The clinical efficacy of a comprehensive program of rehabilitation after coronary artery bypass grafting in patients with coronary artery disease under outpatient department cardio rehabilitation - III stage of rehabilitation

Purpose of the study. Evaluate the clinical efficacy of early poststationary rehabilitation of persons with coronary heart disease (CHD) who underwent coronary artery bypass grafting (CABG) in a cardiac rehabilitation outpatient department (III stage cardiorehabilitation). Material and methods. The study included men (n=36) suffering from coronary artery disease and had undergone CABG after 3-8 weeks after surgery (an average of 7.8±1.6 weeks). Patients were randomized into two groups: the main group where patients are involved in the educational program "School for patients undergoing CABG" (hereinafter - the "School"), controlled and uncontrolled (at home) physical training (PT) - the control group, where patients were only training in the educational "School" with a recommendation to participate in an uncontrolled PT under the house. Classes in education "School" held 1 time per week, lasting 60-80 minutes, for 5 weeks; controlled PT - 3 times per week for up to 60 minutes in the groups for 4 months. The total duration of the observation - 1 year. Patients underwent instrumental tests - electrocardiogram rest, echocardiography, bicycle stress test, laboratory tests of blood - lipid and lipoprotein, glucose, fibrinogen, a survey by questionnaire of motor activity, nutrition, quality of life, HADS (Hospital Anxiety and Depression Scale). Results. After a 4-month course of the PT there was a significant indicator of physical performance. The duration of exercise at the end of the course PT increased from baseline by 32.6% (p<0.05) while preserving the effect of the 12th month. In patients who did not train after CABG, but held an educational "School", exercises were observed increase in the duration of the 12th month of monitoring and to a lesser extent (9.8%); р<0.05; p<0.05. The threshold power of exercises in trained patients increased significantly after 4 months (by 35.2% from baseline; p<0.05) with the increase of the effect to the 6th (by 53.9% from baseline; p<0.05) and 12th month (49.5% of the original); р<0,05; p<0.05. In the absence of physical rehabilitation after CABG tolerance to exercises in patients did not change. Patients held PT, 4 and 12 months there was a slight increase in the ejection fraction of the left ventricle (LV) and the LV stroke volume with a decrease in LV end-systolic volume. The absence of PT in the program of rehabilitation of persons after CABG did not prevent the increase in the concentration of total cholesterol (by 10.2%; p<0,05) and low density lipoprotein cholesterol (by 15.6%; p<0,05) for the 12th month, which was not observed in trained patients. Under the influence of PT in patients improves the quality of life as opposed to those not participating in the training. In general, serious cardiovascular complications in 3 times less common among those involved in a comprehensive program of rehabilitation "PT + "School" (at 11.1%) than in patients who only attend educational "School" (39.2%).

ischemic heart disease, coronary artery bypass surgery, rehabilitation, physical training