Issue №3-20, 2021
Original article
Physical Training Effectiveness and Tolerance in Patients after Myocardial Infraction, Depending on the Initial Physical Activity Tolerance
1 Yulia V. Chistyakova, 1 Irina E. Mishina, 1 Yuri V. Dovgalyuk, 1 Irina V. Mitryaeva, 1 Anna A. Zolotareva, 1 Sophia A. Soldatova
1 Ivanovo State Medical Academy, Ivanovo, Russian Federation
ABSTRACT
AIM. To investigate exercise tolerance in patients undergoing acute coronary syndrome with outcome in myocardial infarction, dependingon physical activity tolerance.
MATERIAL AND METHODS. We studied 80 patients aged from 40 to 75 years old who were admitted from primary vascular centers for athree-week rehabilitation course to the department of medical rehabilitation for patients with somatic diseases of the clinic of the IvanovoState Medical University of the Ministry of Health of Russia, of which 61 were men (76,3%) and 19 women (23,7%). In accordancewith the aim of the study, a 6-minute walk test was performed in all patients before and after the completion of the rehabilitationcourse. Based on the test results, physical exercise tolerance was assessed and the functional class (FC) of coronary heart disease (CHD) was determined. The patients with I class coronary heart disease (CHD) in the number of 20 patients (25%) made up the 1st group, 21patients (26,3%) with II class – the 2nd group, 21 patients (26,3%) with III class – the 3rd group, and 18 patients (22,5%) with IV class– the 4th group.
RESULTS. Every third patient who was admitted to a 3-week cardiac rehabilitation course had short-term adverse reactionson loading during physical training on simulators. Most cases of inadequate reactions were noted in patients with III and IV IHDclass III (according to the 6-minute walk test) having, according to the International Classification of Functioning, Disability and Health(ICF), moderate and pronounced reduction of exercise tolerance function. Patients often had tachycardic and hypertensive reactionsin the porcess of prysical training on stimulators and some patients (more often those with the pronounced decrease in exercise tolerancefunction) had hypotensive reaction which is the most unfavorable type of response to the load. In the vast majority of patientswith I and II CHF with no impairment or mild decrease in exercise tolerance according to ICF, an adequate response of hemodynamicparameters to exercise was determined. Adverse reactions were observed only in every fifth-seventh patient and were manifested onlyin the form of tachycardic and hypertensive reactions to exercise. The study analyzed the effectiveness of rehabilitation measures inthe groups of patients with different levels of tolerance to physical activity. It was found out that all the patients with myocardial infarction,regardless of the initial level, had increased exercise tolerance after cardiac rehabilitation.
CONCLUSION. The 6-minute walk test is insufficiently informative for patients with markedly reduced tolerance to physical activity. The«gold standard» of qualitative and quantitative assessment of reactions and interaction between cardiovascular and respiratory systems,as well as metabolic response of the body during physical activity for these patients is the spiroergometric study.
KEYWORDS: cardiological rehabilitation, acute coronary syndrome, myocardial infarction, exercise tolerance, 6-minute walking test, physical training
Acknowledgments: The study had no sponsorship
Conflict of interest:: The authors declare no apparent or potential conflicts of interest related to the publication of this article
For citation: Chistyakova Yu.V., Mishina I.E., Dovgalyuk Yu.V., Mitryaeva I.V., Zolotareva A.A., Soldatova S.A. Physical Training Effectiveness and Tolerance in Patients after Myocardial Infraction, Depending on the Initial Physical Activity Tolerance. Bulletin of Rehabilitation Medicine. 2021; 20 (3): 104-112. https://doi.org/10.38025/2078-1962-2021-20-3-104-112
For correspondence: Yulia V. Chistyakova, e-mail: chud.iv@mail.ru
References:
- Ivanova G.E., Melnikova E.V., Shmonin A.A., Verbitskay E.V., Aronov D.M., Belkin A.A., Belyaev A.F., Bodrova R.A., Bubnova M.G., Builova T.V., Maltseva M.N., Mishina I.E., Nesterin K.V., Nikiforov V.V., Prokopenko S.V., Sarana A.M, Stakhovskaya L.V., Suvorov A.Yu., Khasanova D.R., Tsykunov M.B., Shamalov N.A., Yashkov A.V. Pilotnyj proekt «Razvitie sistemy medicinskoj reabilitacii v Rossijskoj Federacii»: predvaritelnye rezultaty realizacii na pervom i vtorom jetapah medicinskoj reabilitacii [Pilot project «Development of the medical rehabilitation system in Russian federation (dome)»: preliminary results of implementation in the first and second stages]. Bulletin of Rehabilitation Medicine. 2017; 2(78): 10-15 (In Russ.).
