COMPARATIVE ANALYSIS OF EFFICIENCY OF SUPERVISED AND HOME-BASED PHYSICAL TRAININGS IN THE OUTPATIENT CARDIAC REHABILITATION PROGRAM IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFTING

The purpose. To assess the impact of the three-month supervised and home-based physical trainings in the outpatient cardiac rehabilitation program on exercise tolerance and double product in patients undergoing coronary artery bypass grafting (CABG).
Material and methods: 114 male patients of working age with coronary artery disease (CAD) who have undergone CABG were examined. Patients were enrolled into three groups: Group 1 − patients undergoing supervised cycling trainings (SCT) (n = 36), Group 2 − patients undergoing home-based trainings (HBT) (n = 36) and the control group without any exercise trainings (n = 42). The following parameters were assessed: the six-minute walk test (6MWT) value, exercise tolerance (ET) and double product (DP), determined by the cycle ergometer test (CET) prior to surgery, 1, 4 months and 1 year after CABG.
Results: The 6MWT value increased by 9% in the SCT group, by 6% in the HBT group, and by 1% in the control group during the outpatient cardiac rehabilitation program. ET significantly increased in all study groups according to the analysis of exercise tolerance by the CET 4 months after CABG. However, the improvement was more pronounced in patients with SCT compared to other groups. One year after CABG, this difference balanced between the study groups. DP, assessed by the CET, significantly increased in patients undergoing SCT (p = 0.01), compared to other groups. There were no significant differences found in the rate of cardiovascular events between the study groups.
Conclusion: Home-based trainings are inferior to SCT in the outpatient settings, but they are safe and may improve significantly the 6MWT values compared to patients in the control group. Therefore, home-based trainings may be recommended to patients, if they cannot visit the rehabilitation center.

1. Кремнева Л.В., Ефанов Ю.М., Абатурова О.В., Крючев Н.В., Гибельгаус М.А., Шалаев С.В. Прогностические факторы и исходы повреждений миокарда, возникающих в связи с операцией коронарного шунтирования. Кардиология и сердечно-сосудистая хирургия. 2010; 3 (5): 24–30. Kremneva L.V., Efanov Iu.M., Abaturova O.V., Kriuchev N.V., Gibel’gaus M.A., Shalaev S.V. Predictors and outcomes of myocardial injuries related to coronary bypass grafting. Kardiologiia i serdechno-sosudistaia khirurgiia. 2010; 3 (5): 24–30. [In Russ].

2. Бокерия Л.А., Ступаков И.Н., Гудкова Р.Г. Анализ показателей заболеваемости различными формами болезней системы кровообращения в федеральных округах РФ. Здравоохранение. 2015; 6: 66–75. Bokeriya L.A., Stupakov I.N., Gudkova R.G. Analiz pokazateley zabolevaemosti razlichnymi formami bolezney sistemy krovoobrashcheniya v federal’nykh оkrugakh RF. Zdravookhranenie. 2015; 6: 66–75. [In Russ].

3. Баздырев Е.Д., Иванов С.В., Павлова В.Ю., Барбараш О.Л. Профилактика респираторных осложнений у пациентов с ишемической болезнью сердца при проведении планового коронарного шунтирования. Комплексные проблемы сердечно-сосудистых заболеваний. 2016; V (1): 37–50. Bazdyrev E.D., Ivanov S.V., Pavlova V.Yu., Barbarash O.L. Prevention of respiratory complications in subjects with coronary artery disease when performing planned coronary artery bypass grafting. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2016; V (1): 37–50. [In Russ].

4. Blair J., Corrigall H., Angus N.J., Thompson D.R., Leslie S. Home versus hospital-based cardiac rehabilitation: a systematic review. Rural and Remote Health (Internet). 2011; 11 (2): 1532.

5. Dalal H.M., Zawada A., Jolly K., Moxham T., Taylor R.S. Home based versus center based cardiac rehabilitation: Cochrane systematic review and meta-analysis. Br. Med. J. 2010; 340 (19): 5631. DOI: https://doi.org/10.1136/bmj.b5631.

6. Scalvini S., Zanelli E., Comini L., Dalla Tomba M., Troise G., Febo O. et al. Home based versus in hospital cardiac rehabilitation after cardiac surgery: a nonrandomized controlled study. Physical. Therapy. 2013; 8: 1073–1083.

7. Погосова Г.В., Оганов Р.Г., Колтунов И.Е., Соколова О.Ю., Поздняков Ю.М., Выгодин В.А. и др. Мониторинг вторичной профилактики ишемической болезни сердца в России и странах Европы: результаты международного многоцентрового исследования EUROASPIRE III. Кардиология. 2011; 51(1): 34–40. Pogosova G.V., Oganov R.G., Koltunov I.E., Sokolova O.Yu., Pozdnyakov Yu.M., Vygodin V.A. et al. Monitoring of Secondary Prevention of Ischemic Heart Disease in Russia and Europen Countries: Results of International Multicenter Study EUROASPIRE III. Kardiologiya. 2011; 51(1): 34–40. [In Russ].

