Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting?

Mendes, Miguel

doi:10.1161/circulationaha.115.017800

Cited by 22 publications

(27 citation statements)

References 34 publications

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“…Thirdly, this study concerns AMI survivors treated at a single tertiary centre, most of whom were subjected to percutaneous coronary intervention. Therefore, generalisation to other settings should be done with caution [17]. Fourthly, in 5.8% of individuals the CPET was not performed with the modified Bruce protocol, but with a variation given the individuals’ low functional capacity.…”

Section: Discussionmentioning

confidence: 99%

“…Although the importance of EBCR after an AMI is well established, several factors which pertain to its optimal application have not yet been fully ascertained [11, 12, 17]. Importantly, AMI survivors with a reduced ejection fraction (EF) represent a higher-risk subgroup [3] and in some series are referred less often for these programmes [8, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

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Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

et al. 2019

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Introduction Exercise-based cardiac rehabilitation (EBCR) is part of the management of patients who have suffered an acute myocardial infarction (AMI). Patients with a reduced ejection fraction (EF) comprise a higher-risk subgroup and are referred less often for these programmes. This study aimed at assessing the impact of the baseline EF on the functional benefits, as assessed by peak oxygen uptake (pVO 2 ) and exercise duration, of an EBCR programme in AMI survivors. Methods Observational, retrospective cohort study including all patients admitted to a tertiary centre due to an AMI who completed a phase II EBCR programme after discharge, between November 2012 and April 2017. Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. Results A total of 379 patients were included [40.9% with reduced EF (<50%) at discharge]. After the programme, pVO 2 and exercise duration increased significantly ( p < 0.001). Patients with a reduced EF had a lower pVO 2 and completed a shorter duration of exercise at the beginning and end of the programme. This group presented a higher increase in pVO 2 ( p = 0.001) and exercise duration ( p = 0.007). This was maintained after adjusting for age, gender, history of coronary artery disease, number of sessions, Killip classification, arterial hypertension, dyslipidaemia, diabetes mellitus, smoking status and baseline pVO 2 . Conclusion A phase II EBCR programme was associated with significant improvements in pVO 2 and exercise duration among AMI survivors, irrespective of baseline EF classification. Those with a reduced baseline EF derived an even greater improvement, highlighting the importance of EBCR in this subgroup of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

et al. 2019

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“…Various factors may have affected the final outcome of cardiac rehabilitation, such as age, body mass index (BMI), comorbidities, initial level of physical capacity, commencement and duration of the rehabilitation program, type of exercise training, prescribed medications and low level of physical activity prior rehabilitation [ 16 – 19 ]. It should be noted that most of our patients had previous myocardial infarction (MI), and MET values underestimate the exercise intensity in post-MI men during the modified Bruce treadmill walking test.…”

Section: Discussionmentioning

confidence: 99%

Two early rehabilitation training models in male patients after coronary artery bypass surgery: application of continuous walking training as an alternative to interval cycle ergometer training

Dolecińska

Przywarska

Podgórski³

et al. 2020

kitp

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Introduction: Walking training is a good alternative to the commonly used cycle ergometer training. It is still necessary to develop rehabilitation programs based on walking characterized by a high degree of safety and effectiveness. Aim: Application of continuous walking training as an alternative to interval cycle ergometer training in men after coronary artery bypass graft (CABG) surgery, using the 6-minute walk test (6-MWT) to determine the initial training load. Material and methods: Forty-four men aged 45 to 76 years, up to 3 months after CABG surgery, were randomly assigned to continuous training on a treadmill (study group) or interval training on a cycle ergometer (control group), performed 6 times per week (12-15 sessions). Participants underwent the treadmill exercise stress test (TEST) and 6-MWT at the begining and after completion of the rehabilitation program. Before and 3 minutes after the 6 th and 12 th training session blood lactate concentration was determined. Results: Energy expenditure in TEST increased from 4.4 to 6.3 MET in the study group and from 5.0 to 6.5 MET in the control group. Distance walked in 6-MWT increased from 420 to 519 m and from 438 to 510 m, respectively. Resting heart rate (HR) and double product (DP) decreased only in the study group as well as systolic blood pressure (SBP), HR and DP at peak exercise load in baseline TEST. Mean energy expenditure during training sessions was 2.6 MET in the study group and 2.8 MET in the control group (NS). Exercise blood lactate concentration did not exceed 2.0 mmol/l in both groups. Conclusions: Both rehabilitation programs were of similar effectiveness and their intensity did not exceed the anaerobic threshold.

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“…Recently, the benefit of CR in patients undergoing coronary artery bypass surgery has also been questioned due to the difference in recovery patterns compared to those in other MI patients, and a lack of randomized controlled trials. 51 It is also conceivable that current models of CR that emphasize low-level aerobic trainingdto no more than 85% maximal heart rate, and minimal strength trainingdare simply not capable of generating enough of a stress on the patient to generate an adaptation response. This stresseadaptation cycle is, after all, at the heart of all exercise training.…”

Section: Impact Of Current Models Of Cardiac Rehabilitation On Patienmentioning

confidence: 99%

Survival of the Fittest: Impact of Cardiorespiratory Fitness on Outcomes in Men and Women with Cardiovascular Disease

Safdar

Mangi

2020

Clinical Therapeutics

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Cardiovascular disease (CVD) in general and myocardial infarction in particular are the leading causes of mortality in men and women globally. Sex differences in CVD recovery exist, with higher rates of mortality, recurrent myocardial infarction, and poor functional outcomes seen in women compared to men with CVD. Physical inactivity has been identified as a crucial modifiable risk factor linked with poor survival and recovery in patients with CVD. Cardiac rehabilitation programs that aim to improve physical inactivity and cardiorespiratory fitness (CRF), a measure of physical fitness in patients with CVD, have gained popularity. The goals of this commentary were to summarize the existing literature on the impact of CRF on survival in patients with CVD, to document the impact of sex on CVD outcomes, and to highlight any gaps in current knowledge. Even minor improvements in CRF have been linked with improved survival, although contemporary data from randomized controlled trials have shown mixed results. Gender differences in cardiac rehabilitation have been well documented, with lower referral, enrollment, and completion rates noted in women compared to men with CVD. However, data on sex differences in CRF with cardiac rehabilitation are scant, mostly indicating lower peak CRF observed in female compared to male patients on completion. It is unclear whether similar thresholds of peak CRF are needed in male and female patients to improve survival after onset of CVD, and whether exercise prescriptions need to be adapted to include additional forms of exercise. CRF is also influenced by age, with a decline in peak exercise capacity with advancing age observed in both sexes, but steeper declines noted in men than women. From this perspective, we review the data intersecting age, sex, and exercise on survival in patients with CVD, as well as the biological mechanisms at play, and we identify areas for future research (Clin Ther.

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Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting?

Cited by 22 publications

References 34 publications

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

Two early rehabilitation training models in male patients after coronary artery bypass surgery: application of continuous walking training as an alternative to interval cycle ergometer training

Survival of the Fittest: Impact of Cardiorespiratory Fitness on Outcomes in Men and Women with Cardiovascular Disease

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