Myocardial Infarction (MI)
Conditions
Keywords
Myocardial Infraction, MI, early phase, cardiac rehabilitation
Brief summary
This study aimed to investigate the effects of early-phase exercise-based supervised cardiac rehabilitation on functional exercise capacity, grip strength, fatigue, sleep quality, and health-related quality of life.
Detailed description
Myocardial infarction (MI) is not only a severe form of coronary heart disease but also a leading cause of death and physical disability, particularly in the rapidly growing elderly population. Although percutaneous coronary interventions reduce mortality, ensuring the recovery and reintegration of discharged patients into society remains an unresolved issue. Cardiac rehabilitation (CR) is beneficial for patients with MI in terms of reducing cardiovascular mortality and hospital readmissions, managing cardiovascular risk factors, and improving aerobic capacity. CR is a comprehensive intervention tailored to the individual needs of patients diagnosed with heart disease. It includes personalized exercise training, physical activity promotion, health education, cardiovascular risk management, and psychological support. Initial recommendations for CR were limited to low-risk patients following MI. However, over the past two decades, with the accumulation of evidence supporting the benefits of CR, current clinical guidelines now routinely recommend comprehensive CR for a broader range of cardiac diagnoses, including acute coronary syndrome and heart failure with reduced ejection fraction. Until two decades ago, studies recommended starting CR in the early phase, defined as the second-week post-discharge. However, in the past decade, CR initiation with very low-intensity exercise activity as early as one week after MI onset has been reported as safe and effective. More recently, studies have shown the beneficial effects of terminating bed rest within 12-24 hours and initiating bedside activities. Phase I exercise-based CR has been shown to be effective in improving exercise capacity and preventing recurrent cardiac events. Nonetheless, concerns remain regarding early exercise-based CR due to exercise-induced ischemia after acute MI. While the effects of early rehabilitation initiated post-MI have been investigated in the literature, sufficient evidence has yet to be established.
Interventions
OTHERPhase I and Phase II Cardiac Rehabilitation Program
The program consisted of two stages: an inpatient phase lasting until discharge, followed by an outpatient-supervised Phase II lasting eight weeks. In the intervention group, the participants in the inpatient phase received active-participatory lower extremity movements and progressive walking training (i.e., progressive walking in the room-corridor-hospital) to prepare them for discharge. The inpatient phase I was conducted with supervision following the American Heart Association recommendations. Participants in the intervention group were then administered phase II of the supervised CR program. Phase II CR was performed 3 non-consecutive days a week for 8 weeks as an aerobic exercise program.
Sponsors
Dokuz Eylul University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
This study was designed as a prospective and Randomized Controlled experimental study. Participants were randomly divided into two groups in a 1:1 ratio; the study group and the control group.
Eligibility
Sex/Gender
ALL
Age
30 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Clinically and medically stable patients with first MI * Prescribed cardiac rehabilitation by a cardiologist * Being between 30-65 years old * having ejection fraction (EF) of more than 20% (i.e. EF≥ 20%) * being volunteer to participate
Exclusion criteria
* having coronary artery bypass graft surgery * Being diagnosed with chronic renal failure * Presence of unstable angina * Atrial fibrillation * Severe and symptomatic aortic stenosis * Presence of decompensated heart failure * Exercise-induced myocardial ischemia, * Pericardial disease, * Moderate-to-severe valve disease * COPD or asthma * BMI \> 40 kg/m2 * Orthopedic and neurological problems that prevent exercise
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Functional exercise capacity | 8 weeks | Functional exercise capacity assessment with 6-minute walk test distance as meters |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SF-12 Health releated Quality of Life questionnaire | 8 weeks | Health-related Quality of Life was assessed with the SF-12 Health-related Quality of Life questionnaire (range: 0-100). Lower values on this questionnaire indicate worse symptoms |
| MacNew Heart Disease Health releated Quality of Life questionnaire | 8 weeks | Disease-specific Health-related Quality of Life was assessed with the MacNew Heart Disease Health-related Quality of Life questionnaire (range: 1-7). Lower values on this questionnaire indicate worse symptoms. |
| Fatigue | 8 weeks | Fatigue was assessed with Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale (range: 0-52). Lower values on this scale indicate worse symptoms. |
| sleep quality | 8 weeks | Sleep quality was assessed with the Pittsburgh Sleep Quality Index (range: 0-21). Higher values on this scale indicate worse symptoms. |
| Grip strength | 8 weeks | Hand grip strength with a hand dynamometer (Jamar® ,dynamometer / Promedics Ltd., Blackburn, Lancashire, UK) |
Countries
Turkey (Türkiye)
Outcome results
None listed