Volume 6, Issue 3, September 2018, Page: 108-113
Maintenance of Functional Capacity and Hemodynamic Responses After Discharge from Cardiac Rehabilitation
José Andrés Trejos-Montoya, Department of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
Braulio Alonso Sánchez-Ureña, Department of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
Peter Walter Grandjean, Department of Health, Human Performance and Recreation, Baylor University, Waco, USA
Luis Alberto Blanco-Romero, Department of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
Jorge Enrique Salas-Cabrera, Department of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
Vera Rodríguez-Cambronero, Department of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
Felipe Araya-Ramíre, Department of Human Movement Science and Quality of Life, National University, Heredia, Costa Rica
Received: May 7, 2018;       Accepted: Jun. 7, 2018;       Published: Jun. 29, 2018
DOI: 10.11648/j.ajss.20180603.16      View  1213      Downloads  73
Purpose: To examine the maintenance of functional capacity and hemodynamic responses to exercise in cardiac patients two and a half years after discharge from cardiac rehabilitation program. Methods: Eighty-eight patients with CVD were contacted after discharge from our university-based phase II cardiac rehabilitation program between 2011 and 2014. Only fifty-two patients agreed to participate in the study (age = 59.1 ± 14 years, height = 1.67 ± 0.9 m, weight = 77.5 ± 13.2 kg, BMI = 27.6 ± 3.6 kg/m2). Patients returned 30.7 ± 9.0 months after CR discharge and performed a 6-minute walking test (6MWT). Functional capacity was measured by the distance walked during the 6MWT and hemodynamic responses were measured after the test. Multiple repeated-measures ANOVAs were used to compare variables at baseline (Pre), end of CR (Post1) and follow-up 2.5 yrs after completing CR (Post2). Bonferroni post hoc analysis was used when appropriate. Significance was accepted at the p < 0.05 level. Results: Functional capacity improved 23.1% with CR (443 ± 95 m Pre to 545 ± 87 m Post1, p < 0.001) and was maintained at follow-up (545 ± 87 m Post1 to 542 ± 71 m Post2, p > 0.05). Resting heart rate decreased 7.0% between CR and follow-up (71 ± 9.0 bpm Post1 to 66 ± 11 bpm Post2, p = 0.007). DBP decreased by 5.6% after CR (71 ± 10 mmHg Pre to 67 ± 9.0 mmHg Post1, p = 0.002) and was maintained after discharge (67 ± 9.0 mmHg Post1 to 66 ± 9.0 mmHg Post2, p > 0.05). Patients experienced a greater five-minute heart rate recovery (24 ± 13 bpm Pre vs 38 ± 16 bpm Post1, p < 0.001), which was maintained at follow-up (38 ± 16 bpm Post1 vs 39 ± 12 bpm Post2, p > 0.05). Greater SBP recovery was also found (20 ± 12 mmHg Pre vs 29 ± 16 mmHg Post1, p = 0.004) and maintained at follow-up (29 ± 16 mmHg Post1 vs 27 ± 11 mmHg Post2, p > 0.05). RPP was greater (13066 ± 3152 mmHg*bpm Pre vs 15934 ± 3962 mmHg*bpm Post 1, p < 0.001) and maintained at follow-up Post1 vs 14933 ± 3505 mmHg*bpm Post2, p = 0.288). Conclusion: Patients maintained their functional capacity and hemodynamic responses to exercise two and a half years after discharge from CR, despite they gained body weight.
Cardiac Rehabilitation, Functional Capacity, Hemodynamic Responses
To cite this article
José Andrés Trejos-Montoya, Braulio Alonso Sánchez-Ureña, Peter Walter Grandjean, Luis Alberto Blanco-Romero, Jorge Enrique Salas-Cabrera, Vera Rodríguez-Cambronero, Felipe Araya-Ramíre, Maintenance of Functional Capacity and Hemodynamic Responses After Discharge from Cardiac Rehabilitation, American Journal of Sports Science. Vol. 6, No. 3, 2018, pp. 108-113. doi: 10.11648/j.ajss.20180603.16
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ministerio de Salud: Memoria Institucional 2010-2014. Ministerio de Salud 2014:1-194.
