ABSTRACT
Aim of the study was to assess efficacy of a short program of medium intensity physical training of patients with ischemic heart disease (IHD) after endovascular intervention (EVI) in conditions of practical health care of Russia. Patients (n=100) were randomized into 2 groups - intervention (main group "M", n=50) and control (group "C", n=50) during weeks 2-8 after EVI. Efficacy of undertaken measures was assessed by results of laboratory (lipids), instrumental (electrocardiogram - ECG, exercise test on veloergometer - VEM-test, echocardiography - EchoCG) and clinical investigations. Patients of group M exercised for 45-60 min 3 times/week using work loads 50-60% of those achieved during VEMtest. All patients received therapy standard for EVI treatment IHD as well as lipid lowering drugs when indicated. The use of short program of physical training in this contingent of patients led to significant increase of duration of exercise compared with initial value (by 38% after 1 year, p<0.001) and with control group (p<0.05), increase of efficiency of heart work during VEM-test which differed from that in group "C" at points 1.5 and 6 months (p<0.05). According to EchoCG data parameters of left ventricular (LV) contractility in group "M" significantly improved. With that systolic LV volume diminished 3.1% in 6 months (p<0.05) while its ejection fraction (EF) increased 2.4% (p<0.01). In group "M" at the background of conducted from the very beginning therapy with statins blood concentrations of atherogenic fractions of lipids in blood did not change. At the same time in group "C"their values significantly rose (in 1 year level of total cholesterol - by 12.1%, level of low density lipoprotein cholesterol - by 18.6%, p<0.01 for all comparisons) and at points 4 months and 1 year differences in dynamics of these parameters at intergroup comparison were also significant. In the group of physical training compared with control group according to overall results of 1 year observation more favorable course of disease was registered with more cases of improvement of clinical state (p<0.01) and less cases of its worsening (p<0.01). The obtained results evidence for sufficient efficacy of the short program of physical training and feasibility of its introduction into ambulatory practice for rehabilitation of patients with IHD subjected to EVI on coronary arteries especially in acute coronary syndrome. In combination with the School for IHD patients subjected EVI it can be considered as method of secondary prevention because the study demonstrated its positive effect of risk factors and clinical course of the disease.
