Exercise Training and Interventions for Coronary Artery Disease

Potential preservative mechanisms of cardiac rehabilitation pathways on endothelial function in coronary heart disease

Cardiac rehabilitation, a comprehensive exercise-based lifestyle and medical management, is effective in decreasing morbidity and improving life quality in patients with coronary heart disease. Endothelial function, an irreplaceable indicator in coronary heart disease progression, is measured by various methods in traditional cardiac rehabilitation pathways, including medicinal treatment, aerobic training, and smoking cessation. Nevertheless, studies on the effect of some emerging cardiac rehabilitation programs on endothelial function are limited. This article briefly reviewed the endothelium-beneficial effects of different cardiac rehabilitation pathways, including exercise training, lifestyle modification and psychological intervention in patients with coronary heart disease, and related experimental models, and summarized both uncovered and potential cellular and molecular mechanisms of the beneficial roles of various cardiac rehabilitation pathways on endothelial function. In exercise training and some lifestyle interventions, the enhanced bioavailability of nitric oxide, increased circulating endothelial progenitor cells (EPCs), and decreased oxidative stress are major contributors to preventing endothelial dysfunction in coronary heart disease. Moreover, the preservation of endothelial-dependent hyperpolarizing factors and inflammatory suppression play roles. On the one hand, to develop more endothelium-protective rehabilitation methods in coronary heart disease, adequately designed and sized randomized multicenter clinical trials should be advanced using standardized cardiac rehabilitation programs and existing assessment methods. On the other hand, additional studies using suitable experimental models are warranted to elucidate the relationship between some new interventions and endothelial protection in both macro- and microvasculature.

Effects of cardiac telerehabilitation during COVID-19 on cardiac hemodynamic and functional responses and quality of life: a randomized controlled trial

Purpose

This study aimed to assess the effects of a home-based cardiac telerehabilitation (HBCT) on cardiac hemodynamic and functional responses and health-related quality (HRQOL) of the patients undergoing percutaneous coronary intervention (PCI).

Materials and methods

In this randomized controlled clinical trial, single-blinded. One hundred-fifty-five patients (mean age: 50.41±7.3 years, 41 women and 39 men) who underwent PCI were randomized into the two groups of intervention and control. The HBCT program included supervised exercise training, walking, phone calls, and a pedometer for 8 weeks. Hemodynamic changes, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), resting heart rate (HRrest), maximum heart rate (HRmax), ejection fraction (EF), and rate pressure product (RPP), and functional parameters including the distance walked and metabolic equivalents (METS), also HRQOL were measured in all patients before and after the 8-week HBCT program.

Results

Our results showed significant reductions in SBPrest (126.82±9.17 vs. 131.27±10.24; P =0.044), DBPrest (87.4±5.39 vs. 89.17±7.33; P=0.027), HRrest (76.15±3.01 vs. 77.65±4.16; P=0.041), HRmax (143.1±5.24 vs. 147.57±8.63; P=0.011), and RPP (9.64±0.81 vs. 10.07±0.99; P=0.007) and significant elevations in (45.75±4.31 vs. 43.5±5.21; P=0.039), distance walked (514.95±214.5 vs. 368.04±221.43; P=0.019), Mets (7.41±0.84 vs. 6.89±1.28; P=0.018), as well as HRQOL in the MCS (50.62±10.45 vs. 46.25±7.74; P=0.037), and HRQOL in the PCS (46.75±8.73 vs. 42.37±9.99; P=0.040) in the intervention group compared to the control group.

Conclusion

An HBCT program consisting of supervised exercise training significantly improved hemodynamic response, exercise performance capacity, and HRQOL in patients following PCI.

Efficacy of the Simulation-Based Education Approach Enhanced by Music on Anxiety, Physical Activity, and Respiratory Outcomes in Patients under Open Heart Surgery: A Randomized Three-Group Clinical Study

Background

Many patients with advanced cardiovascular disease need Coronary Artery Bypass Graft (CABG) surgery, indicating the importance of cardiac rehabilitation. Our study explored the combined efficacy of simulation (using demonstration and return-demonstration approach) with music on post-Open Heart Surgery (OHS) outcomes.

Materials and Methods

This randomized, controlled trial was conducted at Imam Reza Hospital, Mashhad, Iran, on 90 patients awaiting OHS. The participants were allocated to 3 groups: education via simulation, education via simulation enhanced by instrumental music, and conventional instruction. Evaluations were performed pre-education and 2-days post-surgery using the activity measure for post-acute care (AM-PAC) "6-Clicks" Questionnaire, 18-item Nursing Outcomes Classification (NOC) index, and State-Trait Anxiety Inventory (STAI). JASP software (JASP Team, 2023, Version 0.17.3) was employed for statistical analyses, using RM-ANOVA and ANCOVA test.

