[The programme of managed ambulatory rehabilitation for patients after heart valve defect surgery]. / Program rízene ambulantní rehabilitace u pacientu po operaci chlopenních srdecních vad.

UNLABELLED: THE AIM of our research was to evaluate the impact of 8-week comprehensive rehabilitation programme on circulatory parameters, left ventricular (LV) function and functional capacity of patients after aortal (ao) and mitral (mi) heart defect surgery. PATIENT SAMPLE AND METHODOLOGY: The rehabilitation programme was completed by 54 patients (exercising, RHB+) following valve defect surgery (13 women/41 men), aged 27-83 (56 +/- 16) years. The majority were patients with aortal (ao) stenosis (39), the remainder had a combined ao defect (7), ao regurgitation (3) or mitral (mi) regurgitation (5). Myocardial revascularisation was concomitantly performed in 18 patients. There were 18 patients in the control group (non-exercising, RHB-). Patients from both groups were assessed before and after the rehabilitation with exercise echocardiography and spiroergometry to the individual maximum. The intervention group underwent the managed rehabilitation programme. The control group exercised individually. RESULTS: Reduction of the heart rate (HR) values at rest and on exercise and of the systolic and diastolic blood pressure (sBP, dBP) was observed in the exercising group. However, these changes were not statistically significant. The systolic, diastolic and global LV function parameters showed improvement although, once again, not statistically significant. Highly significant improvement in exercise tolerance (1.41 W/kg before and 1.67 W/kg after, p < 0.01) and peak oxygen consumption (20.0 ml/min/kg before and 23.6 ml/min/kg after, p < 0.01) were observed in the exercising patients. Improvement in functional and aerobic capacity in the control group was not statistically significant. The resting and exercise parameters (SF, sBP, dBP) have not changed either. CONCLUSION: The ambulatory rehabilitation programme was associated with improvement in circulatory response to exercise together with reduction in resting and exercise SF, sBP a dBP values. Tendency towards improvement in systolic, diastolic and global LV function parameters was observed even though not statistically significant in our sample. Unlike control group, the exercising group showed significant increase in exercise tolerance and aerobic capacity (p < 0.01). Managed rehabilitation programme enabled evaluation of the outcomes of the surgery, better education of the patients and optimal adjustment ofpharmacotherapy, the anticoagulation treatment in particular. We did not observe any adverse reactions or other complications associated with the exercise.

[The influence of rehabilitation on peak oxygen consumption in patients after myocardial infarction treated with beta-blockers]. / Vliv rehabilitate na vrcholovou spotrebu kyslíku u nemocných po infarktu myokardu lécentch betablokátory.

UNLABELLED: THE PURPOSE OF THE STUDY was to verify whether rehabilitation programs improve both stress tolerance and peak oxygen consumption (pVO2) plus the consumption of oxygen at the level of anaerobe threshold (AT) in patients after myocardial infarction treated with beta-blockers. Our objective was to find out the differences in changes in the above indicators in elderly patients. THE SET of consisted of 2 groups of patients aged over 65 (56 +/- 6.1) a > or = 65 let (69 +/- 4.7). The first group contained 96 and the second group 31 patients, respectively. Prior and after the rehabilitation program, stress echocardiography (SE) and symptom-limited spiroergometric test were performed in the patients. RESULTS: A statistically significant improvement in stress tolerance and in the oxygen consumptions indicators was recorded in the group of younger patients (< 65 years of age), both at the peak and at the anaerobe threshold levels (p < 0.001). Patients aged 65 or older recorded a statistically significant improvement in stress tolerance (p < 0.01) on the one hand, but only minor, statistically insignificant improvement in pVO2 and AT oxygen consumption on the other. CONCLUSION: A two-month rehabilitation program improves both stress tolerance and the peak oxygen consumption in patients after myocardial infarction treated with beta-blockers. The improvement is statistically insignificant in elderly patients. The above finding supports our opinion that elderly patients need long-term controlled training which should be performed at regular intervals and with the necessary intensity.