Aim. The aim of our study was to conduct a comparative analysis of aerobic high-intensity interval training and constant moderate intensity training in cardiac rehabilitation of adult patients after open-heart surgery, namely after coronary artery bypass grafting (CABG). Material and methods. 137 patients after CABG were included in the study. 90.4% of patients were consider as class I of chronic heart failure after surgery. Cardiorespiratory trainings were initiate in 4 weeks after surgery, using cycling by veloergometers. Two groups were compare according to rehabilitation programs: one carried out constant aerobic trainings of moderate and medium intensity, and the other, aerobic high-intensity interval trainings. Supervised trainings were carry out for 150 minutes per week. Total length of trainings was 47 weeks. Long-term trainings were distantly monitore. Results. Ergospirometric results as well as results of echocardiography were significantly improve after training course. These results were more significant in high-intensity interval training group, compared to moderate intensity-training group. VO2, heart rate and training power significantly improved. Body mass index significantly diminished in high-intensity interval training group, compared to moderate intensity-training group. In 7 weeks after training ominously decreased blood triglycerides and increased high-density lipoproteins. Conclusion. Cardiorespiratory trainings ameliorate mitochondrial biogenesis, carbohydrate and lipid metabolism, promote to reduce abdominal obesity and other crucial risk factors of coronary patients. Aerobic high-intensity interval cardiac trainings are as safe as moderate intensity cardiac trainings, and in some issues, they outperform moderate intensity cardiac trainings.
Currently, it is promising to study the effect of cardiorehabilitation on the risk of cardiovascular events, re-hospitalization and mortality in patients with cardiovascular diseases, namely in adult patients with myocardial infarction, angina pectoris, who underwent coronary artery bypass grafting and percutaneous coronary interventions. It was found that the number of attendances at cardiorehabilitation sessions affects mortality from cardiovascular diseases. In different countries, there is a problem of low patient adherence to outpatient clinics and cardiorehabilitation courses, which depends on many factors. This article discusses the participation of patients with cardiovascular diseases in cardiorehabilitation programs and the search for new approaches to activate the attendance of cardiorehabilitation courses. One of the relatively new methods is the use of a mobile phone with an appropriate application to increase motivation for physical training, which, in addition to clinical significance, can also become cost-effective for patients. In general, cardiorehabilitation programs should not be episodic events, because phasing and continuity are important conditions for the success and effectiveness of such programs. The main goal of any preventive intervention is to develop stable stereotypes of desirable behavior (useful habits) that will remain with the patient for life.
Background High-intensity interval training is emerging as a potential time efficient strategy in contemporary cardiac rehabilitation. According to current guidelines 150 minutes of moderate physical activity per week is reduced by half to 75 minutes if the week's activity is done at a vigorous intensity. Objective: The main goal of our study was to assess and compare high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) within cardiac rehabilitation after coronary artery bypass grafting. Methods Sixty three patients (48 male, 15 female, at the mean age of 57±12 years) after coronary artery bypass grafting were recruited into exercise training program on cycle ergometer. The training course started 2 weeks after surgery, lasted 4 weeks and then continued in an outpatient care after 3–6 months. MICT was considered as 50% to 75% of VO2 max (maximal oxygen consumption) or 50–75% of heart rate reserve, while HIIT was considered as ≥85% of VO2 max or ≥85% of heart rate reserve. Training protocols included constant load and ramp interval programs. Control group comprised 40 patients without exercise training program. The safety of HIIT/MICT was the primary end point in our study. Secondary end-points included body mass index, echo and hemodynamic parameters, NT-proBNP and HbA1c levels along with standard cardiorespiratory fitness indicators. Results Significant increase in anaerobic threshold (by 16.9%), VO2 max (by 18.6%) and tolerance of physical load in MET (by 6.4%) were mentioned in study groups compared to equivalent measurements in control group (9.7%, 7.9% and 5.4% correspondingly). Substantial changes were also observed in following variables compared to control group: body mass index reduced (p=0.0032), end diastolic diameter decreased (p=0.0315), LV ejection fraction improved (p=0.045), NT-proBNP reduced (p=0.0015) and HbA1c improved (p=0.023). While analyzing aerobic capacity alterations due to HIIT versus MICT by standardized mean difference (95% CI), HIIT was significantly superior to MICT. Aerobic capacity covered VO2 max (ml/kg/min), anaerobic threshold (%), work rate (Wt) and EQo2=VE/Vo2. Conclusions High-intensity interval training proved to be as safe as a moderate-intensity training in patients after coronary artery bypass grafting. It appeared to be significantly superior to moderate-intensity continuous training in improving cardiorespiratory fitness. Obtained results allow implementing aerobic interval training individually after open-heart surgery and shorten rehabilitation period.
Introduction. A number of studies have found a reduction in the risk of rehospitalization during cardiorehabilitation after heart surgery. The purpose of the training program for cardiorehabilitation after cardiac surgery is to optimize energy supply systems. Depending on the intensity and duration of the load being performed, energy supply systems 'switch on' in the body.Purpose of the study: to study the effectiveness of the optimal cardiorehabilitation training program on the aerobic energy supply system in cardiac surgery patients.Materials and methods. In our study, we examined 47 patients who underwent aortic valve replacement under cardiopulmonary bypass, with an EC duration of 52±20.5 minutes. The patients were divided into two groups: the control group (n=23), who underwent a course of cardiorehabilitation on exercise bikes with constant aerobic training of moderate and medium intensity, at the age of 50.2±3.4 years, and the main group (n=24) – with a course of cardiorehabilitation on exercise bikes with aerobic high-intensity interval physical training, at the age of 51.2±2.8 years (p>0.05). Gender was not taken into account. Anaerobic training was carried out on SCHILLER exercise bikes from day 14 after aortic valve replacement. The load power ranged from 25 to 70–95 watts. Before cardiac rehabilitation, the level of lactate, glucose, pH, pCO2, pO2, BE, lipid profile, BNP in the blood before and after ergometric exercise, data on external respiration, heart rate and blood pressure were assessed. After the course of rehabilitation, the above parameters were evaluated. The duration of the course was 2 weeks. Results. When evaluating the indicators at the end of the course of cardiorehabilitation was being done, a significant decrease in the controlled parameters after training was observed in both groups, and largely in the group of high-intensity interval physical training than in the group of constant training of medium intensity.Conclusions. Analysis of the results showed that properly selected parameters of high-intensity interval training could optimize anaerobic glycolysis in patients undergoing operations under cardiopulmonary bypass, as well as increase the functionality of patients. As more and more repetitions of the load are performed, interval training becomes more and more aerobic.
Aim. To develop novel strategies of patients selection and risk stratification after coronary artery bypass surgery before starting aerobic cardiorespiratory training programs. Material and methods. One hundred thirty seven patients 4 weeks after coronary artery bypass surgery were included in our study. RARE scale (risk of activity related events), ergospirometric test, FIT treadmill score and certain laboratory parameters like hemoglobin and alaninaminotransferase were used. Results. Logical interdependence is revealed between certain indicators of cardiorespiratory capacity and risk of developing unfavorable events due to aerobic training activities. Comprehensive protocol is developed based on multifactorial regression analysis, which allows to differentiate patients into low and high class of readiness to physical activities, including aerobic cardiorespiratory training programs. Conclusion. The protocol includes following variables METs, RARE scale, FIT treadmill score, left ventricular ejection fraction, hemoglobin and alaninaminotransferase levels. It is very userfriendly, easy, practical and efficient.
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