Cardiac and Endothelial Function Response to Early Exercise Training After Coronary Artery Bypass Surgery
Condition: Coronary Artery Bypass Grafting; Coronary Artery Disease; Cardiac Rehabilitation
MeSH terms: Coronary Artery Disease
Study type: Interventional

Summary: 
      Background: Coronary artery bypass grafting (CABG) due to coronary artery disease (CAD) is
      one of the main surgical procedures performed in the area of cardiology. Individuals
      undergoing CABG present sarcopenia, decreased muscle strength of the lower limbs, decreased
      respiratory muscle strength and dyspnea due to immobility in the bed and the inherent
      conditions of the disease itself. Cardiorespiratory rehabilitation techniques are rarely used
      with measurement in hospitals and can greatly favor an early and effective reestablishment to
      this population in several parameters. Objective: To evaluate the effect of functional
      electrical stimulation (FES), ventilatory muscle training (TREMVEN), early aerobic training
      (AERO) and isometric handgrip training (ISO) on the functional capacity, endothelial function
      and cardiac parameters of individuals undergoing CABG. Methods: In a randomized clinical
      trial, volunteers will be allocated into four groups: EEF, TREMVEN, AERO or ISO in the
      preoperative period of CABG. After 48 hours (postoperative midway) of the surgery, the
      protocol will begin until after hospital discharge. The endpoints evaluated will be:
      functional capacity, respiratory muscle strength, systolic and diastolic function, arterial
      endothelial function, inflammatory profile and plasma levels of vascular endothelial growth
      factor (VEGF). Scientific contributions: Phase 1 cardiorespiratory rehabilitation with
      alternative interventions may provide an increase in functional capacity, strengthening of
      respiratory muscles, improvement in cardiac and endothelial functions, as well as increased
      systemic VEGF levels (myocardial revascularization) and improvement of the inflammatory
      profile, effectively forwarding the individuals to the rehabilitation phase 2.
    


Intervention name(s): Ventilatory Muscle Training (TREMVEN); Aerobic Training (AERO); Isometric Handgrip Training (ISO)
Intervention type(s): Other; Other; Other
Intervention description(s): Early cardiac rehabilitation after coronary artery bypass graft:
The enrolled participants will perform IMT or P-IMT for 20 minutes during the period of hospitalization, using the Power Breathe device (POWERbreathe International LTD). During training, subjects will be instructed to maintain diaphragmatic breathing at a rate at 15 to 20 breaths/min. The inspiratory load will be set at 30% of maximal static inspiratory pressure (PImax). It will be occur once per day until the hospital exit.; Early cardiac rehabilitation after coronary artery bypass graft:
It will consist of supervised walking, lasting 20 minutes a day, during the period of hospitalization of the participants. Heart rate (HR) will be constantly monitored through a cardiac monitor (Polar), with the objective of maintaining between 50 and 60% of the maximum HR predicted by age; Similar to 40 to 50% of VO2max. Blood pressure, SpO2 and level of dyspnea (Borg's effort perception scale) will also be monitored constantly. It will be occur once per day until the hospital exit.; Early cardiac rehabilitation after coronary artery bypass graft:
Study participants will perform 5 x 2 min alternating bilateral contractions of the hand flexor muscles at 30% maximum voluntary contraction with one minute rest between contractions, in a total of 20 minutes training during the period of hospitalization. It will be occur once per day until the hospital exit.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Coronary artery bypass grafting; Cardiorespiratory rehabilitation; Functional electrical stimulation; Inspiratory muscle training; Aerobic training; Isometric handgrip training; Functional capacity; Endothelial function; Cardiac function