Effects of special physical trainings on haemocardiodynamics in coronary heart disease diagnosed people

PhD T.V. Krasavina1
Dr.Med., Professor V.A. Zaborova1
PhD T.Yu. Shelekhova1
PhD E.V. Rozhnova1
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Keywords: cycle ergometer trainings, cardiorehabilition, therapeutic physical practices.

Introduction. Physical trainings are widely used in the coronary heart disease treatment [1-3, 6-8]. Physical trainings lead to an increase of physical working capacity, decrease in the number of anginal attacks, economization of the cardiac activity during exercise [3-6]. Most researchers associate the changes occurring after intense physical trainings with the adaptation of extracardiac factors, while the effect on the heart is considered exceptional [4-8].

Objective of the study was to rate benefits of different controlled physical trainings on haemocardiodynamics in coronary heart disease diagnosed people.

Methods and structure of the study. Subject to the study were 230 patients diagnosed with coronary heart disease, divided into 8 groups: 4 groups — patients with a severe disease and 4 groups — patients with a mild disease. This differentiation was based on the clinical picture, stress test data and anamnesis on admission for treatment. The following indicators were deemed the disease markers: extensive or complicated myocardial infarction; ST segment depression of more than 1 mm at the last load stage; systolic blood pressure (SBP) of less than 140 mmHg at the last load stage or its decrease by 10-15% at the same stage; power of the last load stage of less than 600 kgm/min. If there were two or more markers, the patients were referred to the "weak" groups, functional classes 3-4, in the rest of the cases - to the "strong" groups, functional classes 1-2, as a rule. The patients’ indicators are presented in the table. Before and after the physical trainings, all patients were subject to a step test with graduated loading on a bicycle ergometer performed in a sitting position. The test was performed with rest pauses until the onset of exercise intolerance [1, 2, 6, 7]. 48 hours before the start of the test, the following drugs were canceled: beta-blockers and calcium antagonists, and 24 hours before - long acting nitrates. We assessed the dynamics of double product (DP) and its components – the maximum heart rate (HRmax) and systolic blood pressure (SBPmax), as well as the dynamics of the maximum load power (LPmax). The physical trainings were conducted as follows: Group 1 patients were engaged in the low-intensity cycle ergometer physical training in supine position at 15-20 W every other day, once a day [6]; Group 2 patients were trained in the same manner, but daily, 2-3 times a day; Group 3 patients had 2 classes conducted by the same method, and each 3rd one conducted in a sitting position at 70-80% of the maximum power; Group 4 patients were engaged in terrenkur. In Group 5, the low-intensity training was conducted 2-3 times a day. In Group 6 – the cycle ergometer physical training in supine position at 70-80% of the maximum power every other day, 3 times a week. In Group 7 - the same as in Group 3. Group 8 was engaged in terrenkur. The groups were statistically homogeneous in terms of the patients’ age, disease duration and the number of training sessions (see table).

Results and discussion. The results were analyzed using the Student t-criterion, Fisher index, and X2. In Groups 1 and 2, double product, HRmax, LPmax increased equally and statistically significantly, while the increase in SBPmax was insignificant. In Group 3, the increase in double product and LPmax was much the same as in Groups 1 and 2, the HRmax increase rate was lower, and SBPmax was higher than in Groups 1 and 2. Therefore, when using the low-intensity trainings only, the increase in double product was due to the increase in HRmax, while the mixed trainings led to the increase in both HRmax and SBPmax. During the testing, the frequency of hypertonic responses to the workloads prior to training was 40% in Groups 1-3, and after training - 2-9% in Groups 1 and 2, and 19% in Group 3, and therefore we consider the increase in SBPmax to be unfavorable. In Group 4, involved in terrenkur, no significant dynamics of these indicators was observed. There was insignificant positive dynamics in some patients without the ST segment depression at the peak of loading, while the patients with the ST segment depression were found to have a violation. In the functionally "strong" Group 5, trained as required by the low-intensity method, there was a significant increase in double product, HRmax, and LPmax; the dynamics of SBPmax was insignificant. When comparing the dynamics in Groups 2 and 5, there was no difference, i.e. the significant difference in the clinical and functional states before treatment did not affect the amount of changes. Group 6 was found to have a highly significant increase in LPmax; there was no dynamics in double product, HRmax, SBPmax, which is consistent with the literature data [1-7]. Group 7 demonstrated a significant increase in double product, SBPmax, HRmax, LPmax. The comparative analysis of this group with Group 3, trained by the same program but characterized by significantly more severe clinical and functional states before treatment, revealed no differences in the dynamics of these indicators.

