Tai Chi Exercises on Physical Activity and Pulmonary Function in CABG

Study Overview
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Brief Summary
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To improve the cardiopulmonary endurance in Coronary artery bypass grafting (CABG) patients. Internationally in cardiac hospital facility of cardiac rehabilitation is available to improve the patient's physical activity and decrease the list of secondary complications. But in Pakistan ideal phase II cardiac rehabilitation is limited available in limited hospitals due to cost issues and limited resources for monitoring during exercise. A Randomized control trail Study was conducted in Armed force institute of cardiology (AFIC) Rawalpindi. The Total sample size was 74 post (CABG). The aim of study was to influence of Tai chai on coronary artery bypass surgery patients.

Detailed Description
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Coronary blood vessel disease is a disease of vessels supplying the muscles of the heart. Heart attack is generally acute condition and mainly produced by an obstruction, that stop the blood supply to the heart. Coronary artery diseases can be progressive or non-progressive. Physical activity or exercise is necessary for all the healthy individuals to prevent the risk of diseases and maintained health status. Physical exercise often varies from physical activity by animation more measured in relations of intensity and period, while physical activity studies tend to integrate an enormous diversity of unspecified activities. Physical activity or exercise is used as conservative treatment of coronary artery diseases as a cardiac rehabilitation. Cardiac rehabilitation gives positive effect on patient's conditions by the exercise training program. Exercise may improve the maximal oxygen consumption (VO2 max) and repetitive capacity or capability to maintain physical activity for long periods of time. Exercise have multiple benefits on improving endothelial function, myocardial stream replacement decreasing smoking, body mass, plasma fats and blood pressure. Guided work out or exercise may decrease the development of coronary atherosclerosis. Different types of Aerobic exercises are the part of cardiac rehabilitation, start at very early in patients with coronary artery bypass grafting. Aerobic exercises may improve the maintenance of functional capacity and muscular strength but it shows no impact on pulmonary function and respiratory muscle strength. Aerobic exercises are perform in different ways some of them are in the form of intervals and some are continues. Studies shows that Four weeks of intense training increased VO2 peak significantly after both aerobic interval training and moderate continues training, but After 6 months only aerobic interval training gives high peak oxygen uptake (VO2 peak). It shows that both training have similarly effects in the tiny tenure and in extensive tenure only effect aerobic interval training. The most common aerobic exercises are perform at Treadmill and bicycle in cardiac rehabilitation program. Studies shows that Treadmill aerobic working out progresses both functional mobility and circulatory appropriateness in patients with chronic (CABG) and is more operational than reference rehabilitation reciprocated to conventional care. Now a day Tai chi is used in all over the world for health and defense or protection. Tai chi is a fighting art it is used in defense and health related fitness it is appropriate conditioning exercise for elder people. In health related benefits Yang Tai chi are most commonly practiced worldwide. Tai chi exercises are also practiced in rehabilitation department to gain the balance, coordination, endurance and physical activity in patients with stroke and coronary artery bypass grafting most commonly. Consistent aerobic workout and lifestyle modification are imperative for preventing and treating high blood pressure. For individuals with hypertension ,The American College of Sports Medicine recommends the following exercise guidelines like frequency: aerobic exercise most preferably all days of a week; resistance exercise 2-3 days per week. Intensity of exercise must be moderate intensity aerobic and resistance exercise. Time of exercise must be 30-60 minutes for every day of aerobic implementation while resistance working out at least one set of 8-12 reiterations for each of the main muscle groups. Studies shows that Tai Chi gives positive effects on blood pressure. Tai Chi training may reduce the systolic and diastolic blood pressure in patients with HTN. Tai chi also reduce the systolic as well as diastolic in normal healthy individuals. Young DR, conducted a study with the title of The properties of aerobic workout and Tai Chi on blood pressure in older individuals and they concluded that the programs of low and modest concentration workout have the same effects on blood pressure in elderly patients. Stroke is a common root of expiry in ageing population it is due to atherosclerosis are hemorrhagic in the minor or intermediate vessels of the brain. In such kind of patient significant reduction in quality of life, neurological discrepancies and deficiency of intellectual function.It reported that stroke patients increasing peak oxygen acceptance and walking distance by workout. Cerebrovascular accident patients frequently have compromised equilibrium and motor function, thus Tai Chi training program can be used in rehabilitation of stroke. A study in elderly subjects on Tai chi, balancing exercise and workout instruction groups. After four months of physical activity the follow up evaluation illustrate that only Tai Chi subjects informed that their daily activities and their whole life had been exaggerated. The result demonstrates that in women emotional as well as physical control is supposed to be improved in sense of enhancement in overall well-being and inspiration to continue physical training also rises. Effectiveness of Tai Chi, brisk hiking, meditation and reading in reducing psychological and emotional stress in 1992 and calculated that Tai Chi activities are used to decrease mental stress or disorder it is advantageous to quit smoking, drinking and other life threatening obsessions also. For the reason that Tai Chi is also used as to enlarge psychological well being and mental sickness. Another study concluded that Tai Chi trainings are an aerobic movements it is very supportive for different age and gender, it also increase functional capability of the participants. There was a research gap in previous study Tai chi training was done after phase II cardiac rehabilitation and duration of training was 6 months to 1 year. In current study we analyze Effect of Tai chi exercise on physical activity, pulmonary function and the rate of perceived exertion after exercise in patients with cardiovascular bypass surgeries in phase II cardiac rehabilitation.

