The phenomenon of long-term commitment (16 years) patients with physical rehabilitation after acute myocardial infarction

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Abstract

Goal. Description of the influence of systematic phisical training (PT) on some indicators of physical performance (Fed) and the assessment of daily locomotor activity and psychological status of patients after myocardial infarction and were followed for 16 years. Material and methods. We observed 11 patients (9 men and 2 women) who after acute myocardial infarction (AMI) have participated in a one-year rehabilitation program, the basis of which amounted to the controlled PT of medium intensity (50-60%). Subsequently, patients continued PT program in hospital and in the home environment (observation of patients was 16 years). Programs of systematic PT were performed in a hospital, carried out with a small break in 2014-2015. Patients are constantly trained (ie the period of continuous PT amounted to 2 years), while a program of home exercises, patients try to perform consistently. They all underwent clinical examination, had a load test performed on a cycle ergometer protocol submaximal loading, questionnaires were evaluated by physical activity, level of subjective control, anxiety and depression and adherence to therapy estimated. Results. Blood pressure (BP) in patients were stable: in 2014 (prior to the beginning of organized PT) systolic blood pressure (SBP) was 127.9±15.2 mm Hg and diastolic blood pressure (DBP) - 74±6.3 mm Hg. In 2 years (2015) after the resumption of organized PT SBP decreased slightly to 121.2±7.0 mm Hg (p<0.05 to the value in 2014), DBP has not changed (79.9±5.4 mm Hg). In 1999, 9 patients were smoking, 2014 - 2 smoking people left, that is, 7 patients to stop smoking with the support of other group members altogether. Patients monitored their cholesterol (LDL) in the blood: 4 patients (36%) through diet and statins, 6 patients (54.5%) - only statins and only one patient - by diet. Motor activity in patients in 2014 was at the level of moderate (77.2±8.3 by questionnaire ODA23+) and remained so in 2015. Patients remained average tolerance physical exercise (PE) and they carried out the same amount of total physical work at HEM-sample and in 1999 (122±25 W) and in 2015 (113±25 W, p>0.05), ie, 16 years. In 2015, when compared with the 1999 peak of PE decreased SBP by 4.6% (p<0.05), mean arterial pressure (12%, p<0.01), double product (DP) magnitude 12.1% (p<0.01), as well as the rate increase efficiency of the heart by the DP to 33,4% (p<0.01). The average score on the anxiety level was 5.7±0.8 and the level of depression 5.8±0.6. Adherence to treatment was high in 70% of patients, ie, 4 points (the average score for the group of 3.8±0.2 on a scale of compliance by Morisky-Green). Conclusion. Involving patients in physical rehabilitation program in a group, in which established social relationships, there is the psychological comfort and prevalent sense of high responsibility for their own health on a background of good awareness through regular contact with the doctor to a large extent explains the phenomenon of long-term high level of commitment of these patients physical rehabilitation and treatment.

About the authors

M. G Bubnova

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: mbubnova@gnicpm.ru
д-р мед. наук, проф., рук. отд. реабилитации и вторичной профилактики сочетанной патологии с лаб. профилактики атеросклероза и тромбоза ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

V. B Krasnitskii

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

канд. мед. наук, вед. науч. сотр. лаб. кардиологической реабилитации отд. реабилитации и вторичной профилактики сочетанной патологии ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

D. M Aronov

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

д-р мед. наук, проф., рук. лаб. кардиологической реабилитации ФГБУ ГНИЦ ПМ, засл. деят. науки РФ 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

N. K Novikova

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

канд. пед. наук, ст. науч. сотр. лаб. кардиологической реабилитации отд. реабилитации и вторичной профилактики сочетанной патологии ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

E. B Kadushina

V.P.Serbskii State Scientific Center for Social and Forensic Psychiatry

науч. сотр. отд-ния психосоматических расстройств отд. пограничной психиатрии ФГБУ ФМИЦПН им. В.П.Сербского 119991, Russian Federation, Moscow, Kropotkinskii per., d. 23

I. F Matveeva

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

науч. сотр. лаб. профилактики атеросклероза и тромбоза отд. реабилитации и вторичной профилактики сочетанной патологии ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3