Patients’ characteristics

Parameters

Group 1,  n=42

Group 2,   n=44

Group 3,   n=42

Group 4,   n=41

Group 5,   n=41

Group 6,   n=15

Group 7,   n=26

Group 8,   n=13

Age, y.o.

53.4 ±0.7

56±1.3

54.9± 1.6

55.6± 0.9

52 ±2

53.3 ±2

52.2±1.2

54.6± 1.2

Disease duration, yrs

4.7 ±1.2

4.3± 1.1

6.2± 1.3

5.1± 1

4.1 ±1

3.7± 0.8

5.1± 0.8

3.7± 1.3

W/o myocardial infarction

6 (14.3%)

13 (29.5%)

7 (26.9%)

6 (14.6%)

10 (66%)

12 (52.2%)

10 (38.5%)

10 (76.9%)

Transmural infarction

25 (59.5%)

22 (50%)

12 (46.2%)

21 (51.3%)

3 (20%)

5 (21.7%)

11 (42.3%)

2 (15.4%)

Small-focal myocardial infarction

2 (4.8%)

6 (13.6%)

4 (15.4%)

12 (29.3%)

2 (14%)

5 (21.7%)

3 (11.5%)

1 (7.7%)

More than 1 myocardial infarction

9 (21.4%)

3 (6.9%)

3 (11.5%)

2 (4.8%)

0

1 (4.4%)

2 (7.7%)

0

1 FC

4 (9.5%)

4 (9.1%)

3 (11.5%)

2 (5%)

8 (53%)

9 (39.1%)

9 (34.6%)

9 (69.2%)

2 FC

2 (4.8%)

6 (13.6%)

15 (57.7%)

16 (39%)

6 (40%)

13 (56.5%)

10 (38.5%)

4 (30.8%)

3 FC

25 (59.5%)

24 (54.6%)

8 (30.8%)

23 (56%)

1 (7%)

1 (4.4%)

7 (26.9%)

0

4 FC

11 (26.2%)

10 (22.7%)

0

0

0

0

0

0

DPmax, c.u.

234±9.6

220±8.7

232±12.3

245±8.9

300±6.7

320±12.9

280±12

323±13.1

LPmax, kgm /min

481±29.9

454±29.4

520±31

618±26.3

626±33

791±38.7

672±35.5

712 ±49

ST segment depression at the peak of loading

35 (83%)

36 (82%)

12 (46.2%)

26 (63.4%)

6 (40%)

2 (8.8%)

5 (19.2%)

2 (15.4%)

Number of training sessions

27±1.3

28±1

26±2

26±0.7

24±1

25.5±2.5

25±3.9

24±1.5

The frequency of hypertonic responses to the workloads and the dynamics of this frequency when comparing Groups 5 and 7 were the same as when comparing Group 3 with Groups 1 and 2. In Group 8, there was insignificant negative dynamics of double product, HRmax, SBPmax; LPmax  - without dynamics. There was no difference in the dynamics of the indicators between Groups 4 and 8, although the difference in the clinical and functional states between the groups before treatment was statistically significant. The physical training of the patients diagnosed with coronary heart disease involved such types of activity as therapeutic physical practices, running, walking, Nordic walking, swimming, games [3, 5, 8]. These classes were adapted to each patient's capabilities by intensity, which ranged from 60 to 100% of individual maximum capabilities, i.e. the physical training programs for the patients were designed on the same lines as for healthy people.

The analysis of the physical training results showed that the workload intensity of 50-70% of maximum did not have any statistically significant effect in the form of improved hemodynamics, which was associated with insufficient training intensity. The intensity of 80% of maximum led to the contradicting results. Most researchers believe that physical trainings increase power capacity but do not affect the heart’s ability to consume oxygen, measured indirectly by double product [7, 8]. The supporters of the positive effect of high-intensity physical trainings on coronary circulation do not provide any convincing data, since some have conducted few researches only, and others have obtained irregular results when processing the data using the Fisher index. There was no statistically significant dynamics of indicators in Group 4 engaged in controlled walking, however, the individuals with the ST segment depression at the peak of loading were found to have negative dynamics. The physical training results in Group 8 indicated deterioration due to the decrease in double product against the background of previous load power, but there is an opinion that these results can be regarded as economization of cardiac activity being favorable in case of coronary heart disease [5]. The feasibility of combining the low- and high-intensity physical trainings was studied in Groups 3 and 7. This combination, although leading to the increase in double product and LPmax, forms a hypertonic type of response to the workloads, which is an unfavorable marker.