World Health Organization: World Health Statistics 2012. WHO Library Cataloguing-in-Publication Data 2012:34-35.
Mozaffarian D, Benjamin MJ, Go AS, Arnett D, K., Blaha MJ, Cushman M, Das SR, Ferranti S, JDesprés JP, Fullerton HJ: Heart Disease and Stroke Statistics—2016 Update. A Report From the American Heart Association. Circulation 2016, 133:e38-e360.
Araya-Ramírez F, Briggs KK, Bishop SR, Miller CE, Moncada-Jiménez J, Grandjean PW: Who is likely to benefit from phase II cardiac rehabilitation?. J Cardiopulm Rehabil Prev 2010, 30 (2):93-100.
Araya-Ramírez F, Ureña-Bonilla P, Blanco-Romero L, Grandjean PW: Efecto de un programa de ejercicios en la capacidad funcional y respuesta hemodinámica de pacientes con enfermedad cardiovascular. Rev Costarricense de Cardiología 2014, 16 (2):5-11.
Gupta R, Sanderson BK, Bittner V: Outcomes at one-year follow-up of women and men with coronary artery disease discharged from cardiac rehabilitation: what benefits are maintained? J Cardiopulm Rehabil Prev 2007, 27 (1):11-18.
Lavie CJ, Milani RV: Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort. American Journal of Cardiology 1995, 76 (3):177-179.
Thompson PD, Buchner D, Piña IL, Balady GJ, Williams MA, Marcus B, Berra K, Blair SN, Costa F, Franklin BA et al: Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease Arteriosclerosis, Thrombosis, and Vascular Biology 2003, 23 (1):42-49.
Williams MA, Ades PA, Hamm LF, Keteyian SJ, LaFontaine TP, Roitman JL, Squires RW: Clinical evidence for a health benefit from cardiac rehabilitation: an update. Am Heart J 2006, 152 (5):835-841.
Franklin BA, Lavie CJ, Squires RW: Exercise-Based Cardiac Rehabilitation and Improvements in Cardiorespiratory Fitness: Implications Regarding Patient Benefit. Mayo Clin Proc 2013, 88 (5):431-437.
Listerman J, Bittner V, Sanderson BK, Brown TM: Cardiac rehabilitation outcomes: impact of comorbidities and age. J Cardiopulm Rehabil Prev 2011, 31 (6):342-348.
Ades PA, Maloney A, Savage P, Carhart R: Determinants of physical functioning in coronary patients: response to cardiac rehabilitation. Archives of Internal Medicine 1999, 159 (19):2357-2360.
Lear SA, Spinelli JJ, Linden W, Brozic A, Kiess M, Frohlich JJ, Ignaszewski A: The Extensive Lifestyle Management Intervention (ELMI) after cardiac rehabilitation: a 4-year randomized controlled trial.. American Heart Journal 2006, 152 (2):333-339.
Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner v, Franklin BA, Gulanick M, Laing ST, Stewart KJ: Resistance Exercise in Individuals With and Without Cardiovascular Disease: 2007 Update. A Scientific Statement From the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2007, 16:572-584.
Kavanagh T, Hamm LF, Beyene J, Mertens DJ, Kennedy J, Campbell R, Fallah S, Shephard RJ: Usefulness of Improvement in Walking Distance Versus Peak Oxygen Uptake in Predicting Prognosis After Myocardial Infarction and/or Coronary Artery Bypass Grafting in Men. Am J Cardiol 2008, 101:1423-1427.
Ghashghaei FE, Sadeghi M, Marandi SM, Ghashghaei SE: Exercise-based cardiac rehabilitation improves hemodynamic responses after coronary artery bypass graft surgery. ARYA Atherosclerosis 2012, 7:151-156.
Hansen D, Dendale P, Raskin A, Schoonis A, Berger J, Vlassak I, Meeusen R: Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume.. Clinical Rehabilitation 2010, 24 (4):319-327.
