Ann Rehabil Med.  2011 Jun;35(3):381-387. 10.5535/arm.2011.35.3.381.

The Effect of a Self Exercise Program in Cardiac Rehabilitation for Patients with Coronary Artery Disease

• Kim C
• Youn JE
• Choi HE

• KMID: 2266858
• DOI: http://doi.org/10.5535/arm.2011.35.3.381

Abstract

OBJECTIVE
To investigate the effect of self exercise in cardiac rehabilitation on cardiopulmonary exercise capacity for selected patients with coronary artery disease. METHOD: The subjects of this study were patients who received percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery and who participated in a cardiac rehabilitation program. The supervised exercise group participated in 6-8 weeks of aerobic exercise training with telemetry ECG monitoring in hospital. The self exercise group, whose exercise risk was low, was instructed to participiate in self exercise training in a community exercise environment according to the exercise tolerance test (ETT) using a modified Bruce protocol. Both groups underwent ETTs before and 6 months after initiation of the cardiac rehabilitation program. We compared the supervised group with the self exercise groups on exercise capacity.
RESULTS
After 6 months, the supervised exercise group showed significant changes in maximum oxygen consumption, maximal heart rate, resting heart rate, and submaximal rate pressure product. The self exercise group also showed significant improvement of maximum oxygen consumption and submaximal rate pressure product. However, the changing rate of maximum oxygen consumption was significantly higher in the supervised exercise group than the self exercise group.
CONCLUSION
Both the supervised and self exercise groups showed similar improvement of cardiopulmonary exercise capacity after 6 months' participation in the cardiac rehabilitation program. However, the changing rate of maximum oxygen consumption, maximal heart rate, and resting heart rate were significantly higher in the supervised exercise group than the self exercise group.

Keyword

Coronary artery disease; Exercise; Rehabilitation; Self

MeSH Terms

Coronary Artery Bypass
Coronary Artery Disease
Coronary Vessels
Electrocardiography
Exercise
Exercise Tolerance
Heart Rate
Humans
Oxygen Consumption
Percutaneous Coronary Intervention
Telemetry
Transplants

Reference

1. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116:682–692. PMID: 15121495.

2. O'Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS Jr, Hennekens CH. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989; 80:234–244. PMID: 2665973.

3. Dugmore LD, Tipson RJ, Phillips MH, Flint EJ, Stentiford NH, Bone MF, Littler WA. Changes in cardiopulmonary fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme. Heart. 1999; 81:359–366. PMID: 10092561.

4. Izawa K, Hirano Y, Yamada S, Oka K, Omiya K, Iijima S. Improvement in physiological outcomes and health-related quality of life following cardiac rehabilitation in patients with acute myocardial infarction. Circ J. 2004; 68:315–320. PMID: 15056827.

5. Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004; 44:988–996. PMID: 15337208.

6. Whiteson JH. Braddom RL, editor. Cardiac rehabilitation. Physical medicine and rehabilitation. 2007. 3rd ed. Philadelphia: Sauders;p. 723.

7. Bunker S, McBurney H, Cox H, Jelinek M. Identifying participation rates at outpatient cardiac rehabilitation programs in Victoria, Australia. J Cardiopulm Rehabil. 1999; 19:334–338. PMID: 10609180.

8. Beswick AD, Rees K, Griebsch I, Taylor FC, Burke M, West RR, Victory J, Brown J, Taylor RS, Ebrahim S. Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups. Health Technol Assess. 2004; 8(41):iii–iv. ix–x. 1–152.

9. Pell J, Pell A, Morrison C, Blatchford O, Dargie H. Retrospective study of influence of deprivation on uptake of cardiac rehabilitation. BMJ. 1996; 313:267–268. PMID: 8704538.

10. Evenson KR, Fleury J. Barriers to outpatient cardiac rehabilitation participation and adherence. J Cardiopulm Rehabil. 2000; 20:241–246. PMID: 10955265.

11. Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Predictors of attendance at cardiac rehabilitation after myocardial infarction. J Psychosom Res. 2001; 51:497–501. PMID: 11602219.