8. Аронов Д.М., Бубнова М.Г., Погосова Г.В., Новикова Н.К., Красницкий В.Б., Поздняков Ю.М. и др. Современные методы реабилитации больных ишемической болезнью сердца на постстационарном (диспансерно-поликлиническом) этапе: пособие для врачей. М.: МЗ РФ, ГУ ГНИИЦ пм; 2004. Aronov D.M., Bubnova M.G., Pogosova G.V., Novikova N.K., Krasnickij V.B., Pozdnjakov Ju.M. et al. Sovremennye metody reabilitacii bol’nyh ishemicheskoj bolezn’ju serdca na poststacionarnom (dispanserno-poliklinicheskom) jetape: posobie dlja vrachej. – Moscow.: MZ RF, GU GNIIC pm; 2004. [In Russ].

9. Николаева Л.Ф., Аронов Д.М. Реабилитация больных ишемической болезнью сердца. М.: Медицина; 1988. Nikolaeva L.F., Aronov D.M. Reabilitatsiya bol’nykh ishemicheskoi bolezn’yu serdtsa. Moscow: Meditsina; 1988. [In Russ].

10. Долецкий А.А., Свет А.В., Андреев Д.А., Санер Х. Кардиореабилитация. Под ред. А.Л. Сыркина. М.; 2016. Doleckij A.A., Svet A.V., Andreev D.A., Saner H. Kardioreabilitacija. Pod red. A.L. Syrkina. Moscow; 2016. [In Russ].

11. Бубнова М.Г., Сеченова Е.В., Аронов Д.М. Оценка эффективности ранней комплексной постстационарной реабилитации больных коронарной болезнью сердца после вмешательств на коронарных сосудах на диспансерно-поликлиническом этапе. Эффективная терапия в кардиологии и ангиологии. 2011; 1: 86–91. Bubnova M.G., Sechenova E.V., Aronov D.M. Ocenka jeffektivnosti rannej kompleksnoj poststacionarnoj reabilitacii bol’nyh koronarnoj bolezn’ju serdca posle vmeshatel’stv na koronarnyh sosudah na dispanserno-poliklinicheskom jetape. Jeffektivnaja terapija v kardiologii i angiologii. 2011; 1: 86–91. [In Russ].

12. Аронов Д.М. Успехи и проблемы кардиореабилитации в России. Кардиология и ангиология. 2011; 1: 22–8. Aronov D.M. Uspehi i problemy kardioreabilitacii v Rossii. Kardiologija i angiologija. 2011; 1: 22–8. [In Russ].

13. Kwan G., Balady G.J. Cardiac Rehabilitation 2012: advancing the field through emerging science. Circulation. 2012; 125: 369–373.

14. Помешкина С.А., Кондрикова Н.В., Крупянко Е.В., Каган Е.С., Барбараш О.Л. Анализ подходов к оценке стойкой утраты трудоспособности у пациентов, подвергшихся коронарному шунтированию. Кардиология. 2013; 7: 62–68. Pomeshkina S.A., Kondrikova N.V., Krupjanko E.V., Kagan E.S., Barbarash O.L. Analiz podhodov k ocenke stojkoj utraty trudosposobnosti u pacientov, podvergshihsja koronarnomu shuntirovaniju. Kardiologija. 2013; 7: 62–68. [In Russ].

15. Williams M. A., Haskell W. L., Ades P. A., Ades P.A., Amsterdam E.A., Bittner V. et al. Resistant exercise in individuals with and without cardiovascular disease: a scientific statement from American Heart Association Clinical Cardiology and Council on Nutrition, Physical Activity and Metabolism. Circulation. 2007; 116 (5): 572–584.

16. Arem H., Moore S.C., Patel A. Leisure time physical activity and mortality: a detailed pooled analysis of the doseresponse relationship. JAMA Intern Med. 2015 Jun; 175 (6): 959-67. doi: 10.1001/jamainternmed.2015.0533. 10. 1001 jamainternmed.2015. 0533.

17. Taylor R.S., Dalal H., Jolly K., Zawada A., Dean S.G., Cowie A., et al. Home – based versus centre – based cardiac rehabilitation. Cochrane Database Syst Rev. 2015; 18; (8): CD007130. DOI: 10.1002/14651858.CD007130.pub3.

18. Aamot I.L., Forbord S.H., Gustad K., Lоckra V., Stensen A., Berg A.T., et al. Home-based versus hospital – based high – intensity interval training in cardiac rehabilitation: a randomized study. Eur J Prev Cardiol. 2014; 21(9): 8 – 1070. DOI: 10.1177/2047487313488299.

19. Szalewska D., Zieliński P., Tomaszewski J., Kusiak-Kaczmarek M., Łepska L., Gierat-Haponiuk K. et al. Effects of outpatient followed by homebased telemonitored cardiac rehabilitation in patients with coronary artery disease. Kardiol Pol. 2015; 73 (11):1101-7. DOI: 10.5603/KP. a2015.0095.

20. Помешкина С.А., Локтионова Е.Б., Архипова Н.В., Барбараш О.Л. Эффективность домашних физических тренировок и приверженность к лечению у пациентов, подвергшихся коронарному шунтированию. Кардиология. 2017; 1(57): 23–29. Pomeshkina S.A., Loktionova E.B., Arkhipova N.V., Barbarash O.L. Efficacy of Home-Based Exercise Training and Adherence to Therapy in Patients After Coronary Artery Bypass Grafting. Kardiologija. 2017; 1(57): 23–29. [In Russ].