Results

The results revealed a significant effect in immediate post-intervention and 2-day follow-up periods across all outcome measures (all p < 0.05), except for activity. Post hoc tests demonstrated substantial variations in effect sizes between intervention and control groups. Both intervention groups had significantly greater impact than the control group, particularly the composite group, showing heightened effects in state and trait anxiety and respiratory scores (p < 0.05).

Conclusions

The combined use of the simulation with rhythmic music in phase one cardiac rehabilitation notably improved post-surgical outcomes, outperforming the method without music. This approach shows promise as an effective instructional strategy in cardiac rehabilitation stages.

Difference of cardiac rehabilitation in the morning or evening on indexes of left ventricular and N-terminal pro-brain natriuretic peptide: a randomized controlled trial

The present study aimed to evaluate the effects a cardiac rehabilitation program (CRP) performed in the morning or evening on left ventricular (LV) filling indices and the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients undergoing percutaneous coronary angioplasty during the COVID-19 pandemic.

Methods

This was a randomized controlled single-blinded clinical trial. Ninety-six patients (mean age: 50.2 ± 8.1 years, 36 women and 44 men) with percutaneous coronary angioplasty were divided into two groups of intervention and control. In each group, the CRP was performed in either morning or evening. The CRP included walking and performing push-ups and sit-ups for 8 weeks. The participants of the control groups received routine care. The functional indices of LV, including LV ejection fraction, systolic function, and diastolic function (i.e. the transmitral flow), the E/e' to left atrium peak strain ratio (as an estimation for LA stiffness), and NT-proBNP level were measured in all participants before starting and at the end of the CRP.

Results

In the intervention group, the individuals performing the CRP in the evening had significantly higher E-wave (0.76±0.02 vs. 0.75±0.03; P=0.008), ejection fraction (52.5±5.64 vs. 55.5±3.59; P=0.011), and diastolic function velocity (E/A ratio, 1.03±0.06 vs. 1.05±0.03; P=0.014) and significantly lower A-wave (0.72±0.02 vs. 0.71±0.01; P=0.041), E/e' ratio (6.74±0.29 vs. 6.51±0.38; P=0.038), and NT-proBNP level (2007.9±214.24 vs. 1933.9±253.13; P=0.045) compared with those performing the program in the morning.

Conclusions

A supervised CRP performed in the evening compared with morning was more effective in improving LV functional indices. Therefore, such home-based interventions are recommended to be performed in the evening during the COVID-19 pandemic.

Effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with coronary artery disease: A meta-analysis

Purpose

The study aims to evaluate the effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function and exercise endurance in patients with coronary artery diseases (CAD).

Methods

We performed a systematic search of the English and Chinese databases from their inception to March 2022. Randomized controlled trials (RCTs) were included to compare high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with CAD. The primary outcomes included peak oxygen uptake (peak VO₂) and anaerobic threshold (AT). The secondary outcomes included left ventricular ejection fraction (LVEF), exercises duration (ED), respiratory exchange ratio (RER), resting heart rate (RHR), peak heart rate (PHR) and oxygen pulse (O₂ pulse). The continuous variables were expressed as mean differences (MD) along with their corresponding standard deviations (SD), and the I² test was applied in the assessment of heterogeneity.

Results

After systematically literature search, 19 studies were finally selected for our meta-analysis (n = 1,036), with 511 patients in the experimental group (high-intensity exercise) and 525 patients in the control group (moderate-intensity exercise). The results showed that high-intensity exercise significantly increased patients' Peak VO₂ [MD = 2.67, 95% CI (2.24, 3.09), P < 0.00001], LVEF [MD = 3.60, 95% CI (2.17, 5.03), P < 0.00001], ED [MD = 37.51, 95% CI (34.02, 41.00), P < 0.00001], PHR [MD = 6.86, 95% CI (4.49, 9.24), P < 0.00001], and O₂ pulse [MD = 0.97, 95% CI (0.34, 1.60), P = 0.003] compared with moderate-intensity exercise. However, there were no significant differences in AT [MD = 0.49, 95% CI (−0.12, 1.10), P = 0.11], RER [MD = 0.00, 95% CI (−0.01, 0.02), P = 0.56], and RHR [MD = 1.10, 95% CI (−0.43, 2.63), P = 0.16].

Conclusion

Our results show that high-intensity exercise training has more significant positive effects compared with moderate-intensity exercise training in improving peak VO₂, LVEF, ED, PHR and O₂ pulse in patients with CAD, while no significant differences were observed in AT, RER and RHR. To sum up, high-intensity exercise training is better than moderate-intensity exercise training in improving cardiopulmonary function and exercise endurance in patients with CAD.

Systematic review registration

PROSPERO (CRD42022328475), https://www.crd.york.ac.uk/PROSPERO/.