Improvement in aerobic capacity during cardiac rehabilitation in coronary artery disease patients: Is there a role for autonomic adaptations?

Abstract

Background It has been previously shown in patients with heart failure that exercise-based rehabilitation programmes may improve functional capacity and autonomic response. The aim of this study was to investigate this issue further by evaluating whether an association exists between autonomic adaptations and improvements of aerobic capacity in a general population of coronary artery disease patients undergoing cardiac rehabilitation. Methods Ninety consecutive patients (age 60 ± 11 years) attended a rehabilitation programme of moderate continuous training (25 ± 8 sessions, 2-3 sessions/week). Functional capacity expressed as oxygen uptake (peak VO) and autonomic function expressed as chronotropic response and heart rate recovery were evaluated by cardiopulmonary exercise tests before and after the rehabilitation programme. According to the expected mean increase in functional capacity, coronary artery disease patients were divided into two groups: those who improved peak VO by more than 2.6 ml/kg/min (R group) and those who did not (NR group). Effects of the rehabilitation programme were compared in R and NR groups. Results The number and intensity of exercise sessions did not differ between R ( N = 39) and NR ( N = 51) groups. However, only R patients improved chronotropic response (R: from 45.1 ± 16.9% to 72.7 ± 34.1%, P < 0.01; NR: from 49.3 ± 18.6% to 48.2 ± 36.5%, P = NS) and heart rate recovery (R: from 16.9 ± 7.0 bpm to 21.0 ± 8.7 bpm, P < 0.01; NR: from 15.2 ± 9.9 bpm to 15.8 ± 8.5 bpm, P = NS). After training both chronotropic response and heart rate recovery were significantly higher in R than NR patients. Conclusions The improvement in aerobic capacity of coronary artery disease patients following exercise-based cardiac rehabilitation programmes is associated with positive adaptations of autonomic function.

Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β‐blocker therapy or both

“…On the contrary, the observation that the subgroup of patients with a pretreatment HRR < 12 bpm significantly benefited from the combined ET and β‐blocker therapy clearly suggests a β‐blocker contribution. Our findings are in accordance with previous studies reporting significant gains in aerobic capacity in patients with coronary disease submitted to β‐blocker therapy in combination with a ET programme (Obma et al ., ; Pratt et al ., ; Ehsani, ; Lazzeroni et al ., ). Further supporting this finding, Pratt et al .…”

“…Similar reasoning was developed in the present study. Conversely, responsiveness to ET, evaluated using ΔVO 2max , has been shown to be moderately correlated with the autonomic status before ET (Hautala et al ., , ; Lazzeroni et al ., ). This clear antagonism becomes evident when we observe, in the present study, that the subgroup with a more compromised autonomic response (HRR < 12 bpm) within the Training group showed a significant improvement in HRR (Table ) that was not accompanied by an equivalent improvement in total time during ETT.…”

“…() clearly demonstrated that patients with coronary heart disease who did not show significant improvement in VO 2 after 25 ± 8 sessions did not show an improvement in heart rate recovery, even if they underwent beta‐blocker therapy (Lazzeroni et al ., ). This absence of improvement may be linked to a reduction in HR max , as HRR is correlated with HR max and cardiac reserve (Lauer et al ., ) or lack of improvement in physical capacity (Lazzeroni et al ., ). However, in the present study, β‐blocker therapy was suspended during ETT to avoid an acute effect of the medication on HRR assessment.…”

Relationship Between Post-exercise Heart Rate Recovery and Changing Ratio of Cardiopulmonary Exercise Capacity

“…In addition, this study is significant in that it clarified the change over time of autonomic dysfunction after AMI. There was a previous study of autonomic function improvement by active center-based cardiac rehabilitation, but few studies have investigated the natural course of autonomic function [ 20 ].…”

Efeitos do treinamento muscular inspiratório no controle autonômico: revisão sistemática

“…In the context of non-pharmacologic treatments, it is well stablished in literature that changing into healthy life habits can improve the autonomic function, such as adopting food patterns and practicing aerobic exercises regularly 8 . Besides, inspiratory muscle training (IMT) is another modality of physical training that had been indicated as an adjuvant therapy in the control of many diseases, having, in some cases, positive responses in the ANS 9,10 .…”