Exercise-based Cardiac Rehabilitation in Coronary Disease: Training Impulse or Modalities?

Leprêtre, Pierre-Marie; Ghannem, M.; Bulvestre, M.; Ahmaı̈di, Saı̈d; Delanaud, Stéphane; Weissland, Thierry; Lopes, Philippe

doi:10.1055/s-0042-112591

Cited by 12 publications

(10 citation statements)

References 33 publications

(95 reference statements)

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“…Seven trials (34,35,37,50,51,54,66) described methods of allocation concealment. Twelve trials (30,34,35,37,43,47,50,51,57,60,64,67) reported blinding methods clearly in the articles or the protocol were assessed as low risk of bias on blinding to participants and personnel. Eleven trials (30,33,35,37,43,50,51,58,60,64) used the third party for analysis to evaluate the outcome indicators were assessed as low risk of bias on blinding of outcome assessors.…”

Section: Risk Of Bias Of Included Trialsmentioning

confidence: 99%

Efficacy and Safety of Resistance Training for Coronary Heart Disease Rehabilitation: A Systematic Review of Randomized Controlled Trials

Fan

et al. 2021

Front. Cardiovasc. Med.

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Background: Resistance training (RT), as part of exercise prescriptions during cardiac rehabilitation for patients with cardiovascular disease (CVD), is often used as a supplement to aerobic training (AT). The effectiveness and safety of RT has not been sufficiently confirmed for coronary heart disease (CHD).Objective: To provide updated evidence from randomized clinical trials (RCTs) on efficacy and safety of RT for the rehabilitation of CHD.Method: Three English and four Chinese electronic literature databases were searched comprehensively from establishment of each individual database to Dec, 2020. RCTs which compared RT with AT, no treatment, health education, physical therapy, conventional medical treatment (or called usually care, UC) in CHD were included. Methodological quality of RCTs extracted according to the risk of bias tool described in the Cochrane handbook. The primary outcomes were the index of cardiopulmonary exercise testing and the quality of life (QOL). The secondary outcomes included the skeletal muscle strength, aerobic capacity, left ventricular function and structure.Results: Thirty-right RCTs with a total of 2,465 participants were included in the review. The pooling results suggest the RT+AT is more effective in the cardiopulmonary exercise function (peak oxygen uptake, peak VO2) [MD, 1.36; 95% CI, 0.40–2.31, P = 0.005; I2 = 81%, P < 0.00001], the physical score of QOL [SMD, 0.71; 95% CI, 0.33–1.08, P = 0.0003; I2 = 74%, P < 0.0001] and global score of QOL [SMD, 0.78; 95% CI, 0.43–1.14, P < 0.0001; I2 = 60%, P = 0.03], also in the skeletal muscle strength, the aerobic capacity and the left ventricular ejection fraction (LVEF) than AT group. However, there is insufficient evidence confirmed that RT+AT can improve the emotional score of QOL [SMD, 0.27; 95% CI, −0.08 to 0.61, P = 0.13; I2 = 70%, P = 0.0004] and decrease left ventricular end-diastolic dimension (LVEDD). No significant difference between RT and AT on increasing peak VO2 [MD, 2.07; 95% CI, −1.96 to 6.09, P = 0.31; I2 = 97%, P < 0.00001], the physical [SMD, 0.18; 95% CI, −0.08 to 0.43, P = 0.18; I2 = 0%, P = 0.51] and emotional [SMD, 0.22; 95% CI, −0.15 to 0.59, P = 0.24; I2 = 26%, P = 0.25] score of QOL. Moreover, the pooled data of results suggest that RT is more beneficial in increasing peak VO2 [MD, 3.10; 95% CI, 2.52–3.68, P < 0.00001], physical component [SMD, 0.85; 95% CI, 0.57–1.14, P < 0.00001; I2 = 0%, P = 0.64] and the emotional conditions [SMD, 0.74; 95% CI, 0.31–1.18, P = 0.0009; I2 = 58%, P = 0.12] of QOL and LVEF, and decreasing LVEDD than UC. Low quality evidence provided that RT had effect in decreasing rehospitalization events than UC [RR, 0.33, 95% CI 0.17 to 0.62, P = 0.0006; I2 = 0%, P = 0.64]. There is no significant difference in the safety of RT compared to AT.Conclusions: RT combined with AT is more beneficial than AT alone for CHD. RT can effectively improve the capacity of exercise and the QOL compared with UC. But the difference between RT and AT is still unknown. More high-quality and large-sample studies are needed to confirm our findings.

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Section: Risk Of Bias Of Included Trialsmentioning

confidence: 99%

Efficacy and Safety of Resistance Training for Coronary Heart Disease Rehabilitation: A Systematic Review of Randomized Controlled Trials

Fan

et al. 2021

Front. Cardiovasc. Med.