Conclusion. The study found that low-intensity cycle ergometer physical trainings in supine position help increase the coronary blood flow measured by diastolic pressure regardless of the initial functionality in health groups 2 and 5; and it is important that benefits of the training depend on the training cycles rather than schedules – i.e. 2-3 trainings per day may be as efficient as 1 per day with a daily rest break. conditional on the same numbers of training sessions – that means that the low-intensity physical training technique may be effectively applied in sanatoria and hospitals. Progress tests in the groups of patients engaged in the high-intensity physical training showed the highest progress achieved by group 6 with a fair prior functionality. The group was subject to the controlled individualized cycle ergometer trainings in sitting position. with the maximal load growing and diastolic pressure staying the same. Combined low- and high intensity physical trainings may not be recommended though due to the potential hypertonic responses to the workloads.

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References

  1. Aronov D.M. Osnovy kardioreabilitatsii [Fundamentals of cardiac rehabilitation]. Kardiologiya: novosti. mneniya. obuchenie. 2016. no.3 (10). pp. 104-110.
  2. Aronov D.M.. Lupanov V.P. Funktsionalnye proby v kardiologii [Functional tests in cardiology]. Funktsionalnye proby v kardiologii. Moscow: MEDpress-inform publ.. 2002. 18 p.
  3. Arutyunov G.P.. Kolesnikova E.A.. Begrambekova Yu.L. Rekomendatsii po naznacheniyu fizicheskih trenirovok patsientam s hronicheskoy serdechnoy nedostatochnostyu [Recommendations for physical training process design for patients with chronic heart failure]. Serdechnaya nedostatochnost. 2017. v. 18. no.1. pp. 41-66.
  4. Bubnova M.G.. Aronov D.M. Raznonapravlennoe vliyanie fizicheskikh nagruzok raznogo vida i intensivnosti na pokazateli sistemy lipidnogo transporta u zdorovyh muzhchin i bolnykh koronarnoy boleznyu serdtsa [Multidirectional effect of physical activity of different types and intensity on lipid transport system performance in healthy men and patients with coronary heart disease]. Vestnik vosstanovitelnoy meditsinyi. 2017.no. 5 (81). pp. 17-24.
  5. Volodina K.A.. Linchak R.M.. Achkasov E.E. et al. Effektivnost skandinavskoy khodby u patsientov. perenesshikh ostry koronarny sindrom [Efficiency of Scandinavian walking in patients after acute coronary syndrome]. CardioSomatika. 2017. v. 8. no. 1. 20 p.
  6. Vykhodtsev A.N.. Siluyanova V.A.. Syrkin A.L.. Ivanov Ya.S. Primenenie fizicheskikh trenirovok nizkoy intensivnosti v lechenii bolnykh ishemicheskoy boleznyu serdtsa [Low-intensity exercise in treatment of patients with coronary heart disease]. Voprosy kurortologii. fizioterapii i lechebnoy fizkultury. 1985. no. 2.pp. 46-49.
  7. Glots D.D.. Novak Z. Vliyanie velotrenirovok v pomeshchenii na parametry gemodinamiki levogo zheludochka muzhchin s ishemicheskoy boleznyu serdtsa i posle infarkta miokarda [Effect of indoors cycling exercise on hemodynamic parameters of left ventricle of men with ischemic heart disease and after myocardial infarction]. Rossiyskiy kardiologicheskiy zhurnal. 2017. v. 22. no. 3. pp. 46-53.
  8. Hardman A.E. Exercise in prevention of atherosclerotic. metabolic and hypertensive disease: review. J. Sports Sci.. 1996;14:201-218.

Corresponding author: krasavina.t@mail.ru

Abstract

Objective of the study was to rate benefits of different controlled physical trainings on haemocardiodynamics in coronary heart disease diagnosed people. The study found that a low-intensity cycle ergometer physical trainings in supine position helps increase the coronary blood flow measured by distaolic pressure regardless of the initial functionality in health groups 2 and 5; and it is rather important that benefits of the training depend on the training cycles rather than schedules – i.e. 2-3 trainings per day may be as efficient as 1 per day with a daily rest break, conditional on the same numbers of training sessions – that means that the low-intensity physical training technique may be effectively applied in sanatoria and hospitals. Progress tests in the groups of patients engaged in the high-intensity physical training showed the highest progress achieved by group 6 with a fair prior functionality. The group was subject to the controlled individualized cycle ergometer trainings in sitting position, with the maximal load growing and diastolic pressure staying the same. Combined low- and high intensity physical trainings may not be recommended though due to the potential hypertonic responses to the workloads.