ABSTRACT
The present study aimed to evaluate the effects a cardiac rehabilitation program (CRP) performed in the morning or evening on left ventricular (LV) filling indices and the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in patients undergoing percutaneous coronary angioplasty during the COVID-19 pandemic. Methods: This was a randomized controlled single-blinded clinical trial. Ninety-six patients (mean age: 50.2 ± 8.1 years, 36 women and 44 men) with percutaneous coronary angioplasty were divided into two groups of intervention and control. In each group, the CRP was performed in either morning or evening. The CRP included walking and performing push-ups and sit-ups for 8 weeks. The participants of the control groups received routine care. The functional indices of LV, including LV ejection fraction, systolic function, and diastolic function (i.e. the transmitral flow), the E/e' to left atrium peak strain ratio (as an estimation for LA stiffness), and NT-proBNP level were measured in all participants before starting and at the end of the CRP. Results: In the intervention group, the individuals performing the CRP in the evening had significantly higher E-wave (0.76±0.02 vs. 0.75±0.03; P=0.008), ejection fraction (52.5±5.64 vs. 55.5±3.59; P=0.011), and diastolic function velocity (E/A ratio, 1.03±0.06 vs. 1.05±0.03; P=0.014) and significantly lower A-wave (0.72±0.02 vs. 0.71±0.01; P=0.041), E/e' ratio (6.74±0.29 vs. 6.51±0.38; P=0.038), and NT-proBNP level (2007.9±214.24 vs. 1933.9±253.13; P=0.045) compared with those performing the program in the morning. Conclusions: A supervised CRP performed in the evening compared with morning was more effective in improving LV functional indices. Therefore, such home-based interventions are recommended to be performed in the evening during the COVID-19 pandemic.
ABSTRACT
BACKGROUND: It seems that the time of performing cardiac rehabilitation is important in determining the risk of cardiac complications in patients with myocardial infarction (MI). The present study aimed to investigate the effects of a home-based cardiac rehabilitation program (HCRP) conducted in either the morning or evening on cardiometabolic risk factors in phase IV (maintenance) MI patients. METHODS: In this randomized controlled clinical trial, 80 patients with MI were divided into 2 groups of intervention and control (40 individuals per group). Patients in each group were categorized into morning and evening subgroups (20 individuals per subgroup). The therapeutic regimen in the intervention group included HCRP, routine medications, and exercise and walking programs for 8 weeks. Patients in the control group received routine treatments for 8 weeks. Cardiovascular risk factors comprising of cardiac troponin I (cTnI), mean platelet volume (MPV), C-reactive protein (CRP), and cardiometabolic indicators including cholesterol (Cho), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and the maximum rate of oxygen consumption (VO2 max) were measured for all patients before and after the intervention. RESULTS: Our results showed significant reductions in Cho, TG, HDL, LDL, VO2 max, CRP, and MPV (P < 0.05) in the group performing HCRP in the evening compared with the morning group. CONCLUSION: Performing HCRP in the evening, compared with morning, can be significantly more effective in improving the levels of cardiometabolic risk factors in patients with MI. Therefore, it is recommended that rehabilitation programs be implemented in these patients in evening shifts.
ABSTRACT
Abstract Background: cardiac rehabilitation is a structured program to prevent secondary cardiovascular diseases. Objective: to investigate and compare the effectiveness of home-based cardiac rehabilitation program (HBCRP) on improving cardiovascular stress indices in men and women who had experienced myocardial infarction (MI). Methods: in this randomized controlled clinical trial, 80 patients with MI were divided into two groups of intervention and control (n = 40 per group). Analyses were erformed separately in females and males in the both groups. The HBCRP included receiving routine medications along with walking for 8 weeks. The control group only received the routine care along with counseling about having adequate physical activity. Cardiovascular stress indicators including heart rate at rest (HRrest), maximum heart rate (HRmax), recovery heart rate (RHR)at 1 and 2 minutes after the exercise test (i.e. RHR1 and RHR2), systolic and diastolic blood pressures at rest (SBPR and DBPR), and rate pressure product (RPP) were measured by a researcher blinded to the intervention before and after the test. Results: the results showed significant reductions in RHR1 (p<0.001), RHR2 (p<0.01), SBPR (p<0.01), DBPR (p<0.01), and RPP (p<0.001) in both males and females in the intervention group. A significant increase was also observed in HRmax (p<0.001) in the intervention group. However, there were no significant differences in HRmax and other variables comparing per- and post-experiment values in the control group. Conclusion: our results showed that 8 weeks of HBCRP sex-independently reduced cardiovascular stress indices in both men and women with MI.
Resumen Antecedentes: la rehabilitación cardíaca es un programa estructurado para prevenir las enfermedades cardiovasculares secundarias. Objetivo: estudiar y comparar la efectividad de un programa de rehabilitación cardíaca en casa (HBCRP, por sus siglas en inglés) en la mejoría de los índices de estrés cardiovascular en hombres y mujeres que habían sufrido un infarto de miocardio (IM). Métodos: en este ensayo clínico controlado aleatorizado, 80 pacientes con IM se dividieron en dos grupos de intervención y control (n = 40 en cada grupo). Se realizaron análisis por separado en mujeres y hombres en ambos grupos. El HBCRP incluía la administración de medicamentos de rutina junto con caminatas por 8 semanas. El grupo de control solo recibió tratamiento de rutina junto con orientación acerca de la realización de actividad física adecuada. Un investigador cegado a la intervención midió los indicadores de estrés cardiovascular incluyendo frecuencia cardíaca en reposo (FCrep), frecuencia cardíaca máxima (FCmax), recuperación de la frecuencia cardíaca (RFC) 1 y 2 minutos después de la prueba de ejercicio (i.e. RFC1 y RFC2), tensión arterial sistólica y diastólica en reposo (TASR y TADR) y producto frecuencia-presión (PFP), antes y después de la prueba. Resultados: los resultados mostraron una reducción significativa en RFC1 (p<0.001), RFC2 (p<0.01), TASR (p<0.01), TADR (p<0.01), y PFP (p<0.001), tanto en hombres como en mujeres del grupo de intervención. También se observó un aumento significativo en FCmax (p<0.001) en el grupo de intervención. Sin embargo, no hubo diferencias significativas en FCmax y otros variables al comparar los valores pre- y post-experimentales en el grupo control. Conclusión: nuestros resultados mostraron que 8 semanas de HBCRP redujeron los índices de estrés cardiovascular independientemente del sexo, tanto en hombres como en mujeres con IM.