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“…As indicated from existing studies, aerobic training combined with resistance exercise and aerobic training can significantly improve the cardiopulmonary response in patients with CHD 7 . Hansen et al's study 8 reported that aerobic combined with resistance exercise exerts a better effect on exercise therapy for patients with CHD than aerobic training independently.…”

Section: Introductionmentioning

confidence: 98%

“…And anaerobic threshold level acts as a vital reference index for the formulation of exercise prescriptions for CHD patients. Resistance exercise can help to increase myocardial perfusion and improves myocardial ischemia while improving muscle mass and exercise ability 7 …”

Section: Introductionmentioning

confidence: 99%

Rehabilitation effects of circuit resistance training in coronary heart disease patients: A systematic review and meta‐analysis

Wang

et al. 2022

Clinical Cardiology

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Background and Hypothesis The rehabilitation effect of circuit resistance training in coronary heart disease (CHD) patients remains unclear. We perform this review to examine the rehabilitation effect of circuit resistance training in CHD patients and to provide a basis for the formulation of reasonable individual exercise prescriptions for CHD patients. Methods Randomized controlled trials (RCTs) were searched on PubMed, Web of Science, The Cochrane Library, Embase, Clinical Trials, and CNKI. About 1232 studies were identified. Nine RCTs were finally used for the present meta‐analysis to determine the rehabilitation effect of circuit resistance training in CHD patients, compared to aerobic training. Individuals enrolled for the studies were at a mean age of 60.5 years old and were all CHD patients. Following the PRISMA guidelines, we extracted basic information about the study and patient characteristics, as well as measurements (e.g., the peak oxygen uptake, the body mass index [BMI], the body fat percentage, the systolic blood pressure, the total cholesterol, and triglycerides). Subsequently, this meta‐analysis determined the overall effect by using standardized mean difference (SMD) and 95% confidence interval (CI). Results Compared with aerobic training, circuit resistance training significantly decrease the BMI and the body fat percentage. Conclusions As suggested from the present meta‐analysis of RCTs, circuit resistance training is effective in improving the BMI and the body fat percentage in CHD patients and may help delay the progression of CHD. CRT has the advantage of lower load in most cases with a similar effect.

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“…Cardiac rehabilitation programs are aimed at limiting the psychological and physiological stresses of cardiovascular disease, optimizing cardiovascular risk reduction, reducing disability, and improving cardiovascular function to achieve the highest quality of life possible in patients ( 12 ). However, Leprêtre et al ( 13 ) emphasized that the numerous models of care for heart disease could explain the low-level evidence for the beneficial effects of ECR ( 14 ). Moreover, ECR is, to our knowledge, mostly proposed in secondary prevention for heart transplant candidates ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Benefits of a Supervised Ambulatory Outpatient Program in a Cardiovascular Rehabilitation Unit Prior to a Heart Transplant: A Case Study

Poty

Krim²,

Lopes

et al. 2022

Front. Cardiovasc. Med.

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Preoperative peak oxygen uptake (V.O2peak) and ventilatory efficiency (V.E/V.CO2slope) are related to the vital prognosis after cardiac transplantation (HTx). The objective of our study was to evaluate the effects of exercise-based cardiac rehabilitation (ECR) program on the preoperative exercise capacity of a HTx candidate. A male patient, aged 50–55 years, with chronic heart failure was placed on the HTx list and performed 12 weeks of intensive ECR (5 sessions-a-week). Our results showed that the cardiac index continuously increased between the onset and the end of ECR (1.40 vs. 2.53 L.min–1.m2). The first 20 sessions of ECR induced a V.O2peak increase (15.0 vs. 19.3 ml.min–1.kg–1, corresponding to 42.0 and 53.0% of its maximal predicted values, respectively). The peak V.O2 plateaued between the 20th and the 40th ECR session (19.3 vs. 19.4 ml.min–1.kg–1) then progressively increased until the 60th ECR session to reach 25.7 ml.min–1.kg–1, i.e., 71.0% of the maximal predicted values. The slope of V.E/V.CO2 showed a biphasic response during the ECR program, with an increase between the onset and the 20th ECR session (58.02 vs. 70.48) and a decrease between the 20th and the 40th ECR session (70.48 vs. 40.94) to reach its minimal value at the 60th ECR session (31.97). After the first 40 sessions of the ECR program, the Seattle Heart Failure Model score predicted median survival time was estimated at 7.2 years. In conclusion, the improvement in exercise capacity and cardiorespiratory function following the ECR helped delay the heart transplant surgery in our patient awaiting heart transplantation.

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Exercise-based Cardiac Rehabilitation in Coronary Disease: Training Impulse or Modalities?

Cited by 12 publications

References 33 publications

Efficacy and Safety of Resistance Training for Coronary Heart Disease Rehabilitation: A Systematic Review of Randomized Controlled Trials

Efficacy and Safety of Resistance Training for Coronary Heart Disease Rehabilitation: A Systematic Review of Randomized Controlled Trials

Rehabilitation effects of circuit resistance training in coronary heart disease patients: A systematic review and meta‐analysis

Benefits of a Supervised Ambulatory Outpatient Program in a Cardiovascular Rehabilitation Unit Prior to a Heart Transplant: A Case Study

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