Comprehensive cardiological rehabilitation contributes to the improvement of the functional capabilities of the heart
Author Ольга Кияница
According to a study published in Heart, comprehensive cardiac rehabilitation, including training sessions, can improve the patient’s functionality and lower blood pressure to a greater extent than cardiac rehabilitation using physical activity alone or ordinary care for patients with CVD.
“This is the first ever randomized controlled trial in Latin America and the third in history among low- and middle-income countries.It demonstrated that the restoration of heart function leads to clinically significant improvements in functionality and lower blood pressure. At the same time, comprehensive heart rehabilitation exceeds heart rehabilitation with the participation of functional exercises, ”wrote Gabriela Souellen and Silva Chavez, graduate students of the department of physical therapy at the Federal University of Minas Gerais, Belo Horizonte, Brazil. “These results also confirm the importance of comprehensive heart rehabilitation in low- and middle-income countries to provide patients with the benefits associated with heart rehabilitation.”
The study involved 115 adults with ischemic heart disease or myocardial infarction, who received medical treatment and were sent for heart rehabilitation in the period from March 2015 to April 2017. All participants passed preliminary assessments, including a step-by-step test of shuttle walking, determination of blood pressure and obesity.
Participants were randomly divided into three groups: the control group (men with an average age of 59 years), cardiac rehabilitation group only with exercise (men with an average age of 59 years) and the complex heart rehabilitation group (men with an average age of 61 years).
In the control group, patients received routine care, which included consultations with doctors when it was medically necessary.
- Patients who were prescribed cardiac rehabilitation intervention only by physical exercise performed individually selected workload and controlled exercises for 6 months.
- Comprehensive intervention for the rehabilitation of the heart consisted of part of the exercises with the addition of 24 training sessions held in the group immediately before or after training. In these classes, patients were taught principles of proper nutrition, exercise, mental health, and risk factor management.
The functional ability of the condition of the patients was initially evaluated using the distance traveled. For the second time, measurements of blood pressure, BMI, waist circumference, glucose and lipids were studied.
The researchers found that the distance test improved only in groups with cardiac rehabilitation with exercise (from 391.5 m to 488.1 m; average change — 96.5 m) and with full cardiac rehabilitation (from 358.4 m to 464.8 m; average change - 106.4 m). Those who participated in the complex rehabilitation of the heart also had a greater functional capacity than those who received the usual assistance. In addition, in patients undergoing comprehensive cardiac rehabilitation, there was a decrease in systolic blood pressure (an average of 6.2 mmHg).
“These benefits are likely to lead to a significant reduction in mortality, although adequate tests are needed to demonstrate this,” the researchers wrote. “Thus, promotion of a wider introduction of heart rehabilitation is needed to improve care for patients with heart disease in Brazil, as well as in other Latin American countries and in low- and middle-income countries” - Melissa J. Webb.
Today, in the United States, Canada, and most of Europe, comprehensive cardiac rehabilitation is considered standard.Yet there are certain gaps in the implementation of the program. In particular, the following questions should be answered:
- How to achieve 100% referral of patients meeting the criteria for cardiac rehabilitation?
- How to create an infrastructure that makes it possible for recommended individuals to participate in the program?
- How to overcome non-infrastructural barriers for registration?
- How can you improve adherence to the prescribed program?
Finally, patients who complete the program should pay attention to possible ways to preserve the improvements achieved.
Video: Cardiac Rehab: Smart for Healing Hearts - Mayo Clinic