The Impact of Complex Cardiac Rehabilitation on Manifestation of Risk Factors in Patients with Coronary Heart Disease

Abstract

Background. Each year more than 4.3 million people in Europe will die of cardiovascular disease. Therefore, the implementation of simple interventions such as smoking cessation, weight loss, improved diets, and increased exercise is the top priority in prevention and rehabilitation programs. The aim of this study was to evaluate the impact of complex rehabilitation on the manifestation of risk factors and cardiac events in patients with coronary heart disease. Material and Methods. A total of 140 patients with coronary heart disease and NYHA functional class II–IV ischemic heart failure were recruited to the study. The patients were divided into 2 groups: 70 patients who underwent a 6-month complex rehabilitation course (rehabilitation group) and 70 patients who received drug treatment only (control group). Smoking, dietary, and physical activity habits were documented using the questionnaires. Blood pressure (BP), body weight and height, and total serum cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (Tg), and blood glucose levels were measured. Measurements were repeated after 3 and 6 months. Results. After 6 months, significantly reduced systolic BP was observed in both the groups as compared with the baseline values (P<0.05). A significant decrease in the diastolic BP; total cholesterol, LDL-cholesterol, triglyceride and blood glucose levels; body mass index, and percentage of patients with the metabolic syndrome as compared with the baseline data was documented only in the rehabilitation group (P<0.05). All the patients quitted smoking as well as all the patients in the rehabilitation group changed their dietary habits (P<0.05). Fewer patients were excluded from the rehabilitation group because of cardiac events as compared with the control group (7.1% vs. 11.4%, P<0.05). Conclusions. Complex long-term rehabilitation of cardiovascular patients significantly reduced the manifestation of major cardiovascular risk factors and the rate of cardiac events. Aerobic exercise must be the most important part of training but well-done resistance training must also be encouraged.

Impact of Community-Based Cardiac Rehabilitation on Clinical Parameters of Patients with Cardiovascular Diseases

“…However, it is worth noting that our study participants had relatively lower LDL levels even at baseline, compared to that in the study by Kubilius et al, where the baseline LDL levels in the intervention and control groups were 3.7 ± 0.8 mmol/L and 3.0 ± 1.4 mmol/L respectively. Given that reductions in LDL, TC and FBG were also observed in previously conducted studies 6 , 7 , 11 , our study results provide support that community-based CR programmes are able to improve lipid profiles and FBG in cardiovascular patients.…”

“…Power and Sample Size Calculations programme version 3.1.2 was used to calculate the sample size for a study of a continuous response variable between independent intervention and control groups of patients in a 1:2 ratio. Sample size estimation was based on the hypothesis of this study that improvements in LDL levels will be at least that of a previous study by Kubilius et al , where the LDL mean difference between cardiovascular patients in the intervention and control groups was 1.1mmol/L 7 . Assuming the response within patients in the intervention group was normally distributed with standard deviation (SD) of 2.5 mmol/L, a minimum of 61 and 122 cardiovascular patients in the intervention and control groups respectively was required in order to reject the null hypothesis that the population mean between the two comparison groups are equal, with 80% power and type I error (α) less than 0.05.…”

“…CR is associated with a reduction in mortality, hospital admissions and quality of life 4 , 5 . Numerous other studies have demonstrated improvements in clinical parameters such as blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL) and triglycerides (TG) 5 - 7 .…”

Effects of Lifestyle Modification Programs on Cardiac Risk Factors

“…We located a Canadian study with 126 participants in traditional CR [20] and a European trial with 68 patients with medical management but no CR or lifestyle program. [21] The data in both studies permitted calculation of risk factor changes from baseline to 3 months on subjects providing virtually all requested data, comparable to the FULL analyses in this study. In the study of traditional CR, three risk factors (SBP, DBP, and HDL) all showed significant improvements that exceeded those of the Ornish and MBMI programs.…”

“…In the no lifestyle study, three risk factors (SBP, SBP, and BMI) showed significant improvements (declines) since baseline, one risk factor (HDL) showed a significant deterioration (increase) over baseline, while two risk factors (total cholesterol and LDL) showed no significant change. [21] Surprisingly, the pure controls achieved greater 3-month improvements in SBP and DBP than the lifestyle programs. This is probably because the pure controls had elevated average baseline blood pressures (SBP 150/DBP 92), whereas those of Ornish (129/72) and MBMI (135/73) participants were normal.…”