References

  1. Leon A.S, Franklin B.A, Costa F et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111: 369-76.
  2. Аронов Д.М., Бубнова М.Г., Барбараш О.Л. и др. Российские клинические рекомендации «Острый инфаркт миокарда с подъемом сегмента ST электрокардиограммы: реабилитация и вторичная профилактика»//CardioСоматика. 2014; 1: 4-42.
  3. Piepoli M.F, Corra’ U, Benzer W et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2010; 17: 1-17.
  4. Taylor R.S, Brown A, Ebrahim S et al. Exercise - based rehabilitation for patients with coronary heart disease: review and meta - analysis of randomized controlled trials. Am J Med 2004; 116: 682-92.
  5. Clark A.M, Hartling L, Vandermeer B et al. Meta - analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 659-72.
  6. Lawler P.R, Filion K.B, Eisenberg M.J. Efficacy of exercise - based cardiac rehabilitation post - myocardial infarction: a systematic review and meta - analysis of randomized controlled trials. Am Heart J 2011; 162: 571-584.e2.
  7. Hammill B.G, Curtis L.H, Schulman K.A et al. Relationship between cardiac rehabilitation and long - term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation 2010; 121: 63-70.
  8. De Vries H, Kemps H.M.C, van Engen-Verheul M.M et al. Cardiac rehabilitation and survival in a large representative community cohort of Dutch patients. Eur Heart J 2015; 36: 1519-28.
  9. Аронов Д.М., Красницкий В.Б., Бубнова М.Г. и др. Влияние физических тренировок на физическую работоспособность, гемодинамику, липиды крови, клиническое течение и прогноз у больных ишемической болезнью сердца после острых коронарных событий при комплексной реабилитации и вторичной профилактике на амбулаторно - поликлиническом этапе (Российское кооперативное исследование). Кардиология. 2009: 49-56.
  10. Аронов Д.М. Кардиореабилитация больных ИБС: рецепт для России. Лечащий врач. 2007; 3: 22-6.
  11. Аронов Д.М., Бубнова М.Г. Проблемы внедрения новой системы кардиореабилитации в России. Рос. кардиол. журн. 2013; 4 (102): 14-22.
  12. Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П. и др. Люберецкое исследование смертности (исследование ЛИС): факторы, влияющие на отдаленный прогноз жизни после перенесенного инфаркта миокарда. Профилактическая медицина. 2013; 2: 32-9.
  13. Иванова Г.Е., Аронов Д.М., Белкин А.А. и др. Пилотный проект «Развитие системы медицинской реабилитации в Российской Федерации». Вестн. восстановительной медицины. 2016; 2: 2-6.
  14. Kusunoki S, Maruji A, Kobayashi K et al. Subjective barriers to adherence to cardiac rehabilitation program after hospital discharge in patients with acute myocardial infarction [in Japanese]. J Jpn Coron Assoc 2008; 14: 206-10.
  15. Grace S, Chessex C, Arthur H et al. Systematizing inpatient referral to cardiac rehabilitation 2010: Canadian Association of Cardiac Rehabilitation and Canadian Cardiovascular Society joint position paper. J Cardiopulm Rehabil Prev 2011; 31: E1-E8.
  16. Higgins R.O, Murphy B.M, Goble A.J et al. Cardiac rehabilitation program attendance after coronary artery bypass surgery: overcoming the barriers. Med J Aust 2008; 188: 712-4.
  17. Mueller E, Savage P.D, Schneider D.J et al. Effect of a computerized referral at hospital discharge on cardiac rehabilitation participation rates. J Cardiopulm Rehabil Prev 2009; 29: 365-9.
  18. Turk-Adawi K.I, Oldridge N.B, Tarima S.S et al. Cardiac Rehabilitation Enrollment Among Referred Patients. Рatient and organizational factors. J Cardiopulm Rehabil Prev 2014; 34: 114-22.
  19. Bustamante M.J, Kramer V.G, Adasme M et al. Patient Adherence to a Cardiovascular Rehabilitation Program: What Factors Are Involved? Int J Clin Med 2015; 6: 605-14.
