Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume

Abstract

Objective: To assess whether exercise volume during phase II rehabilitation affects long-term clinical benefits in patients with coronary artery disease.

Design: Prospective randomized clinical trial with long-term follow-up.

Setting: Hospital outpatient clinic.

Subjects: Coronary artery disease patients (age 65 ± 9 years, 82% males) attending a phase II rehabilitation programme were randomized into two groups of exercise volumes: 40- versus 60-minute training sessions. Patients exercised for three days per week for seven weeks, at 65% of baseline oxygen uptake capacity. Next, they were followed up for 18 months. Out of 165 patients with coronary artery disease who completed the exercise intervention, 119 attended the 18-month follow-up assessment.

Main measurements: Body anthropometrics, resting haemodynamics, blood lipid profile, glycaemia, and C-reactive protein level, smoking behaviour, habitual physical activity, cardiovascular disease incidence and mortality.

Results: In total population, a significant worsening of various cardiovascular disease risk factors was found at 18 months follow-up (P<0.05), and few patients (27% of total group) adhered to the recommended minimal physical activity level. No difference in change of body anthropometrics, resting haemodynamics, blood lipid profile, glycaemia, and C-reactive protein level, and smoking behaviour was seen between different exercise volumes (P>0.05). In addition, total cardiovascular disease incidence (13% versus 22% in 40- versus 60-minute group, respectively) and habitual physical activity were not different between groups (P>0.05).

Conclusion: In patients with coronary artery disease following cardiac rehabilitation, the cardiovascular disease risk profile worsened significantly during long-term follow-up. A smaller exercise volume during phase II rehabilitation generated equal long-term clinical benefits compared to a greater exercise volume.

Get full access to this article

View all access options for this article.

References

Giannuzzi P. , Temporelli PL , Marchioli R. et al. Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian cardiac rehabilitation network. Arch Intern Med 2008 ; 168: 2194-204.

Dendale P. , Berger J. , Hansen D. , Vaes J. , Benit E. , Weymans M. Cardiac rehabilitation reduces the rate of major adverse cardiac events after percutaneous coronary intervention. Eur J Cardiovasc Nurs 2005; 4: 113-16.

Lisspers J. , Sundin O. , Ohman A. , Hofman-Bang C. , Ryden L. , Nygren A. Long-term effects of lifestyle behavior change in coronary artery disease: effects of recurrent coronary events after percutaneous coronary events. Health Psychol 2005; 24: 41-48.

Belardinelli R. , Paolini I. , Cianci G. , Piva R. , Georgiou D. , Purcaro A. Exercise training intervention after coronary angioplasty: the ETICA trial . J Am Coll Cardiol 2001; 37: 1891-900.

Hedback B. , Perk J. , Hornblad M. , Ohlsson U. Cardiac rehabilitation after coronary artery bypass surgery: 10-year results on mortality, morbidity and readmissions to hospital. J Cardiovasc Risk 2001; 8: 153-58.

Vanhees L. , Fagard R. , Thijs L. , Amery A. Prognostic value of training-induced change in peak exercise capacity in patients with myocardial infarcts and patients with coronary bypass surgery. Am J Cardiol 1995; 76: 1014-19.

Milani RV , Lavie CJ The effects of body composition changes to observed improvements in cardiorespiratory parameters after exercise training with cardiac rehabilitation. Chest 1998; 113: 599-601.

Taylor RS , Brown A. , Ebrahim S. et al. Exercise-based rehabilitation for patients with coronary artery disease: systematic review and meta-analysis of randomized controlled trials . Am J Med 2004; 116: 682-92.

Sarrafzadegan N. , Rabiei K. , Kabir A. et al. Changes in lipid profile of patients referred to a cardiac rehabilitation programme. Eur J Cardiovasc Prev Rehabil 2008; 15: 467-72.

10.

Soja AM , Zwisler AD , Frederiksen M. et al. Use of intensified comprehensive cardiac rehabilitation to improve risk factor control in patients with type 2 diabetes mellitus or impaired glucose tolerance - the randomized DANish stUdy of impaired glucose metabolism in the settings of cardiac rehabilitation (DANSUK) study. Am Heart J 2007; 153: 621-28.

11.

Caulin-Glaser T. , Falko J. , Hindman L. , La Monde M. , Snow R. Cardiac rehabilitation is associated with an improvement of c-reactive protein levels in both men and women with cardiovascular disease. J Cardiopulm Rehabil Prev 2005; 25: 332-36.

12.

Fletcher GF , Balady GJ , Amsterdam EA et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001; 104: 1694-740.

13.

Hansen D. , Dendale P. , Berger J. , Meeusen R.

Rehabilitation in cardiac patients: what do we know about training modalities?

Sports Med 2005; 35: 1063-84.

14.

Hansen D. , Dendale P. , Berger J. et al. Importance of exercise session duration in the rehabilitation of coronary artery disease patients. Eur J Cardiovasc Prev Rehabil 2008; 15: 453-59.

15.

Ross WD , Marfell-Jones MJ Kinanthropometry. In MacDougal JD. ed. Physiological testing of the high-performance athlete, second edition. Canadian Association of Sports Sciences, Sports Medicine Council of Canada , 1991.

16.

Craig CL , Marshall AL , Sjostrom M. et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381-95.

17.

Willich SN , Muller-Nordhorn J. , Kulig M. et al. Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease A prospective cohort study. Eur Heart J 2001; 22: 307-13.

18.

Reid RD , Morrin LI , Pipe AL et al. Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) Study. Eur J Cardiovasc Prev Rehabil 2006; 13: 529-37.

19.

Arrigo I. , Brunner-LaRocca H. , Lefkovits M. , Pfisterer M. , Hoffmann A. Comparative outcome one year after formal cardiac rehabilitation: the effects of a randomized intervention to improve exercise adherence. Eur J Cardiovasc Prev Rehabil 2008; 15: 306-11.

20.

Moore SM , Charvat JM , Gordon NH et al. Effects of a CHANGE intervention to increase exercise maintenance following cardiac events. Ann Behav Med 2006 ; 31: 53-62.

21.

Hanssen TA , Nordrehaug JE , Eide GE , Hanestad BR Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention. Eur J Cardiovasc Prev Rehabil 2007; 14: 429-37.

22.

De Velasco JA , Rodriguez JA , Ridocci F. , Aznar J. Action to improve secondary prevention in coronary heart disease patients: one-year follow-up of a shared care programme . Eur Heart J 2004; 6: J27-32.

23.

Lear SA , Ignaszewski A. , Linden W. et al. The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial. Eur Heart J 2003; 24: 1920-27.