- Galtseva N.V. Reabilitaciya v kardiologii i kardiohirurgii [Rehabilitation in cardiology and cardiac surgery]. Klinicist. 2015; (2): 13-22 (In Russ.).
- Ivanova G.E., Trukhanov A.I. Globalnye perspektivy razvitija medicinskoj reabilitacii [Global prospects for the development of medical rehabilitation]. Bulletin of Rehabilitation Medicine. 2017; 6(82): 2-6 (In Russ.).
- Aronov D.M., Bubnova M.G., Barbarash O.L., Doletsky A.A., Krasnitsky V.B., Lebedeva E.V., Lyamina N.P., Repin A.N., Svet A.V., Chumakova G.A. Ostryj infarkt miokarda s pod”emom segmenta ST elektrokardiogrammy: reabilitaciya i vtorichnaya profilaktika. Rossijskie klinicheskie rekomendacii [Acute myocardial infarction with ST-segment elevation electrocardiograms: rehabilitation and secondary prevention. Russian clinical guidelines]. CardioSo-matika. 2014; (S1): 5-41 (In Russ.).
- Arutyunov G.P., Rylova A.K., Kolesnikova E.A., Kostyukevich O.I., Evzerikhina A.V. Kardioreabilitaciya [Cardiac rehabilitation]. Moscow. MEDpress inform. 2013: 336 p. (In Russ.).
- Makarova I.N. Reabilitaciya pri zabolevaniyah serdechnososudistoj sistemy [Rehabilitation in diseases of the cardiovascular system]. Moscow. GEOTARMedia. 2010; 314 p. (In Russ.).
- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 39(33): 3021-104. https://doi.org/10.1093/eurheartj/ehy339
- Timmis A., Townsend N., Gale CP. et al. European Society of Cardiology: Cardiovascular Disease Statistics 2019. European Heart Journal. 2020; 41(1): 1285. https://doi.org/10.1093/eurheartj/ehz859
- Cosentino F., Grant P.J., Aboyans V. et al. 2019 ESC Guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration with the EASD. European Heart Journal. 2020; 41(2): 255-323. https://doi.org/10.1093/eurheartj/ehz486
- Doimo S., Fabris E., Piepoli M. et al. Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study. European Heart Journal. 2019; (40): 678-85. https://doi.org/10.1093/eurheartj/ehy417
- Glotz D.D., Novak Z. Vliyanie velotrenirovok v pomeshchenii na parametry gemodinamiki levogo zheludochka muzhchin s ishemicheskoj bolezn’yu serdca i posle infarkta miokarda [The effect of indoor cycling on the parameters of left ventricular hemodynamics in men with coronary heart disease and after myocardial infarction]. Rossijskij kardiologicheskij zhurnal. 2017; 3(143): 46-53 (In Russ.).
- Schuler G., Adams V., Goto Y. Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. European Heart Journal. 2013; (34): 1790-1799. https://doi.org/10.1093/eurheartj/eht111
- Gilmutdinova L.T., Galimulina E.N., Bagautdinov A.A., Faizova E.R., Gilmutdinov B.R., Shakirov A.R. Effektivnost’ fizicheskoj reabilitacii pacientov posle stentirovaniya koronarnyh arterij v usloviyah sanatoriya [Effectiveness of physical rehabilitation of patients after coronary artery stenting in sanatorium conditions]. Spa Medicine. 2020; (2): 14-21 (In Russ.).
