The Effect of a Self Exercise Program in Cardiac Rehabilitation for Patients with Coronary Artery Disease

OBJECTIVE: To investigate the effect of self exercise in cardiac rehabilitation on cardiopulmonary exercise capacity for selected patients with coronary artery disease. METHOD: The subjects of this study were patients who received percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery and who participated in a cardiac rehabilitation program. The supervised exercise group participated in 6-8 weeks of aerobic exercise training with telemetry ECG monitoring in hospital. The self exercise group, whose exercise risk was low, was instructed to participiate in self exercise training in a community exercise environment according to the exercise tolerance test (ETT) using a modified Bruce protocol. Both groups underwent ETTs before and 6 months after initiation of the cardiac rehabilitation program. We compared the supervised group with the self exercise groups on exercise capacity. RESULTS: After 6 months, the supervised exercise group showed significant changes in maximum oxygen consumption, maximal heart rate, resting heart rate, and submaximal rate pressure product. The self exercise group also showed significant improvement of maximum oxygen consumption and submaximal rate pressure product. However, the changing rate of maximum oxygen consumption was significantly higher in the supervised exercise group than the self exercise group. CONCLUSION: Both the supervised and self exercise groups showed similar improvement of cardiopulmonary exercise capacity after 6 months' participation in the cardiac rehabilitation program. However, the changing rate of maximum oxygen consumption, maximal heart rate, and resting heart rate were significantly higher in the supervised exercise group than the self exercise group.

Treatment of Adhesive Capsulitis with Steroid Injection Followed by Hyaluronic Acid Injection

OBJECTIVE: To investigate the effects of sono-guided intraarticular steroid injection followed by sodium hyaluronate injection weekly for 2 weeks on adhesive capsulitis of the shoulder. METHOD: In this prospective randomized controlled trial, 16 patients (group A) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg once a week for 3 weeks, and 13 patients (group B) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg for the first week, and subsequently a mixture of 0.5% lidocaine 8 ml and sodium hyaluronate 2 ml once a week for the next 3 weeks. A self exercise program was instructed for all subjects. The effects were assessed using visual numeric scale (VNS), shoulder pain and disability index (SPADI), and range of shoulder motion (flexion, abduction, internal rotation. external rotation, and extension) at study entry, every week until 2 weeks have passed after the last injection. RESULTS: The VNS, SPADI, and range of shoulder motion improved 1 week after 1st injection and continued to improve until 2 weeks after last injection in both two groups. There were no difference in changes of VNS and SPADI between these two groups, but range of shoulder motion especially in passive and active internal rotation of patients in group A improved more than those in group B. CONCLUSION: Steroid injection combined with hyaluronic acid injection has comparable effects with triamcinolone for treatment of adhesive capsulitis of the shoulder. Sono-guided intraarticular injection of steroid combined with hyaluronic acid can substitute for intraarticular injection of triamcinolone and be useful especially for patients susceptible to adverse effects of steroid injection.

The Effects of Cardiac Rehabilitation in Patients with ST Elevation Myocardial Infarction and Non-ST Elevation Myocardial Infarction

OBJECTIVE: To compare the effects of cardiac rehabilitation between patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). METHOD: Thirty three patients with STEMI or NSTEMI who underwent percutaneous transluminal coronary angioplasty were recruited. All patients participated in cardiac rehabilitation program including ECG monitoring exercise for 6 weeks. Several parameters such as exercise duration, oxygen consumption, heart rate, blood pressure and rate pressure product were evaluated through graded exercise test before and 6 months after initiation of cardiac rehabilitation program. RESULTS: After cardiac rehabilitation program, the STEMI group showed significant changes in exercise time, maximum oxygen consumption, resting heart rate and submaximal rate pressure product. The NSTEMI group also showed significant improvement of exercise time, maximum oxygen consumption and submaximal rate pressure product. There was no significant difference in the changing rate between two groups. CONCLUSION: Both the STEMI and the NSTEMI groups showed similar improvement of cardiopulmonary exercise capacity 6 months after cardiac rehabilitation program.