Aim. To investigate exercise tolerance in patients undergoing acute coronary syndrome with outcome in myocardial infarction, dependingon physical activity tolerance. Material and methods. We studied 80 patients aged from 40 to 75 years old who were admitted from primary vascular centers for athree-week rehabilitation course to the department of medical rehabilitation for patients with somatic diseases of the clinic of the IvanovoState Medical University of the Ministry of Health of Russia, of which 61 were men (76,3%) and 19 women (23,7%). In accordancewith the aim of the study, a 6-minute walk test was performed in all patients before and after the completion of the rehabilitationcourse. Based on the test results, physical exercise tolerance was assessed and the functional class (FC) of coronary heart disease (CHD) was determined. The patients with I class coronary heart disease (CHD) in the number of 20 patients (25%) made up the 1st group, 21patients (26,3%) with II class – the 2nd group, 21 patients (26,3%) with III class – the 3rd group, and 18 patients (22,5%) with IV class– the 4th group. Results. Every third patient who was admitted to a 3-week cardiac rehabilitation course had short-term adverse reactionson loading during physical training on simulators. Most cases of inadequate reactions were noted in patients with III and IV IHDclass III (according to the 6-minute walk test) having, according to the International Classification of Functioning, Disability and Health(ICF), moderate and pronounced reduction of exercise tolerance function. Patients often had tachycardic and hypertensive reactionsin the porcess of prysical training on stimulators and some patients (more often those with the pronounced decrease in exercise tolerancefunction) had hypotensive reaction which is the most unfavorable type of response to the load. In the vast majority of patientswith I and II CHF with no impairment or mild decrease in exercise tolerance according to ICF, an adequate response of hemodynamicparameters to exercise was determined. Adverse reactions were observed only in every fifth-seventh patient and were manifested onlyin the form of tachycardic and hypertensive reactions to exercise. The study analyzed the effectiveness of rehabilitation measures inthe groups of patients with different levels of tolerance to physical activity. It was found out that all the patients with myocardial infarction,regardless of the initial level, had increased exercise tolerance after cardiac rehabilitation. Conclusion. The 6-minute walk test is insufficiently informative for patients with markedly reduced tolerance to physical activity. The«gold standard» of qualitative and quantitative assessment of reactions and interaction between cardiovascular and respiratory systems,as well as metabolic response of the body during physical activity for these patients is the spiroergometric study.

Background. The relevance of the comparative study of exercise tolerance in male and female cardiac patients is due to the need to individualize physical rehabilitation programs. Aims: to study the impact of gender on exercise tolerance in patients with acute coronary syndrome undergoing a course of rehabilitation in a day hospital. Methods. 110 patients with acute coronary syndrome were examined: 81 men (73.6%) aged 34 to 75 years and 29 women (26.4%) aged 44 to 74 years. In accordance with the purpose of the study, all patients were exposed to stress testing before and after the end of the three-week rehabilitation course. Results. According to the analysis of the six-minute walk test and the Bicycle ergometric test, men had better physical endurance than women. Features of hemodynamic indicators during physical activity also correlate with gender: in comparison with men, the maximum physical load in women was accompanied by higher heart rate values. At the end of the rehabilitation course, women had a more pronounced improvement of Bicycle ergometry indicators: a greater increase in maximum power and the percentage of load performed during the test. Conclusions. The gender differences in exercise tolerance in cardiac patients identified in the study should be taken into account when designing rehabilitation programs.

Background.Even though the six-minute walking test is a simple and widely available tool for the evaluation of the functional capacity of cardiac patients, its interpretation is associated with some difficulties and contradictions.Aims:To evaluate the dynamics of tolerance to physical activity during outpatient rehabilitation of patients with ischemic heart disease using predicted values of distance in the six-minute walking test.Materials and methods.97 patients (70 men and 27 women, average age 59.6 [50; 60] years) after acute coronary syndrome and after myocardial revascularization were included. The six-minute walking test was performed at the beginning of the 3-weeks stage of cardiac rehabilitation and before the patients discharge. The results of the test were reported as an absolute value, a change in absolute value, and the percentage of predicted values, estimated with the reference equation by Enright and colleagues.Results.The absolute value of distance in the six-minute walking test was increased significantly from 418 [385; 465] m to 485 [440; 525] m (p0.001). The number of patients with a distance less than 300 m was decreased significantly (12 patients, 12% vs 2 patients, 2%,p0.001). In most patients, the absolute increase in distance was 30 m and more (81 people, 84%). After comparing the perceived data with the calculated predicted values, it was revealed that the distance raised from 79 [71; 82]% to 92 [88; 96]% of the predicted values. And 56 patients (58%) had a distance equal to 90% or more from its predicted value.Conclusions.During the third stage of cardiac rehabilitation the significant increase of the absolute value of the six-minute walking test, the growth of the percentage of predicted values, and the decrease of patients with a distance less than 300 m were found. All these estimation methods may be used to demonstrate and prove favourable changes of tolerance to physical activity in patients with ischemic heart disease.

