Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)

摘要

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeakrose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.