Early-phase Exercise-based Cardiac Rehabilitation After MI

Dokuz Eylul University32 enrolled

Overview

This study aimed to investigate the effects of early-phase exercise-based supervised cardiac rehabilitation on functional exercise capacity, grip strength, fatigue, sleep quality, and health-related quality of life.

Myocardial infarction (MI) is not only a severe form of coronary heart disease but also a leading cause of death and physical disability, particularly in the rapidly growing elderly population. Although percutaneous coronary interventions reduce mortality, ensuring the recovery and reintegration of discharged patients into society remains an unresolved issue. Cardiac rehabilitation (CR) is beneficial for patients with MI in terms of reducing cardiovascular mortality and hospital readmissions, managing cardiovascular risk factors, and improving aerobic capacity. CR is a comprehensive intervention tailored to the individual needs of patients diagnosed with heart disease. It includes personalized exercise training, physical activity promotion, health education, cardiovascular risk management, and psychological support. Initial recommendations for CR were limited to low-risk patients following MI. However, over the past two decades, with the accumulation of evidence supporting the benefits of CR, current clinical guidelines now routinely recommend comprehensive CR for a broader range of cardiac diagnoses, including acute coronary syndrome and heart failure with reduced ejection fraction. Until two decades ago, studies recommended starting CR in the early phase, defined as the second-week post-discharge. However, in the past decade, CR initiation with very low-intensity exercise activity as early as one week after MI onset has been reported as safe and effective. More recently, studies have shown the beneficial effects of terminating bed rest within 12-24 hours and initiating bedside activities. Phase I exercise-based CR has been shown to be effective in improving exercise capacity and preventing recurrent cardiac events. Nonetheless, concerns remain regarding early exercise-based CR due to exercise-induced ischemia after acute MI. While the effects of early rehabilitation initiated post-MI have been investigated in the literature, sufficient evidence has yet to be established.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Myocardial Infarction (MI)

Interventions

Phase I and Phase II Cardiac Rehabilitation ProgramOTHER

The program consisted of two stages: an inpatient phase lasting until discharge, followed by an outpatient-supervised Phase II lasting eight weeks. In the intervention group, the participants in the inpatient phase received active-participatory lower extremity movements and progressive walking training (i.e., progressive walking in the room-corridor-hospital) to prepare them for discharge. The inpatient phase I was conducted with supervision following the American Heart Association recommendations. Participants in the intervention group were then administered phase II of the supervised CR program. Phase II CR was performed 3 non-consecutive days a week for 8 weeks as an aerobic exercise program.

Eligibility

Sex: ALLMin age: 30 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Clinically and medically stable patients with first MI * Prescribed cardiac rehabilitation by a cardiologist * Being between 30-65 years old * having ejection fraction (EF) of more than 20% (i.e. EF≥ 20%) * being volunteer to participate Exclusion Criteria: * having coronary artery bypass graft surgery * Being diagnosed with chronic renal failure * Presence of unstable angina * Atrial fibrillation * Severe and symptomatic aortic stenosis * Presence of decompensated heart failure * Exercise-induced myocardial ischemia, * Pericardial disease, * Moderate-to-severe valve disease * COPD or asthma * BMI \> 40 kg/m2 * Orthopedic and neurological problems that prevent exercise

Locations (1)

Dokuz Eylul University

Izmir, Balçova, Turkey (Türkiye)

Outcomes

Primary Outcomes

Functional exercise capacity

Functional exercise capacity assessment with 6-minute walk test distance as meters

Time frame: 8 weeks

Functional exercise capacity

Functional exercise capacity assessment with 30 s sit-stand test repetitions

Time frame: 8 weeks

Secondary Outcomes

SF-12 Health releated Quality of Life questionnaire

Health-related Quality of Life was assessed with the SF-12 Health-related Quality of Life questionnaire (range: 0-100). Lower values on this questionnaire indicate worse symptoms

Time frame: 8 weeks

MacNew Heart Disease Health releated Quality of Life questionnaire

Disease-specific Health-related Quality of Life was assessed with the MacNew Heart Disease Health-related Quality of Life questionnaire (range: 1-7). Lower values on this questionnaire indicate worse symptoms.

Time frame: 8 weeks

Fatigue

Fatigue was assessed with Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale (range: 0-52). Lower values on this scale indicate worse symptoms.

Time frame: 8 weeks

sleep quality

Sleep quality was assessed with the Pittsburgh Sleep Quality Index (range: 0-21). Higher values on this scale indicate worse symptoms.

Time frame: 8 weeks

Grip strength

Hand grip strength with a hand dynamometer (Jamar® ,dynamometer / Promedics Ltd., Blackburn, Lancashire, UK)

Time frame: 8 weeks

Data from ClinicalTrials.gov

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