improvement and different clinically relevant cardiovascular events. Methods and results This was a registry-based study of post-MI patients, referred to CR. All patients were submitted to exercise testing before and after CR (36 sessions, 2–3 times/week, and combined exercise). Patients were divided into two groups, based on the difference in exercise capacity before and after the CR programme with the cut-off of two metabolic equivalents (METs) improvement. We assessed the correlation between the extent of exercise capacity improvement and the following cardiovascular events: major adverse cardiac events (MACE), cardiovascular-related hospitalizations, and unplanned coronary angiography. A total of 499 patients were included (mean age 56 ± 10 years, 20% women). Both groups significantly improved in terms of exercise capacity, natriuretic peptide levels, resting heart rate, and resting diastolic pressure; however, lipid status significantly improved only in patients with ≥2 METs difference in exercise capacity. A total of 13.4% patients suffered MACE (median follow-up 858 days); 21.8% were hospitalized for cardiovascular reasons (median follow-up 791 days); and 19.8% had at least one unplanned coronary angiography (median follow-up 791 days). Exercise capacity improvement of ≥2 METs was associated with lower rates of MACE, cardiovascular hospitalizations, and unplanned coronary angiography in all examined univariate and multivariate models. Conclusion This study has shown that exercise improvement of ≥2 METs is associated with a significant decrease in MACE, cardiac hospitalizations, and unplanned coronary angiography.

The Effect of Aquatic Exercise Training on Heart Rate Variability in Patients with Coronary Artery Disease

“…Exercise-based cardiac rehabilitation reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD) [ 1 , 2 , 3 ]. Ample evidence suggests that exercise training improves markers of cardiovascular health such as risk factors, exercise capacity, vascular function and heart rate variability (HRV); however, the vast majority of exercise studies in patients with CAD employ land-based aerobic dynamic modalities, such as cycling or treadmill walking [ 3 , 4 , 5 ].…”

“…Exercise-based cardiac rehabilitation reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD) [ 1 , 2 , 3 ]. Ample evidence suggests that exercise training improves markers of cardiovascular health such as risk factors, exercise capacity, vascular function and heart rate variability (HRV); however, the vast majority of exercise studies in patients with CAD employ land-based aerobic dynamic modalities, such as cycling or treadmill walking [ 3 , 4 , 5 ]. Conversely, aquatic exercise (such as swimming or water aerobics training)—while a popular exercise modality—remains rarely provided or even discouraged, mainly because of its perceived risks (i.e., unfavorable hemodynamic response to water immersion and temperature, possibly yielding ventricular dysfunction and/or dysrhythmias in cardiac patients) [ 6 , 7 ].…”

Irisin is an Effector Molecule in Exercise Rehabilitation Following Myocardial Infarction (Review)

“…Cardiac rehabilitation reduces risk factors, and increases the aerobic fitness, medication adherence, and survival after percutaneous coronary intervention and coronary artery bypass graft surgery ( Colantonio et al, 2017 ; Rosenson et al, 2017 ). Moreover, it improves survival and reduces risk of recurrent MI in patients with acute MI (AMI) ( Novaković et al, 2022 ). A previous meta-analysis comprising 63 trials and 14,486 patients assigned to exercise-based cardiac rehabilitation or no referral following MI or revascularization, reported that cardiac rehabilitation was associated with a lower risk of cardiovascular death [relative risk (RR) 0.74, 95% CI 0.64–0.86] and hospital readmission (RR 0.82, 95% CI 0.70–0.96) at 12-months ( Anderson et al, 2016 ).…”

Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? A long-term prospective, randomised, parallel single randomised trial (COR-PRIM)

“… 3 Cardiac rehabilitation in postmyocardial infarction improve lifestyle habits such as physical activity and dietary intake, and has also shown positive effects on blood lipids, blood pressure and smoking. 4–6 In a small randomised trial, cardiac rehabilitation programme for patients with myocardial infarction or who had undergone coronary artery by-pass graft surgery (CABG), focusing on stress management, physical exercise and dietary intake, reduced morbidity and hospitalisation for CHD. 7 Attendance in cardiac rehabilitation programme has long-term effects on survival among patients who have undergone CABG with reduced 10-year all-cause mortality.…”

“…3 Cardiac rehabilitation in postmyocardial infarction improve lifestyle habits such as physical activity and dietary intake, and has also shown positive effects on blood lipids, blood pressure and smoking. [4][5][6] In a small randomised trial, cardiac rehabilitation…”