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What is new in rehabilitation following cardiac surgery?

comment by Maria Simonenko, EAPC Secondary Prevention and Rehabilitation Section

Cardiovascular Rehabilitation

Aerobic exercise is a critical component of cardiac rehabilitation (CR) for patients who have undergone cardiac surgery [1]. A lot of patients were included in the study of M.P. Doyle et al., but the pooled mean age was 66±10 years, and pooled mean percentage of male patients was 73% [1]. So there will be more practical benefits to include younger patients and female ones too.

According to previous studies, women had a significantly lower peak VO2 than men, but had better survival at all levels of exercise capacity [2]. The current practice of uniform application of peak VO2 as an aid to determine heart transplantation (HTx) timing should be re-examined [2].

n addition, high-intensity aerobic interval exercise (HIIE) appeared to be safe in this selected population of men with mild to moderate systolic chronic heart failure and the HIIE protocol with short intervals (30 s) and passive recovery appeared to be optimal among those tested in the study of P. Meyer et al. [3].

Moreover, exercise based CR in the modern era aims to improve aerobic and functional capacity through the use of aerobic based exercise such as walking and stationary cycling, providing benefits of symptom amelioration, attenuation of cardiac disease progression and reduced hospital admissions and mortality [4,5,6,7,8]. X. Yang et al. showed in their study that exercise was not clearly associated with reductions in cardiac death, the recurrence of myocardial infarction (MI), repeated PCI, CABG, or restenosis [9].

According to G.O. Dibben et al., there is moderate evidence of an increase in physical activity (PA) with CR participation compared with control [10]. Patients performing high frequency aerobic exercise reached most functional milestones significantly earlier than those performing low-frequency exercise, and aerobic exercise improved cardiac autonomic function assessed by heart rate variability, compared with usual care [1,11,12].

High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA [10]. Post-HTx patients maintain a moderately active lifestyle. Measures of exercise tolerance generally are related to recent daily recreational activities in patients after HTx, but these associations are modest. The many physiologic factors unique to heart transplanted recipients likely play a more important role than deconditioning in determining exercise tolerance in these patients [13].

However, M.P. Doyle et al. have not discussed in their study the difference of CR after cardiac surgery procedures. T. Kavanagh et al. suggested that exercise capacity, as determined by direct measurement of VO2peak, exerts a major long-term influence on prognosis in men after MI, CABG, or ischemic heart disease (IHD) and can play a valuable role in risk stratification and counseling [14].

Aerobic exercise commenced early after cardiac surgery significantly improves functional and aerobic capacity following cardiac surgery at hospital discharger compared with current usual physiotherapy care and may provide improvements in aerobic capacity in the short to medium term [1].

In conclusion, aerobic exercise training improves peak oxygen consumption in healthy, elderly and cardiac patients and we should have more studies in this field.


Note: The content of this article reflects the personal opinion of the author and is not necessarily the official position of the European Society of Cardiology. 



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