Julija Borkytė1, Denis Šileikis1, lekt. Joana Kriščiokaitytė1,2
1 Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
2 Lithuanian University of Health Sciences Kauno klinikos, Department of rehabilitation, Kaunas, Lithuania
Aim: To evaluate the influence of exercise-based Cardiac Rehabilitation on exercise capacity, cardiovascular system and quality of life in patients with coronary heart disease.
1) To evaluate the physical capacity of the study subjects and control group before and after Cardiac Rehabilitation.
2) To evaluate cardiovascular adaptation to physical activity of the study subjects and control group before and after Cardiac Rehabilitation.
3) To evaluate the hemodynamic response to physical activity of the study subjects and control group before and after Cardiac Rehabilitation.
4) To assess the quality of life of the study subjects and control group before and after Cardiac Rehabilitation.
Study was performed at different rehabilitation hospitals in Druskininkai, Abromiškės, Birštonas and Palanga between 2015 and 2017. A total of 377 patients with recent myocardial infarction and heart failure classified as NYHA III were selected. Patients were divided into two groups: study group (n = 188), average age 64,01 ± 1,41, and control group (n = 187), average age 65,15 ± 11,36. A personalized cardiac rehabilitation program was assigned each patient according to their individual exercise/physical capacity level. Study group patients were given opportunity to complete their cardiac rehabilitation program within home environment. Patients’ physical capacity was assessed in the same rehabilitation department at the beginning and at the end of the study. Evaluation methods include: 6-minute walk test, spiroergometry, veloergometry, arterial blood pressure and pulse measurements, post-traumatic stress disorder symptom scale, stress coping response questionnaire (COPE), Borg Scale questionnaire – to evaluate patients’ perceived exertion level, cardiac symptom intensity scale, life quality assessment. A K. Wallston et al. Multidimensional Health Locus of Control Scale (MHLC) was used to determine patients’ health locus of control. SF-36 questionnaire was used to determine patients’ subjective health. Hospital Anxiety and Depression (HAD), A.S.Zigmond, R.P.Snaith, scale was used to evaluate patients’ emotional state. Questionnaires were processed and analyzed using the statistical data analysis package SPSS 22.0 and Mac OS Mountain Lion Excel program. The results are considered reliable when p <0.05.
Cardiac contraction rate compared before and one minute after physical activity was significantly higher (p < 0.05). After rehabilitation using resistance training, hemodynamic indices improved significantly. Before physical exercise, systolic blood pressure was 134.1 ± 11.07 mmHg, diastolic blood pressure was 85.1 ± 3.56 mmHg, heart rate was 77.1 ± 2.15 bpm. One minute after physical exercise, systolic blood pressure was 166.1 ± 12.43 mmHg, diastolic blood pressure – 91.2 ± 1.34 mmHg, heart rate – 97.3 ± 1.23 bpm. Five minutes after physical activity, systolic blood pressure was 134.2 ± 4.43 mmHg, diastolic blood pressure was 86.1 ± 2.43 mmHg, heart rate – 80.2 ± 3.45 bpm. After cardiac rehabilitation difference in systolic blood pressure before and one minute after physical exercise was statistically significant (p < 0.05). Difference in heart rate before and after cardiac rehabilitation program was statistically significant (p < 0.05). Maximum oxygen intake (MaxVO2) was chosen as an additional indicator to evaluate physical capacity of patients with ischaemic heart disease before and after cardiac rehabilitation. It reflects cardiovascular stamina. Before cardiac rehabilitation MaxVO2 was 19.3 ± 4.57 ml/min/kg, after – 24.02 ± 5.26 ml/min/kg. An improvement in life quality assessment can be observed in both patients’ groups after rehabilitation. More favourable mean pain score observed in study group 95.1 ± 3.82, compared to the control group 98.12 ± 2.47. An emotion-focused way to overcome stress is also more pronounced among patients that did not show symptoms of post-traumatic stress syndrome (mean 67.11 ± 13.55), compared to patients with symptoms of post-traumatic stress syndrome (mean 61.24 ± 14.32) (p = 0.031). Patients’ quality of life compared with before and after cardiac rehabilitation was significantly higher (p < 0.05) in relation to pain and health.
- We found that physical capacity and maxVO2 significantly increased in study subjects after Cardiac Rehabilitation.
- We found that the adaptation of the cardiovascular system to physical activity and the parameters’ change was not sufficient in all participants before and after Cardiac Rehabilitation.
- The hemodynamic response to physical activity significantly improved in the study subjects after Cardiac Rehabilitation.
- We determined that quality of life improved in all participants after Cardiac Rehabilitation.