Introduction/ Background

1. Effect of Aerobic vs Combined Aerobic – Strength Training on 1-Year, Post-Cardiac Rehabilitaion Outcomes in Women After A Cardiac Event Clinical Significance Moholdt et al (2009) Aerobic Interval Training Versus continuous moderate exercise after coronary artery bypass surgery: A randomized study of cardiovascular effects and quality of life. American Heart Journal 158: 1031-1037. This article supports the original article’s finding that quality of life improves with exercise training in cardiac rehabilitation patients. This particular study found improved physical capacity in both groups, but their ultimate goal for these patients was to improve quality of life which they found a significant improvement at four weeks and remained improved at six months. Cardiac rehabilitation (CR) uses a multidisciplinary approach and provides a secondary prevention through risk factor identification and modification in order to aid in the prevention of disease progression and recurrence of cardiac events. Cardiovascular disease is the leading cause of mortality in North America, and coronary artery disease (CAD) accounts for approximately 50% of the cardiovascular disease deaths in women. The risk of cardiovascular disease increases significantly when women enter their menopausal years. A key component to CR is exercise training. The benefits of supervised exercise, and CR are well recognized, with improvements having been shown in functional capacity, risk factor profiles and cardiovascular mortality. Quality of Life (QOL) and functional ability to perform everyday activities may be the most important outcomes since female cardiac patients more often tend to be widowed at the time of their cardiac event. Strength may enable functional ability and promote quality of life in older women following a cardiac event. Introduction/ Background Procedures: Initially baseline data were taken on day 1 of the research study. Strength testing and the graded exercise test were done on separate days. Participants were randomized and the physicians responsible for the exercise testing were blind to the patient’s assignments. Initially, all participants attended aerobic exercise classes twice a week for eight weeks in order to have a standard entry point and allow the women to become habituated to the exercise environment. Aerobic training: The patients attended the AT group twice a week for 6 months. Each session had a 10-15 min warm-up, aerobic interval training with stationary cycles, treadmills, arm ergometers, and stair climbers followed by 10-15 min of a cool down period lasting 40 min total. Aerobic plus strength training: Patients attended exercise sessions twice a week for 6 months. In addition to the aerobic exercise training (see above) these women completed 2 sets of 8-10 reps of upper body (UE) and 10-12 repetitions of lower body (LE) exercises. Each repetition was completed with a slow controlled movement with 2 sec of concentric lifting and 4 sec eccentric lowering. Resistance exercise intensity was increased gradually. Strength training took 20- 25 minutes and the total amount of active exercise was matched to the aerobic group to give comparability to the groups. More women in the AST group continued exercise after discharge from CR than those in the AT group. Both groups showed an increase in all 4 measurements of strength. The PCS was increasing more rapidly in the AST group (fig. 2). There was a decline in peak VO2 in both groups one year after discharge from CR and there was no statistical difference between the two groups. Self efficacy had statistically significant improvements in both groups one year follow up for stair climbing, lifting, and walking. Results Article 1 Methods and Materials Article 2 Moghadam BA, Tavakol K, Hadian MR, Bagheri H, Jalaei S (2009) Phase III cardiac rehabilitation after CABG: Combined aerobic and strengthening exercise protocols. International Journal of Therapy and Rehabilitation 16: 420-430. This study found that the exercise protocols improved certain biophysical and biochemical parameters, as well as patient’s functional capacity. This is similar to the original article because they both found benefits in the different exercise protocols for cardiac rehabilitation participants. Article 2 used a control group doing an aerobic exercise protocol and three aerobic strength training protocols. This study found greater net gains in the combined exercise groups than the aerobic group which is synonymous with the original article. Summary Abstract J RehabilMed 2007; 39: 730-735 Arthur HM, Gunn E, Thorpe KE, Ginis KM, Mataseje L, McCartney N, McKelvie The results in these studies are significant for any provider working with a CR patient. It is important for these patients to participate in any exercise program to improve their self-efficacy and quality of life. A combined aerobic and strength training program will give the patient the best results. Including Strength training will provide these patients with an ability to perform activities of daily living with better effectiveness. Objective: To compare the effect and sustainability of 6 months combined aerobic/strength training vs aerobic training alone on quality of life in women after coronary artery by-pass graft surgery or myocardial infarction. Design: Prospective, 2-group, randomized controlled trial. Participants: Ninety-two women who were 8–10 weeks postcoronary artery by-pass graft surgery or myocardial infarction, able to attend supervised exercise, and fluent in English. Methods: The aerobic training alone group had supervised exercise twice a week for 6 months. The aerobic/strength training group received aerobic training plus upper and lower body resistance exercises. The amount of active exercise time was matched between groups. The primary outcome, quality of life, was measured by the MOS SF-36; secondary outcomes were self-efficacy, strength and exercise capacity. Results: After 6 months of supervised exercise training both groups showed statistically significant improvements in physical quality of life (p = 0.0002), peak VO2 (19% in aerobic/strength training vs 22% in aerobic training alone), strength (p < 0.0001) and self-efficacy for stair climbing (p = 0.0024), lifting (p < 0.0001) and walking (p = 0.0012). However, by 1-year follow-up there was a statistically significant difference in physical quality of life in favor of the aerobic/strength training group (p = 0.05). Conclusion: Women with coronary artery disease stand to benefit from both aerobic training alone and aerobic/strength training. However, continued improvement in physical quality of life may be achieved through combined strength and aerobic training. • Strength training is an important exercise intervention for female cardiac patients since most activities performed later in life by these patients require strength and not endurance such as climbing stairs, carrying groceries, lifting objects, performing housework, getting in and out of chairs, and even walking. • Both physiological and physical gains are made from either an aerobic or a combined aerobic-strength program, and to sustain improvements from exercising a combined strength and aerobic training method is best. • Most health care providers will be working with patients who have heart disease so the exercise interventions will be useful in any situation. Discussion • Both the AT and AST are associated with short term (6 months) improvements in physical HRQoL in women after CABGS or MI. Combined AST may be associated with longer term sustainability of HRQoL benefits compared to the AT group. • Both exercise protocols were associated with improvements in peak VO2, strength, and self efficacy during formal, supervised CR. • Both physical and psychological gains are evident with both forms of exercise, but it is possible that continued improvements are achieved best with combined strength and aerobic training in women with CAD. Purpose To compare the effect and sustainability of a 6 month combined aerobic and strength training program to aerobic training alone in women who had coronary artery by-pass graft surgery (CABGS) or myocardial infarction (MI). • Study design: • Prospective, 2-group randomized controlled trial. • Eligible women were randomly assigned to: • (i) aerobic exercise training (AT) or • (ii) combined aerobic-strength training (AST). • The study variables were all measured at baseline, after 2 months, after 6-months of completing the exercise training program, and one year after discharge which was 18 months from the baseline. • Outcome Measures: • The HRQoL, measured with the Medial Outcomes Study Short Form Health Survey (SF-36) • Perceived self-efficacy measured with a set of scales used for clinical use, strength was measured with a 1 repetition maximum (1RM), and exercise capacity measured by a graded exercise test on a cycle ergometer using peak oxygen uptake Presented by: Jill Heil, Bellarmine University, DPT Student