This study aims to evaluate the contrasting effects of circuit training with and without upper and lower limb resistance training on paroxysmal nocturnal dyspnea, functional capacity and endurance on post-CABG patients.
A randomized controlled trial underlined that dynamic strength training dramatically increased peripheral muscular strength and power when combined with endurance training, which may enhance patient prognosis, according to a study done on patients with cardiovascular disease. According to the study, dynamic strength training is therefore advised as a crucial part of cardiovascular rehabilitation. The results showed that strength training was associated with lesser increases in intra-arterial blood pressure and cardiac output, indicating sufficient cardiovascular safety. All things considered, this study questions accepted therapeutic practice and reignites the discussion about the best dynamic strength training. highlighted the importance of lower limb muscle strengthening in an RCT following CABG surgery; Phase II cardiac rehab showed significant gains in lower limb strength and overall physical and cardiorespiratory performance 6 weeks following hospital discharge, as determined by the Short Physical Performance Battery and 6MWT. Although, cardiac rehabilitation following coronary artery bypass graft (CABG), has been shown to increase functional capacity and quality of life. Significant gaps exist in determining the exact exercise prescription for symptom alleviation and functional recovery. Existing researches primarily focused on conventional continuous aerobic training (CAT) or the circuit-based training alone, with little attention on targeted upper and lower limb resistance training in clinical settings. Furthermore, the majority of the literature assesses the outcomes such as peak oxygen uptake (V̇O₂max), six-minute walk distance (6-MWD) or general dyspnea scores. While paroxysmal nocturnal dyspnea is clinically significant and unpleasant condition among post-CABG patients, is understudied. Dyspnea is usually examined using non-specific tools and techniques during rehabilitation programs but a few studies used cardiac-specific symptom classification tools in post-CABG rehabilitation. In addition, there is a lack of randomized clinical trials that investigate combined effects of circuit-resistance training in Phase-II cardiac rehabilitation on multiple domains like dyspnea severity, muscle strength, endurance and functional capacity within a single-structured rehabilitation program. Some studies include small sample sizes or shorter study durations which limit the validity of the findings and the ability to derive clinically significant conclusions. Furthermore, insufficient information is available from low and middle-income nations where patient characteristics and healthcare resources are differ from those in high-income countries. This emphasizes the importance of doing context-specific to help define evidence based cardiac rehabilitation procedures. Therefore, the current study addresses the gaps by systematically comparing the effects of circuit training with and without targeted upper and lower limb resistance training using a complete set of outcome variables.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
A series of exercises in a circuit format, with 1 minute of exercise followed by 30 seconds of rest. The circuit was repeated 2-3 times, with a 2-minute break between circuits along with upper and lower limb Resistance exercises (30-40% of 1-RM) using weights and therapeutic bands
A series of exercises in a circuit format, with 1 minute of exercise followed by 30 seconds of rest. The circuit was repeated 2-3 times, with a 2-minute break between circuits.
Punjab Institute of Cardiology
Lahore, Punjab Province, Pakistan
Modified Medical Research Council (mMRC)
The mMRC Dyspnea Scale is a validated tool to assess the severity of dyspnea among the patients with pulmonary complications. This scale was utilized to quantify the symptoms of paroxysmal nocturnal dyspnea among the participants in the study, offering an insight to the effectiveness of exercise interventions on the respiratory symptoms
Time frame: First day
1-Repetition Maximum (1-RM)
1-RM is a useful tool in the studies in the studies evaluating the effectiveness of strength training such as those addressing upper and lower limb resistance training. This test specifies the maximum weight that a subject can lift in a single repetition, providing a precise, quantitative baseline evaluation of dynamic strength. It can be used as a solid baseline for tracking and comparing strength changes during intervention. Thus, 1-RM is a practical and objective tool in rehabilitation research. It allows the researchers to analyze the effectiveness of certain treatments and monitor functional changes over the course of treatment or regimen.
Time frame: First day
Modified Borg Scale (BORG CR-10):
Modified Borg Dyspnea Scale is a highly validated subjective tool, to assess rate of perceived exertion during exercise to monitor exercise intensity and tailor to individual patient in cardiac rehabilitation settings. It is safe and cost-effective. It has a rating of 0-10 with zero representing (no breathlessness) and 10 (maximal exertion). It is a subjective measure of how hard the body is pushing against exertion during exercise. Specially designed for the assessment of cardiac endurance
Time frame: First day
6-Minute Walk Test 6-MWT:
It is a reliable tool for assessing functional capacity among the patient population that present with underlying cardiovascular and pulmonary conditions. We used this tool in the assessment of functional capacity among the patients that participated in the study. This test specifically measures the distance covered in 6 minutes. In this test the participant walks along a flat straight pathway (usually 30-meter indoor corridors) in six minutes at their own pace. The maximum distance covered in 6 minutes documented the functional capacity among the participants under study.
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Time frame: First day
Incremental Shuttle Walk Test (ISWT)
Incremental Shuttle Walk Test (ISWT) is a highly reliable and valid tool for the assessment of cardiac endurance as a distinct outcome separately from overall functional capacity. It measures cardiac endurance under progressively increasing workloads within the safe limits. We used this tool to assess the cardiopulmonary endurance and baseline functional status in CABG population and to measure the improvements post-intervention outcomes. The test is safe, cost-effective and convenient to implement in all the clinical settings requiring little equipment and simultaneously assesses physiological responses such as heart-rate HR, oxygen saturation SPO2, and blood pressure in accordance with the subjective effort.
Time frame: First day