12. Blumenthal JA, Williams RS, Wallace AG, Williams RB Jr, Needles TL. Physiological and psychological variables predict compliance to prescribed exercise therapy in patients recovering from myocardial infarction. Psychosom Med. 1982; 44:519–527. PMID: 7163455.

13. Gulanick M, Bliley A, Perino B, Keough V. Recovery patterns and lifestyle changes after coronary angioplasty: the patient's perspective. Heart Lung. 1998; 27:253–262. PMID: 9713717.

14. Kim C, Lim HS, Ahn JK, Bang IK, Lee SM, Kim YJ. The reasons that cardiac patients did not participate in and drop out from the cardiac rehabilitation program. J Korean Acad Rehabil Med. 2002; 26:790–796.

15. The American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs. Human kinetics. 1999; 3:45.

16. Neal B. Kaplan W, Laing R, editors. Secondary prevention of cardiovascular disease: fixed dose combinations. Priority medicines for Europe and the world. 2004. Geneva, Switzerland: World Health Organization.

17. Law MR, Watt HC, Wald NJ. The underlying risk of death after myocardial infarction in the absence of treatment. Arch Intern Med. 2002; 162:2405–2410. PMID: 12437397.

18. World Health Organization. The World Health Report 1997- conquering suffering, enriching humanity. World Health Forum. 1997; 18:248–260. PMID: 9478137.

19. Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med. 2001; 345:892–902. PMID: 11565523.

20. Balady GJ, Ades PA, Comoss P, Limacher M, Pina IL, Southard D, Williams MA, Bazzarre T. Core components of cardiac rehabilitation/secondary prevention programs: a statement for healthcare professionals from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group. Circulation. 2000; 102:1069–1073. PMID: 10961975.

21. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001; (1):CD001800. PMID: 11279730.

22. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116:682–692. PMID: 15121495.

23. Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med. 2001; 345:892–902. PMID: 11565523.

24. Ades PA, Waldmann ML, McCann WJ, Weaver SO. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med. 1992; 152:1033–1035. PMID: 1580707.

25. Andrew GM, Oldridge NB, Parker JO, Cunningham DA, Rechnitzer PA, Jones NL, Buck C, Kavanagh T, Shephard RJ, Sutton JR. Reasons for dropout from exercise programs in post coronary patients. Med Sci Sports Exerc. 1981; 13:164–168. PMID: 7253867.

26. Pell J, Pell A, Morrison C, Blatchford O, Dargie H. Retrospective study of influence of deprivation on uptake of cardiac rehabilitation. BMJ. 1996; 313:267–268. PMID: 8704538.

27. Nohara R, Kambara H, Hohiuddin IH, Ono S, Okuda K, Makita S, Hamazaki H, Aoto K, Shimomura M, Hayashi M, et al. Cardiac sports rehabilitation for patients with ischemic heart disease. Jpn Circ J. 1990; 54:1443–1450. PMID: 2287049.

28. Evenson K, Fleury J. Barriers to outpatient cardiac rehabilitation participation and adherence. J Cardiopulm Rehabil. 2000; 20:241–246. PMID: 10955265.

29. Cannistra LB, Balady GJ, O'Malley CJ, Weinger DA, Ryan TJ. Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation. Am J Cardiol. 1992; 69:1274–1279. PMID: 1585859.

30. Jolly K, Taylor RS, Lip GY, Stevens A. Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: a systematic review and meta-analysis. Int J Cardiol. 2006; 111:343–351. PMID: 16316695.

31. Kim C, Lim SW, Lee SM, Ahn JK. Effectiveness of aerobic exercise in cardiac patients. J Korean Acad Rehabil Med. 2000; 24:1155–1160.

32. Kraus WE, Houmard JA, Duscha BD, Knetzger KJ, Wharton MB, McCartney JS, Bales CW, Henes S, Samsa GP, Otvos JD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002; 347:1483–1492. PMID: 12421890.

33. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Pina IL, Rodney R, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104:1694–1740. PMID: 11581152.

34. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: cochrane systematic review and meta-analysis. BMJ. 2010; 340:b5631. PMID: 20085991.