Reid L, Morrin A, Pipe A, Dafoe W, Lyall H, Wielgosz A, McDonald P, Plotnikoff R, Higginson L, Oldridge N et al: Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise after Cardiac Hospitalization (TEACH) Study.. European Journal of Cardiovascular Prevention and Rehabilitation 2006, 13 (4):529-537.
Volaklis K, Douda T, Kokkinos F, Tokmakidis S: Physiological alterations to detraining following prolonged combined strength and aerobic training in cardiac patients. European Journal of Cardiovascular Prevention and Rehabilitation 2006, 13 (3):375-380.
Tokmakidis S, Volaklis K: Training and detraining effects of a combined strength and aerobic training program on blood lipids in patients with coronary artery disease. J Cardiopulm Rehabil 2003, 23:193-200.
Mandic S, Hodge C, Stevens E, Walker R, Nye E, Body D, Barclay L, Williams M: Effects of Community-Based Cardiac Rehabilitation on Body Composition and Physical Function in Individuals with Stable Coronary Artery Disease: 1.6-Year Follow up. BioMed Research International 2013, 1:1-7.
Bosch C, Myers J, Habersaat A, Ibarraza H, Kottman W, Dubach P: Maintenance of Exercise Capacity and Physical Activity Patterns 2 Years After Cardiac Rehabilitation.. Journal of Cardiopulmonary Rehabilitation and Prevention 2005, 25 (1):14-21.
Brubaker PH, Warner JGJ, Rejeski WJ, Edwards DG, Matrazzo BA, Ribisl PM, Miller HSJ, Herrington DM: Comparison of standard- and extended-length participation in cardiac rehabilitation on body composition, functional capacity, and blood lipids. Am J Cardiol 1996, 78 (7):769-773.
Giannuzzi P, Temporelli P, Marchioli R, Pietro A, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C 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.. Archives of Internal Medicine 2008, 168 (20):2194-2204.
Rogers M, Yamamoto C, Hagberg J, Holloszy J, Ehsani A: The effect of 7 years of intense exercise training on patients with coronary artery disease. Journal of the American College of Cardiology 1987, 10 (2):321-326.
Willich S, Müller J, Kulig M, Binting S, Gohlke H, Hahnmann H, Bestehorn K, Krobot K, Völler H: Cardiac risk factors, medication, and recurrent clinical events after acute coronary disease. A prospective cohort study. European Heart Journal 2001, 22 (4):307-313.
Steele B: Timed walking tests of exercise capacity in chronic cardiopulmonary illness J Cardiopulm Rehabil 1996, 16:25-33.
Kim HY: Statistical notes for clinical researchers: post-hoc multiple comparisons. Restor Dent Endod 2015, 40 (2):172-176.
Oerkild B, Frederiksen M, Hansen F, Simonsen L, Skovgaard L, Prescott E: Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomized clinical trial. Age and Ageing 2011, 40 (1):78-85.
Bock B, Carmona R, Esler J, Tikemeir P: Program Participation and Physical Activity Maintenance after Cardiac Rehabilitation. Behavior Modification. 27 2003, 1.
Walther C, Gielen S, Hambrecht R: The effect of exercise training on endothelial function in cardiovascular disease in humans. Exerc Sport Sci Rev 2004, 32:129 - 134.
Curtis B, O`Keefe J: Autonomic tone as a cardiovascular risk factor: the dangers of chronic fight or flight. Mayo Clin Proc 2002, 77:45-54.
Cahalin LP, Arena R, Labate V, Bandera F, Lavie CJ, Guazzi M: Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing. European Journal of Heart Failure 2013, 15:519-527.
Mujika I, Badilla S: Cardiorespiratory and metabolic characteristics of detraining in humans. Med Sci Sports Exerc 2001, 33 (3):413-421.
Hambrecht R, Adams V, Erbs S, Linke A, Kränkel N, Shu Y, Baither Y, Gielen S, Thiele H, Gummert JF et al: Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 2003, 107 (25):3152-3158.
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