Official Title
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The Effect of Tai Chi Exercises on Physical Activity and Pulmonary Function In Patients With Coronary Artery Bypass Grafting

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Other: Aerobic Exercises
* Other: Tai Chi Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: post-operative CABG patients, Ejection fraction >40% were included Exclusion Criteria: 2,3,4 scale of angina, unstable congestive heart failure, Substantial myocardial ischemia, Cardiac arrhythmias, Reopen chest after surgery, Uncontrolled diabetes and hypertension

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Aerobic Exercises<br>Bicycling Exercise (lower Limb) | Other: Aerobic Exercises<br>* 5 to 10 min warm up exercises than 30min bicycle exercise and 5 to 10 min cool down exercises<br>|
| Experimental: Tai Chi Exercises<br>Tai Chi Exercises (yang 24 Postures) | Other: Tai Chi Exercises<br>* 5 to 10 min warm up exercises and 30 min Tai Chi exercises and than than 5 to 10 min cool down exercises.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| forced expiratory volume in one second (FEV1) | Changes from the Baseline, forced expiratory volume in one second (FEV1) in liters will be measured through Digital spirometer | 6 weeks | 
| Forced vital capacity (FVC) | Changes from the Baseline, forced vital capacity (FVC) in liters will be measured through Digital spirometer | 6 weeks | 
| Peak expiratory flow (PEF). | Changes from the Baseline, Peak expiratory flow (PEF) in Liters/seconds will be measured through Digital spirometer | 6 weeks | 
| International physical activity questionnaire (IPAQ) | Changes from Baseline, (IPAQ) It is recommended that activity bouts of greater than 3 hours are truncated. That is to say that a bout cannot be longer than 3 hours (180 minutes). This means that in each category a maximum of 21 hours of activity are permitted a week (3 hours X 7 days) To calculate metabolic equivalent (MET) minutes a week multiply the MET value given (remember walking = 3.3, moderate activity = 4, vigorous activity = 8) by the minutes the activity was carried out and again by the number of days that that activity was undertaken. For example if someone reports walking for 30 minutes 5 days a week then the total MET minutes for that activity are 3.3 X 30 X 5=495 Met minutes a week. You can add the MET minutes achieved in each category (walking, moderate activity and vigorous activity) to get total MET minutes of physical activity a week. | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Borg's rating of perceived exertion (RPE) scale | (RPE) Scale - Modified BORG scale. Grading scale for fatigue and endurance. 0. At rest. 1. Very easy. 2. Somewhat easy. 3. Moderate. 4. Somewhat hard. 5. Hard 7 very Hard and 10 very, very hard | 6 weeks | 
| Heart Rate | Changes from the Baseline; Heart Rate (beats per minute) | 6 weeks | 
| Oxygen Saturation (SPO2) | Changes from the Baseline; Saturation in Percentage | 6 weeks | 
| Blood Pressure | Changes from the Baseline; Blood Pressure in (mmHg) | 6 weeks | 
| Heart Rate Reserve | Changes from the Baseline; Heart Rate Reserve beat per minute | 6 weeks | 
| Respiratory Rate | Changes from the Baseline; Respiratory Rate breath per minute | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bicycling, Coronary Artery Disease, Pulmonary Function, Tai Chi