Cardiac Rehabilitation to Improve Physical Functioning in Refractory Angina: A Pilot Study

Abstract

Objectives: Refractory angina patients suffer debilitating chest pain despite optimal medical therapy and previous cardiovascular intervention. Cardiac rehabilitation is often not prescribed due to a lack of evidence regarding potential efficacy and patient suitability. A randomised controlled study was undertaken to explore the impact of cardiac rehabilitation on cardiovascular risk factors, physical ability, quality of life and psychological morbidity among refractory angina sufferers. Methods: Forty-two refractory angina patients (65.1 ± 7.3 years) were randomly assigned to an 8-week Phase III cardiac rehabilitation program or symptom diary control. Physical assessment, Progressive Shuttle Walk test, Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, the York Angina Beliefs scale, ENRICHD Social Support Instrument and SF-36 were completed before and after intervention and at 8-week follow-up. Results: Following cardiac rehabilitation, patients demonstrated improved physical ability compared with controls in Progressive Shuttle Walk level attainment (p = 0.005) and total distance covered (p = 0.015). Angina frequency and severity remained unchanged in both groups, with the control demonstrating worsening SF-36 pain scale (63.43 ± 22.28 vs. 55.46 ± 23.98, p = 0.025). Cardiac rehabilitation participants showed improved Health Anxiety Questionnaire reassurance (1.71 ± 1.72 vs. 1.14 ± 1.23, p = 0.026) and York Beliefs anginal threat perception (12.42 ± 4.58 vs. 14.35 ± 4.73, p = 0.05) after cardiac rehabilitation. Physical measures were broadly unaffected. Conclusions: Cardiac rehabilitation can be prescribed to improve physical ability without affecting angina frequency or severity among patients with refractory angina.

Exercise Training for Refractory Angina: Why Does It Work?

“…The approximately 25% increment in walking distance (and increase in walking speed) documented by Asbury et al [14] is consistent with the adaptive responses to exercise known to occur during cardiac rehabilitation, beyond the effects of maximal medication and revascularization. It is possible that even further benefit might be achieved with longer periods of training [19,20].…”

“…In this issue of Cardiology , Asbury et al [14] present results from a pilot study of cardiac rehabilitation in patients with stable but refractory angina who have been maximally treated in the current therapeutic era and are not candidates for further revascularization. They show that cardiac rehabilitation in these patients can improve physical capacity as measured by walking time and distance without adverse effects on the frequency or severity of angina, and with concomitant improvement in psychological well-being and quality of life.…”

Exercise Training for Refractory Angina: Improving the Coronary Collateral Circulation

“…We commend Asbury et al [1] for their very interesting pilot study on the effect of exercise training on refractory angina pectoris. This study was done in the context of a cardiac rehabilitation programme.…”

“…The study of Asbury et al [1] is accompanied by a very well-considered editorial which addresses the question of how physical exercise might reduce angina symptoms [4]. We believe that another key mechanism of physical exercise should be highlighted.…”

Author’s Reply

“…We thank the readers for their interest in our article [1] and for their insightful comments. We used cardiac rehabilitation in our study as it is a prescribable and reproducible form of exercise that suited the needs of a controlled research study.…”