Phase 1 Cardiac Rehabilitation With and Without Lower Limb Paddling Effects in Post CABG Patients.
Condition: Coronary Artery Disease
MeSH terms: Coronary Artery Disease; Myocardial Ischemia; Coronary Disease
Study type: Interventional

Summary: 
      To compare the effect of Phase 1 cardiac rehabilitation with lower limb paddling, with phase
      1 cardiac rehabilitation without lower limb paddling Effects in Post Coronary artery bypass
      graft (CABG) Patients.
    

Detailed description: 
      Coronary artery disease (CAD) is the most common type of heart disease. CAD happens when the
      arteries that supply blood to heart muscle become hardened and narrowed. This is due to the
      buildup of cholesterol and other material, called plaque, on their inner walls. This buildup
      is called atherosclerosis. As it grows, less blood can flow through the arteries. As a
      result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain
      (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the
      hearts' blood supply, causing permanent heart damage.

      Previous studies reported positive effects of early exercise in the ICU on these measures .
      In a meta-analysis published earlier, early mobilization increased the number of
      ventilator-free days during hospitalization, but not the duration of Minute ventilation (MV).
      A possible explanation is that many patients without MV were included . As a result, these
      results should be interpreted with caution. The mortality rate is a traditional measure of
      the health status of critically ill patients. Muscle weakness is associated with increased
      mortality. Physical therapy in the intensive care unit (ICU) had no effect on mortality in
      many previous systematic reviews and meta-analyses. Similar to previous studies, early
      mobilization did not improve ICU mortality, hospital mortality, or 28-day mortality rates in
      the previously published meta-analysis. The discharged-to-home rate is an important
      prognostic indicator for critically ill patients, first showed that early mobilization
      increased the discharged-to-home rate compared to the control group.

      In previous study it was concluded that, after the performance of the mobilization protocol,
      the patients in the Immunoglobulins (IG) improved the distance walked in the 6 min walk test
      (6MWT), which was assessed during 7 postoperative days and 60 days after hospital discharge,
      and it was less time in ICU and lower prevalence of pulmonary complications, when compared to
      the control group (CG). It was also concluded that with the results obtained from their
      study, it was possible to introduce an early mobilization protocol in the ICU routinely unit
      and sensitize the medical board about the importance of proper physiotherapy conduct.

      Another previously conducted study states that regardless of the different techniques and
      periods of mobilization applied, early mobilization may be initiated safely in the ICU
      setting and appears to decrease the incidence of Intensive care unit-acquired weakness
      (ICU-AW), improve the functional capacity, and increase the number of patients who are able
      to stand, number of ventilator-free days and discharged-to-home rate without increasing the
      rate of adverse events. However, due to the substantial heterogeneity among the included
      studies, the evidence has a low quality.

      Previous study states the importance of this approach; this has been emphasized in previous
      studies on experienced paddlers, rowers, cross-country skiers, cyclists and runners. However,
      some studies in sports that depend upon a high lower extremity documented a dependence of
      results from a specific Paddler on the season when the test was undertaken. During paddling,
      ventilatory functions are also very important. Values for the maximal minute ventilation
      (Vmax) and tidal volume obtained in the cycle ergometer were higher than in paddling in
      previous studies. During endurance performance the tidal volume depends on age, sex and
      constitutional factors and, in athletes, mainly on the nature and duration.The Max oxygen
      consumption (VO2) differences between maximal cycling and paddling were non-significant in
      previous studies. The ventilation equivalent affords insight into the economy of respiration.
      The magnitude is dependent on constitutional factors, especially on morphological conditions
      of the respiratory system, and partly on sex, age and, especially in athletes, on the economy
      of ventilation.
    

Intervention name(s): Phase 1 Cardiac Rehabilitation; Phase 1 Cardiac Rehabilitation with Lower Limb Paddling
Intervention type(s): Other; Other
Intervention description(s): Step 1:Breathing exercises, 3 sets of 10 repetitions. Active upper and lower extremity exercises, 3 sets of 10 repetitions; bed inclined at 45°.
Step 2:Active exercises as in step 1. Stay in the upright position and perform walking on the spot for three series of 1 min.
Step 3:Active exercises as in step 2. Ambulation within the inpatient wards (7 min). Transfer to an allocated chair beside the bed (at least 30 min).
Step 4:Same exercises as in step 3. Ambulation within the inpatient wards (10 min). Transfer to an allocated chair beside the bed (at least 1 h).
Step 5:Same exercises as in step 4. Ambulation within the inpatient wards (15 min). Transfer to an allocated chair beside the bed (at least 2 h).
Step 6:Active exercises from the previous day. Ambulation within the inpatient wards (20 min). Step training (3 times continuously, 20 cm standardized step).
Step 7:Exercises from the previous day. Step training (6 times continuously, 20 cm standardized step).; Step 1 to step 6 of Phase 1 Cardiac Rehabilitation given to the patients along with Lower limb exercise on Paddler lasting 20 min (5-min warm-up, 10 min of low-intensity exercise, and 5-min recovery), 30 rpm ( rotation per minute)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Coronary Artery Disease; Cardiac Rehabilitation; CABG; Ergometer