  20. Jelinek M.V, Thompson D.R, Ski C et al. 40 years of cardiac rehabilitation and secondary prevention in post - cardiac ischaemic patients. Are we still in the ilderness? Int J Cardiol 2015; 179: 153-9.
  21. Menezes A.R, Lavie C.J, Milani R.V et al. Cardiac rehabilitation in the United States. Prog Cardiovasc Dis 2014; 56: 522-9.
  22. Worcester M.U, Murphy B.M, Mee V.K et al. Cardiac Rehabilitation Programmes: Predictors of Non-Attendance and Drop-Out. Eur J Cardiovasc Prev Rehabil 2004; 11: 328-35.
  23. Kotseva K, Wood D, De Backer G et al. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009; 16: 121-37.
  24. Brown T.M, Hernandez A.F, Bittner V et al. Predictors of cardiac rehabilitation referral in coronary artery disease patients: findings from the American Heart Association’s. Get With The Guidelines Program. J Am Coll Cardiol 2009; 54: 515-21.
  25. Мартынов А.А., Cпиридонова Е.В., Бутарева М.М. Повышение приверженности пациентов стационаров и амбулаторно - поликлинических подразделений к лечебно - реабилитационным программам и факторы, оказывающие влияние на комплаентность. Вестн. дерматологии и венерологии. 2012; 1: 21-7.
  26. Бубнова М.Г., Аронов Д.М., Вигдорчик А.В. (от имени участников программы). Эффективность и безопасность терапии Флувастатином Форте у пожилых - открытое Российское наблюдение и анализ приверженности пациентов терапии статинами: программа «ЭФФОРТ»//CardioСоматика. 2011; 3: 13-22.
  27. Balady G.J, Ades P.A, Bittner V.A et al. Referral, Enrollment, and Delivery of Cardiac Rehabilitation/Secondary Prevention Programs at Clinical Centers and Beyond: A Presidential Advisory from the American Heart Association. Circulation 2011; 124: 2951-60.
  28. Rozanski A, Blumenthal J.A, Davidson K.W et al. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005; 45: 637-51.
  29. Strike P.C, Steptoe A. Systematic review of mental stress - induced myocardial ischaemia. Eur Heart J 2003; 24: 690-703.
  30. Miller N.H, Taylor C.B, Davidson D.M et al. The efficacy of risk factor intervention and psychosocial aspects of cardiac rehabilitation. J Cardiopul Rehabil 1990; 10: 198-209.
  31. Scrutinio D. Temporelli P.L, Luigi P et al. Long - term Secondary Prevention Programs After Cardiac Rehabilitation for the Reduction of Future Cardiovascular Events: Focus on Regular Physical Activity Future Cardiol 2009; 5 (3): 297-314.
  32. Бубнова М.Г., Аронов Д.М., Красницкий В.Б. и др. Программа домашних физических тренировок после острого коронарного синдрома и/или эндоваскулярного вмешательства на коронарных артериях: эффективность и проблема мотивации больных. Терапевт. архив. 2014; 86 (1): 23-32.
  33. Аронов Д.М., Бубнова М.Г., Красницкий В.Б. и др. Современные методы реабилитации больных КБС на постстационарном (диспансерно - поликлиническом) этапе. Пособие для врачей. М., 2004.
  34. Аронов Д.М., Лупанов В.П. Функциональные пробы в кардиологии. М: МЕДпресс - информ, 2003.
  35. Красницкий В.Б., Аронов Д.М., Джанхотов С.О. Изучение физической активности у больных ИБС с помощью специализированного Опросника Двигательной Активности «ОДА-23+». Кардиоваск. тер. и проф. 2011; 8: 90-7.
  36. Бажин Е.Ф., Голынкина Е.А., Эткинд А.М. Метод исследования уровня субъективного контроля. Психологический журн. 1984; 5 (3): 152-62.
  37. Zigmond A.S, Snaith R.P. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 1983; 67 (6): 361-70.
  38. Morisky D.E, Green L.W, Levine D.M. Concurrent and predictive validity of a self - reported measure of medication adherence. Med Care 1986; 24 (1): 67-74.
  39. Аронов Д.М., Жукова Л.В. Об адаптации к физическим нагрузкам больных ишемической болезнью сердца. Кардиология. 1985; 4: 121-2.

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