Conclusions Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease .
While our analysis was constrained by the quality of included trials and missing information about intervention components , there appears to be little differential effect of variations in exercise intervention , particularly on mortality outcomes .
Background While the clinical benefits of exercise-based cardiac rehabilitation are well established , there is extensive variation in the interventions used within these trials .
It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes .
This study aims to systematic ally examine the relationship between individual components of the exercise intervention in cardiac rehabilitation ( such as intensity and frequency ) and clinical outcomes for people with coronary heart disease .
[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].
AIM To investigate efficacy of early and long term physical training ( PT ) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease ( IHD ) of able to work age - survivors of acute coronary events . MATERIAL AND METHODS Three hundred ninety two patients were enrolled in this study . They were r and omized into intervention group " O " ( n=197 ) and control group " C " ( n=195 ) . Inclusion period was 3- 8 weeks from onset of myocardial infa rct ion ( MI ) , unstable angina ( UA ) , or intervention on coronary arteries . Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory ( levels of lipids ) , instrumental ( ECG , exercise test on veloergometer , echocardiography ) , and clinical examination . In the group " O " regimen of PT with work loads of moderate intensity ( 50 - 60 % of power achieved during exercise test ) was used . Duration of FT was 45 - 60 min , frequency - 3 times a week . All patients received st and ard therapy for IHD and a lipid lowering drug when indicated . RESULTS Proofs of efficacy of PT in the given contingent of patients were obtained . This was manifested by significant increase of physical working capacity : prolongation of exercise time ( + 31.7 % , p<0.001 ) , increases of volume of work performed ( + 74.3 % , p<0.001 ) and efficiency of cardiac work according to results of exercise tests . All parameters were significantly different from those in the group " C " . Structural functional parameters of the heart also improved in the group " O " : left ventricular ( LV ) stroke volume increased 4.5 % ( p<0.005 ) , ejection fraction increased 7.2 % ( p<0.001 ) , diastolic LV volume decreased 2.5 % ( p<0.05 ) , systolic LV volume decreased 8.1 % ( p<0.001 ) . In the group " C " stroke volume and LV ejection fraction rose to a lesser degree - by 5.5 % ( p<0.01 ) and 2.9 % ( p<0.05 ) , respectively . Differences between groups in dynamics of these parameters turned out to be significant ( p<0.05 ) . Moreover in group " C " LV diastolic volume increased 2.3 % ( p<0.05 ) and systolic volume did not change , while left atrium increased 3.4 % ( p<0.002 ) . At intergroup comparison differences in dynamics of these parameters were significant ( p<0.005 ) . Analysis of lipid profile after 1 year showed no changes in patients of group " C " , while in group " O " it revealed significant ( 3.6 % ) lowering of total ( T ) cholesterol ( CH ) ( p<0.05 compared with baseline and change in group " C " ) and elevation of high density lipoprotein ( HDL ) CH ( + 12.3 % , p<0.001 ; compared with group " C " p<0.005 ) . Atherogeneity index TCH/HDLCH decreased 8.5 % in the group " O " ( p<0.01 ) , and increased 12 % ( p<0.02 ) in the group " C " , difference between groups was statistically significant ( p<0.001 ) . In the group " O " body mass index decreased 2.8 % ( p<0.001 ) , and frequency of attacks of angina decreased 50.8 % ( p<0.001 ; compared with group " C " p<0.001 ) . Statistically significant differences were registered between the following parameters of composite end point and surrogate points : total number of cardiovascular events - 26 ( 14.8 % ) vs 47 ( 27 % ) , p<0.01 ; number of cardiovascular catastrophes - 5 ( 3 % ) vs 15 ( 8.7 % ) , p<0.05 ; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2 , p<0.05 in groups " O " and " C " , respectively . Thus in the group " O " positive effect of PT on the course and outcomes of the disease was registered compared with the group " C " . CONCLUSION The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events . It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease
Conclusions Exercise-based cardiac rehabilitation is effective at reducing important clinical outcomes in patients with coronary heart disease .
While our analysis was constrained by the quality of included trials and missing information about intervention components , there appears to be little differential effect of variations in exercise intervention , particularly on mortality outcomes .
Background While the clinical benefits of exercise-based cardiac rehabilitation are well established , there is extensive variation in the interventions used within these trials .
It is unknown whether variations in individual components of these exercise interventions provide different relative contributions to overall clinical outcomes .
This study aims to systematic ally examine the relationship between individual components of the exercise intervention in cardiac rehabilitation ( such as intensity and frequency ) and clinical outcomes for people with coronary heart disease .