Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial

Introduction Sleep deprivation is common after coronary artery bypass grafting (CABG). It is mostly managed well by exercise. The number of reported post-CABG cases that respond negatively to exercise is scanty. The etiology is usually associated with the underlying sleep pathology, and how it responds to exercise. Cases with undiagnosed central sleep apnea post CABG have not been reported before. Case description A medically stable male patient, 63 years old, hypertensive, but not diabetic, had entered coronary artery bypass grafting (CABG) 8 weeks before attending the outpatient cardiac rehabilitation unit and was referred for a cardiac rehabilitation program at this time. He entered a study in the cardiac rehabilitation center utilizing either aerobic or combined aerobic and resistance training for 10 weeks to improve sleep architecture and functional capacity post-CABG. After randomization, he entered the group doing combined aerobic and resistance exercises. All of the patients in this group improved except him, his sleep quality worsened, but his functional capacity improved. After a complete analysis of sleep on polysomnography, it was revealed that the patient had central sleep apnea that was mostly worsened by resistance training. The patient was withdrawn from the study by the 8th week, and his sleep condition improved gradually. After then, he was asked to attend the cardiac rehabilitation center again to share in aerobic exercise, having evidence that central sleep apnea does not respond negatively to this form of training. After 12 months of follow-up, the patient still shows no signs of sleep deprivation. Conclusion Sleep deprivation is prevalent in post-CABG patients, but with different presentations and it can generally improve by exercise. Identification of the underlying cause of the sleeping difficulty is a cornerstone of targeted treatment.

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“…The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in functional capacity. 7 9…”

Section: Diagnostic Assessmentmentioning

confidence: 99%

Would the Actigraph Always be Sufficient for Sleep Analysis in Exercise-Based Studies? A Case Report of Negative Response of Sleep to Exercise

Atef

Gaber

2023

Sleep Sci

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“…This was a pretest-posttest design study, nested within a pilot randomized controlled trial, 14 Participants were in the resistance training arm of the Supervised Early Resistance Training study. 14 The protocol of the primary study, detailing recruitment, inclusion and exclusion criteria, randomization, allocation concealment and blinding, has been described previously. 15 Written informed participant consent was obtained prior to data collection.…”

Section: Designmentioning

confidence: 99%

“…Data from participants in the resistance training group of a pilot randomized controlled trial were analyzed in this study. 14 Participants were adults undergoing cardiac surgery via median sternotomy at the Royal Melbourne or Melbourne Private hospitals between April 16, 2018, and August 31, 2019. Eligibility criteria for the pilot randomized controlled trial included (1) first elective cardiac surgery via median sternotomy, (2) no diagnosed cognitive impairment, (3) no musculoskeletal conditions limiting exercise ability, (4) sufficient English to provide informed consent and complete surveys, and (5) able to attend the exercise testing site for exercise and/or testing sessions.…”

Section: Participantsmentioning

confidence: 99%

“…Eligibility criteria for the pilot randomized controlled trial included (1) first elective cardiac surgery via median sternotomy, (2) no diagnosed cognitive impairment, (3) no musculoskeletal conditions limiting exercise ability, (4) sufficient English to provide informed consent and complete surveys, and (5) able to attend the exercise testing site for exercise and/or testing sessions. 14,15 Exercise Intervention Participants in the resistance training group completed a twice-weekly, moderate-intensity resistance training program for 12 weeks under the supervision of an accredited exercise physiologist. The 6 dynamic upper limb exercises performed on cam-based machines (ie, machines with a cam device that distribute the load evenly throughout the entire exercise range of movement) that were assessed in this study consisted of a seated row, shoulder pulldown, shoulder press, triceps dip, lateral raise, and bicep curl.…”

Section: Participantsmentioning

confidence: 99%

“…The exercise intervention was previously reported. 14,15 Each cam-based resistance machine was adjusted for each participant to ensure optimal comfort and uniformity of the testing set-up and exercise performance (Supplementary Materials A & B).…”

