Małgorzata Wilk

Effects of Nordic Walking training on exercise capacity and fitness in men participating in early, short-term inpatient cardiac rehabilitation after an acute coronary syndrome — a controlled trial

Objective: To investigate the effects of Nordic Walking training supplemental to a standard, early rehabilitation programme on exercise capacity and physical fitness in men after an acute coronary syndrome. Design: A controlled trial. Setting: Cardiac rehabilitation service of a provincial hospital. Subjects: Eighty men 2—3 weeks after an acute coronary syndrome, with good exercise tolerance. Interventions: Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group). Main measures: Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test. Results: Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 ± 1.8 versus 9.2 ± 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 ± 1.5 versus 0.7 ± 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group. Conclusions: Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.

Value of exercise capacity and physical activity in the prevention of cardiovascular diseases—brief review of the current literature

A low level of physical activity and decreased exercise capacity are independent risk factors for cardiovascular and all-cause mortality. The assessment of the level of physical activity and its improvement following preventive procedures is methodologically difficult. In population studies, subjective methods, such as questionnaires, activity records and other somewhat imperfect measures (accelerometers, pedometers, and pulse monitors), are used. Direct and especially indirect assessment of physical capacity with exercise tests has become increasingly more accessible and cheap. Both methods have been proved to have high prognostic value. Assessment of physical capacity enables objectification of information on the level and effects of a subject’s physical activity acquired via a questionnaire. Taking into account the above-mentioned issues, the role of the assessment of exercise capacity and its improvement is not adequately appreciated. Routine evaluation of exercise capacity has not been included in the current statements on epidemiology and prevention, even in those with an increased Framingham or SCORE risk index in whom low exercise tolerance has been proved to have an unfavorable influence on prognosis. The importance of an increase in the level of physical activity resulting in an improvement in exercise capacity in different population groups should be verified in the near future, but in our opinion there is indirect but strong evidence that actions to improve exercise capacity should become the main goals in the prevention of cardiovascular and all-cause mortality, such as cessation of cigarette smoking, body weight reduction, correction of lipid and carbohydrate metabolism disturbances, and a decrease in blood pressure.

Early phase 2 inpatient rehabilitation after acute coronary syndrome treated with primary percutaneous coronary intervention: short- and long-term effects on blood pressure and metabolic parameters.

Objective: The aim of this study was to assess the 1-yr follow-up effects of inpatient rehabilitation and its prolongation with an ambulatory training program on blood pressure and metabolic risk factors in patients after an acute coronary syndrome. Design: A controlled (n = 20) prospective study was undertaken. The study group consisted of 54 consecutive patients participating in a 3-wk inpatient rehabilitation. Of these, 14 chose to continue the training for 3 mos (CR_In+Amb group) and 40 declined (CR_In group). Results: Body mass index increased in the CR_In and control groups. The magnitude of change was greater in controls (2.2 ± 2.14 vs. 0.7 ± 1.70 kg/m2; P < 0.05). Waist circumference increased only in the control group, and at 12 mos, it was higher than in the CR_In and CR_In+Amb groups (P < 0.05). Mean systolic and diastolic blood pressure increased in the CR_In (from 121/76 to 130/82 mm Hg; P < 0.01) and control (from 122/74 to 139/87 mm Hg; P < 0.01) groups. At 12 mos, blood pressure in the CR_In group was lower than in the control group but higher than in the CR_In+Amb group (119/77 mm Hg; P < 0.05). Total cholesterol, low-density lipoprotein cholesterol level, and triglyceride level at 12 mos were higher in the control group than in the CR_In and CR_In+Amb groups (P < 0.05). C-reactive protein decreased in the CR_In and CR_In+Amb groups (P < 0.01). Conclusions: Inpatient rehabilitation was associated with beneficial effects on blood lipids and C-reactive protein in coronary patients and attenuated the rise in blood pressure and adiposity indices observed in nonparticipants. Prolongation of rehabilitation with an ambulatory program improved blood pressure control.

The impact of short-term cardiac rehabilitation on changing dietary habits in patients after acute coronary syndrome.

PURPOSE: The aim of this study was to determine whether short-term cardiac rehabilitation (CR), including dietary counseling, had an impact on changing eating habits in patients after acute coronary syndrome (ACS), treated with primary percutaneous coronary intervention (PCI). METHODS: The controlled, prospective, nonrandomized study was performed on 44 patients, early following ACS/PCI, who underwent 2- to 3-week inpatient CR with dietary counseling and compared to 18 patients who did not participate in CR. An analysis of the daily diet composition was performed at baseline, at 3 months post-ACS, and at 1 year post-ACS. RESULTS: In the CR group, comparing baseline with 3 months post-ACS, daily calorie intake was significantly reduced from a mean ± SD of 2260 ± 525 kcal to 2037 ± 514 kcal (P < .05), and daily cholesterol intake from 509 ± 237 to 394 ± 199 mg (P < .05). The daily energy intake of saturated fatty acids was also significantly reduced from 13.6% at baseline to 12.2 ± 4.5% at 3 months and further reduced at 1 year post-ACS to 10.2 ± 4.3% (P < .05). Although both groups exhibited increased body mass index, the increase was significantly greater in the nonrehabilitation group than in the CR group at 1 year post-ACS (2.61 ± 2.23 vs 0.86 ± 1.67 kg/m2, respectively, P < .001). CONCLUSIONS: The analysis suggests that a short-term CR program following ACS, which includes educational meetings on dietary prevention of atherosclerosis, may result in some favorable and lasting modifications of eating habits of post-ACS patients.

Ocena efektów treningu fizycznego z zastosowaniem dodatkowego obciążenia kończyn w trakcie wczesnej rehabilitacji pacjentów po leczonym interwencyjnie ostrym zespole wieńcowym

Introduction. We aimed to investigate the effects of modified cardiac rehabilitation programme on functional fitness level. We modified the programme with the elements of resistance training relied on use of the ankle and wrist weights (1, 0.5 kg each). Material and methods. The study was performed on 40 patients in 2–3 weeks following acute coronary syndrome (ACS), after they underwent percutaneous coronary intervention (PCI). Patients were divided in to two groups: two groups of 20 patients each: control group with standard training and experimental group with elements of resistance training. An analysis of the data was performed before and after 18-session rehabilitation programme. The study was performed only in patients at moderate risk of cardiac disease according to American College of Sports Medicine 8th edition risk stratification. Results. Contemporary standard of cardiac rehabilitation provided to the patients post-ACS improved significantly (p < 0.05) the endurance parameters assessed with the 6-min walking test (from 517.75 ± 57.27 to 581 ± 94.04 m for the standard rehabilitation and from 523.00 ± 45.43 to 598.47 ± 57.30 m for modified programme with the elements of resistance). The strength of the arms and legs assessed with the dynamometry improved significantly with more pronounced improvement in the group with resistance training elements than in the standard rehabilitation group (from 33.10 ± 8.35 to 42.65 ± 11.90 kg and from 127.00 ± 25.49 to 154.40 ± 31.86 kg, respectively; p < 0.05). The strength endurance assessed with the SFT for the legs increased significantly in both groups. Conclusions. Early-phase cardiac rehabilitation extended with the elements of resistance training results in greater improvement, especially in the elements of strength.