Background The basis of cardiac rehabilitation programs (CRP) is aerobic physical training, which improves exercise capacity in patients with an acute myocardial infarction (MI) after primary angioplasty of the infarct-related vessel. However, which type - aerobic interval training (AIT) or aerobic continuous trainings (ACT) are most effective for improving peak oxygen uptake (VO2 max) remains unclear and controversial. Purpose To evaluate the effects of CRP, including AIT or ACT, on exercise capacity and lung function in patients with MI after primary angioplasty of the infarct-related vessel. Methods Seventy MI patients (58 men and 12 women, mean age – 59,2±8,0 years) were undergone the three-week CRP in the Ivanovo State Medical Academy Clinic. The CRP for all patients included: daily controlled physical training on the Bicycle Ergometer and Treadmill, group exercises in therapeutic gymnastics, dosed walking and walking on the stairs with an individually calculated pace. Depending on the mode of physical training all patients were randomized of five weekly sessions in to two groups, comparable in age and gender: AIT group (35 patients) and ACT group (35 patients). The ACT group was training at 50–60% of peak heart rate. The AIT group protocol consisted of ten 1-min intervals at 85–90% of maximal heart rate separated by ten 1-min active recovery periods of moderate intensity at 40–60% of the maximal heart rate. Changes in 6-min walk distance test (6MWT), peak oxygen uptake (VO2max), relative load power, total lung capacity (TLC) and forced expiratory volume in one second (FEV1) before and after CRP were investigated. Data are presented as a median (interquartile ratio [Q1; Q3]). Results After finishing CRP 6MWT distance increased in both groups, but was higher in AIT group 492 [460–510] m compared to the ACT group – 465 [424–510] m (p<0.05). Peak oxygen uptake increased more (p<0.05) after AIT: from 16.8 [15.3–19.8] to 20.7 [16.5–21.9] ml kg–1 min–1 (p<0.05), than after ACT – from 15.8 [14.7–18.6] to 16.1 [15.8–20.5] ml kg–1 min–1 (p>0.05). At the end of the CRP relative load power during cardiopulmonary exercise test was higher in AIT group compared to the ACT group: 1.5 [1.3–1.7] vs 1.2 [1.0–1.5] Wt/kg respectively (p<0.05). In the AIT group TLC increased significantly from 3.13 [2.63–4.05] to 4.14 [3.91–4.87] L (p<0.05) then in ACT group: from 3.19 [2.82–3.74] to 3.21 [3.03–3.57] L (p>0.05). FEV1 had no changes in both groups. Both programs reduced anxiety and depression, systolic and diastolic blood pressure and increased quality of life. Conclusion AIT as compared to ACT provided a more pronounced training effect on the cardiorespiratory system due to high-intensity loading phases. Therefore, AIT is more preferable in cardiac rehabilitation of patients with MI after primary angioplasty of the infarct-related vessel. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Ivanovo State Medical Academy

The need for adaptation of existing cardiac rehabilitation programs for elderly myocardial infarction patients is dictated both by the progressive aging of the Russian population and by the higher prevalence of cardiovascular diseases among them, including coronary heart disease in the form of a previous myocardial infarction. The necessary condition for successful realization of the set task is to take into account the identified features of myocardial infarction patients of older age group, who are admitted for cardiac rehabilitation. Aim. To give a comparative characteristic of patients with myocardial infarction of older and middle age groups admitting to the third stage of cardiac rehabilitation in the Ivanovo State Medical Academy clinic (ISMA). Material and methods. 85 patients with myocardial infarction were examined, they were admitted from primary vascular centers for a three-week course of cardiac rehabilitation at the ISMA clinic. According to the WHO age periodization, 2 groups were identified: 40 middle-aged patients (Group 1); 45 elderly patients (Group 2). An individual cardiac rehabilitation program was developed for each patient, which included daily controlled physical training, dosed walking, staircase walking at individually calculated pace, correction of the revealed cardiovascular risk factors, information support, adequate drug therapy, correction of psychological disorders if needed. Clinical features of the disease course, tolerance to physical activity were analyzed in both groups. Results. The characteristic features of MI patients of the older age group in comparison with the middle-aged patients admitted to the third stage of cardiac rehabilitation in the ISMA clinic are: dominance of non-working pensioners; high polymorbidity; higher frequency of development of repeated MI without ST-segment elevation on ECG; predominance of complicated formation of left ventricular aneurysms and heart rhythm disturbances forms of MI; low frequency coronary revascularization in the acute period of the course of the disease; prevalence of persons with signs of diastolic heart failure with preserved or slightly reduced left ventricular ejection fraction; lower exercise tolerance. After completion of cardiac rehabilitation course in patients of older age group the increase in 6MWT distance covered was 18%, while in middle-aged group it was only 8.3%. The implementation of the three–week rehabilitation program led to an increase in the number of patients with 1 FC of coronary heart disease due to a decrease in the number of patients with 3 and 4 FC of coronary heart disease in the middle-aged group and 4 FC of coronary heart disease in the elderly. Conclusion. The identified features specify the necessity to include methods of concomitant pathology correction, individual approach to the choice of physical activity programs based on a thorough clinical assessment, including risk stratification of post-rehabilitation complications and rehospitalizations in the cardiac rehabilitation program. A three-week program of the third stage of cardiac rehabilitation of MI patients increases exercise tolerance to a greater extent in elderly patients compared with middle-aged patients.