Section: Participantsmentioning

confidence: 99%

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SAfety and Feasibility of EArly Resistance Training After Median Sternotomy: The SAFE-ARMS Study

et al. 2022

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Objective The purpose of this study was to determine the safety and feasibility of subacute upper limb resistance exercise on sternal micromotion and pain and the reliability of sternal ultrasound assessment following cardiac surgery via median sternotomy. Methods This experimental study used a pretest-posttest design to investigate the effects of upper limb resistance exercise on the sternum in patients following their first cardiac surgery via median sternotomy. Six bilateral upper limb machine-based exercises were commenced at a base resistance of 20 lb (9 kg) and progressed for each participant. Sternal micromotion was assessed using ultrasound at the mid- and lower sternum at 2, 8, and 14 weeks postsurgery. Intrarater and interrater reliability was calculated using intraclass correlation coefficients (ICCs). Participant-reported pain was recorded at rest and with each exercise using a visual analogue scale. Results Sixteen adults (n = 15 males; 71.3 [SD = 6.2] years of age) consented to participate. Twelve participants completed the study, 2 withdrew prior to the 8-week assessment, and 2 assessments were not completed at 14 weeks due to assessor unavailability. The highest median micromotion at the sternal edges was observed during the bicep curl (median = 1.33 mm; range = −0.8 to 2.0 mm) in the lateral direction and the shoulder pulldown (median = 0.65 mm; range = −0.8 to 1.6 mm) in the anterior–posterior direction. Furthermore, participants reported no increase in pain when performing any of the 6 upper limb exercises. Interrater reliability was moderate-to-good for both lateral-posterior (ICC = 0.73; 95% CI = 0.58–0.83) and anterior–posterior micromotion (ICC = 0.83; 95% CI = 0.73–0.89) of the sternal edges. Conclusion Bilateral upper limb resistance exercises performed on cam-based machines do not result in sternal micromotion exceeding 2.0 mm or an increase in participant-reported pain. Impact Upper limb resistance training commenced as early as 2 weeks following cardiac surgery via median sternotomy and performed within the safe limits of pain and sternal micromotion appears to be safe and may accelerate postoperative recovery rather than muscular deconditioning.

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The influence of sleep disorders on perioperative neurocognitive disorders among the elderly: A narrative review

Chen,

Zhai,

Lan

et al. 2024

Ibrain

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This review comprehensively assesses the epidemiology, interaction, and impact on patient outcomes of perioperative sleep disorders (SD) and perioperative neurocognitive disorders (PND) in the elderly. The incidence of SD and PND during the perioperative period in older adults is alarmingly high, with SD significantly contributing to the occurrence of postoperative delirium. However, the clinical evidence linking SD to PND remains insufficient, despite substantial preclinical data. Therefore, this study focuses on the underlying mechanisms between SD and PND, underscoring that potential mechanisms driving SD‐induced PND include uncontrolled central nervous inflammation, blood–brain barrier disruption, circadian rhythm disturbances, glial cell dysfunction, neuronal and synaptic abnormalities, impaired central metabolic waste clearance, gut microbiome dysbiosis, hippocampal oxidative stress, and altered brain network connectivity. Additionally, the review also evaluates the effectiveness of various sleep interventions, both pharmacological and nonpharmacological, in mitigating PND. Strategies such as earplugs, eye masks, restoring circadian rhythms, physical exercise, noninvasive brain stimulation, dexmedetomidine, and melatonin receptor agonists have shown efficacy in reducing PND incidence. The impact of other sleep‐improvement drugs (e.g., orexin receptor antagonists) and methods (e.g., cognitive‐behavioral therapy for insomnia) on PND is still unclear. However, certain drugs used for treating SD (e.g., antidepressants and first‐generation antihistamines) may potentially aggravate PND. By providing valuable insights and references, this review aimed to enhance the understanding and management of PND in older adults based on SD.

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Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial

Cited by 7 publications

References 34 publications

Would the Actigraph Always be Sufficient for Sleep Analysis in Exercise-Based Studies? A Case Report of Negative Response of Sleep to Exercise

Would the Actigraph Always be Sufficient for Sleep Analysis in Exercise-Based Studies? A Case Report of Negative Response of Sleep to Exercise

SAfety and Feasibility of EArly Resistance Training After Median Sternotomy: The SAFE-ARMS Study

The influence of sleep disorders on perioperative neurocognitive disorders among the elderly: A narrative review

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