- International Classification of Functioning, Disability and Health - ICF. 2001.
- Faggiano P., D’Aloia A., Gualeni A. et al. Assessment of oxygen uptake during the 6-minute walking test in patients with heart failure: preliminary experience with a portable device. American Heart Journal. 1997; (134): 203-206. https://doi.org/10.1016/s0002-8703(97)70125-x
- Wu G., Sanderson B., Bittner V. The 6-minute walk test: how important is the learning effect? American Heart Journal. 2003; 146(1): 129-133. https://doi.org/10.1016/S0002-8703(03)00119
- Baklushin A.E., Mishina I.E., Romanchuk S.V., Dovgalyuk Yu.V., Belova V.V., Alexandriyskaya N.E., Arkhipova S.L. Soderzhanie i pervye rezul’taty reabilitacii kardiologicheskih bol’nyh v klinike [Contents and first results of rehabilitation of cardiac patients in the clinic]. Bulletin of Rehabilitation Medicine. 2014; (6): 43-46 (In Russ.).
- Ivanova G.E., Aronov D.M., Bubnova M.G., Mishina I.E., Sarana A.M. Pilotnyj proekt «Razvitie sistemy medicinskoj reabilitacii v Rossijskoj Federacii». Sistemy kontrolya i monitorirovaniya effektivnosti medicinskoj reabilitacii pri ostrom infarkte miokarda [Pilot project «Development of the medical rehabilitation system in the Russian Federation». Systems for monitoring and monitoring the effectiveness of medical rehabilitation in acute myocardial infarction]. Bulletin of the Ivanovo Medical Academy. 2016; 21(1): 15-18 (In Russ.).
- Dovgalyuk Y.V., Mishina I.E., Chistyakova Y.V. Dinamika tolerantnosti k fizicheskoj nagruzke v ocenke jeffektivnosti program reabilitacii bolnyh pere-nesshih ostryj koronarnyj sindrom na ambulatornom jetape [The dynamics of tolerance to physical activity in evaluating the effectiveness of programs of rehabilitation of patients with acute coronary syndrome at the outdoor stage]. Bulletin of Rehabilitation Medicine. 2019; 3(91): 11-14 (In Russ.).
- Karvonen M.J., Kentala E., Mustala O. The effects of training on heart rate; a longitudinal study. Annales Medicinae Experimentalis et Biologiae Fenniae. 1957; (35): 307-315.
- Aronov D.M. Fizicheskaya reabilitaciya bol’nyh pozhilogo vozrasta, stradayushchih serdechnoj nedostatochnost’yu II-IV funkcional’nogo klassa [Physical rehabilitation of elderly patients suffering from functional class II-IV heart failure.]. Manual for doctors. Moscow. Medpraktika-M. 2005: 28 p. (In Russ.).
- Tanaka H., Monahan K.D., Seals D.R. Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology. 2001; 37(1): 153-156. https://doi.org/10.1016/s0735-1097(00)01054-8.
- Zolotukhin N.N., Konkov A.V. Pokazateli sostoyaniya organizma pri ishemicheskoj bolezni serdca [Indicators of the state of the body in coronary heart disease]. Bulletin of Rehabilitation Medicine. 2019; 3(91): 15-19 (In Russ.).
- Kalenchin T.I., Rysevets E.V., Antonovich J.V. [Some features of early inpatient rehabilitation of patients with myocardial infarction]. Mezhdunarodnyj kongress kardiologov i terapevtov. Sbornik nauchnyh trudov. Minsk. 12-13 maya 2016 [International Congress of Cardiologists and Therapists. Collection of scientific papers. Minsk, May 12-13, 2016]. Minsk. Capital Print. 2016: 120-123 (In Russ.).
©
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.