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The influence of extending early stationary rehabilitation by ambulatory form in patients treated interventionally after ACS on the exercise capacity on the components of psychic state of mind and quality of life

100%

Przywarska I., Deskur-Smielecka E., Borowicz-Bienkowska S., Wilk M., Brychcy A., Dylewicz P.

Medical Rehabilitation

2009

vol. 13(2)

12-16

Objectives: The evaluation of the direct and remote effects of stationary rehabilitation following interventionally treated acute coronary syndrome and its extension by a three-month period of supervised training in ambulatory conditions within the scope of physical capacity psychic state and quality of life.Materials and methods: The research was conducted in a group of 44 patients (32 men and 12 women) aged 56.9±9, 62 years old for a period of 2-3 weeks following interventional treatment of acute coronary syndrome. All the patients had participated in stationary rehabilitation, 14 of whom expressed a willingness to participate in a futher three-month period of ambulatory rehabilitation. All patients prior to the commencement of rehabilitation had threadmill exertion tests. Fear was evaluated by means of the SOPER questionnaire. Basic mood and psychic tension as well as the feeling of health were assessed by means of the VAS scale of the Euro-Qol 5D questionnaire. The set of tests was repeated after the completion of the stationary phase, and after time periods of 3 months and a year.Results: Patients subjected to the extended 3-month ambulatory phase of rehabilitation displayed a greater increase in exercise tolerance when compared with the group that had merely undergone the 3-week stationary rehabilitation. Patients with extended rehabilitation gradually improved their evaluation of their state of health and after a year maintained it at the level it had been after the completion of the stationary rehabilitation. In patients who did not express a willingness to continue an organised form of exercise in ambulatory conditions the noticeable improvement in health following the end of rehabilitation was not long lasting. After a year, regardless of the programme of rehabilitation selected, an improvement in the psychic state was noted, which was expressed in an increased positive mood although the level of fear did not change to a significant degree.Conclusions: 1. Extended rehabilitation, combining stationary and ambulatory forms, after interventional treatment of ACS gives a better long-term effect in the area of improving exercise capacity and patient self-evaluation of state of health than is in the case after three-week stationary rehabilitation. 2. The extending of the period of rehabilitation has no influence on attaining the postrehabilitation changes on the level of mood and fear.

Assessment of the selected physiological effects of Nordic Walking performed as a part of a physical exercise program during the second phase of rehabilitation after a myocardial infarction

84%

Wilk M., Kocur P., Różańska A., Przywarska I., Dylewicz P., Owczarski T., Deskur-Śmielecka E., Borowicz-Bieńkowska S.

Medical Rehabilitation

2005

vol. 9(2)

20-25

Cel: Spacery i marsze są prostą a jednocześnie efektywną formą aktywności fizycznej powszechnie stosowaną w rehabilitacji kardiologicznej. W ostatnich latach podejmuje się próby urozmaicenia ćwiczeń marszowych poprzez szersze włączenie pracy kończyn górnych, co umożliwia między innymi coraz bardziej popularna forma aktywności ruchowej znana jako Nordic Walking. Celem niniejszej pracy była ocena wpływu marszu nordyckiego na stopień poprawy tolerancji wysiłku oraz sprawność ogólną chorych rehabilitowanych po zawale serca (ZS). Metoda: Badaniom poddano 30 pacjentów, którzy w okresie 14–28 dni po ZS przebywali na Oddziale Rehabilitacji Kardiologicznej. U wszystkich pacjentów włączonych do programu badawczego przed rehabilitacją i po jej zakończeniu wykonano próbę wysiłkową wg zmodyfikowanego protokołu Bruce’a, 6-minutowy test marszowy oraz test sprawności fizycznej „Fullerton”. Chorych podzielono na dwie grupy. 10 pacjentów uczestniczyło w standardowym programie treningowym (grupa K), a u 20 pacjentów zastosowano dodatkowo (5x w tygodniu po 40 min) trening marszowy typu Nordic Walking (grupa NW). Polegał on na przejściu 3 kilometrów z przerwami przeznaczonymi na ćwiczenia oddechowe i rozciągające. W trakcie marszu oraz ćwiczeń z pacjenci wykorzystywali specjalne kije skonstruowane do tej formy aktywności ruchowej Wyniki: W obu grupach trenujących uzyskano poprawę tolerancji wysiłku, jednak odsetek poprawy w grupie NW (30%) był wyższy niż w grupie K (14%). Podobnie zachowywały się wartości iloczynu podwójnego (RPP). Istotne statystycznie zwiększenie RPP po treningu rehabilitacyjnym stwierdzono jedynie w grupie z NW (z 18,2 x 103 ±3,3 x 103 do 20,7 x 103 ±4,4 x 103) (p<0,05). 6-minutowa próba marszowa wykazała wyższy odsetek poprawy w grupie NW (22%) niż w grupie K (17%). Wyniki testu „Fullerton” wykazują istotną statystycznie poprawę analizowanych parametrów w obu grupach. Wnioski: Wstępne badania wskazują na celowość wdrażania marszu nordyckiego do programów rehabilitacji kardiologicznej po zawale serca z uwagi na wysoką efektywność w zakresie wpływu na poprawę tolerancji wysiłku i sprawności fizycznej. Pełne zaadoptowanie Nordic Walking jako jednej z istotnych metod wczesnej rehabilitacji kardiologicznej będzie możliwe po dokonaniu i przeanalizowaniu większej liczby obserwacji poszerzonych o dodatkowe parametry, głównie w zakresie wpływu na czynniki ryzyka oraz parametry jakości życia.

Background: Walks and marches are a simple yet effective forms of physical activity, commonly used in the cardiac rehabilitation. It has been recommended recently to combine march training with exercises involving upper limbs. One of the most popular methods is Nordic Walking, during which special poles are used to increase the work of upper part of the body. The aim of the study was to assess the influence of Nordic Walking on the improvement in exercise tolerance and physical performance in patients rehabilitated after a myocardial infarction.Methods: The study population consisted of 30 patients hospitalized in a cardiac rehabilitation ward 14 to 28 days after myocardial infarction. On admission and after completing the rehabilitation program patients performed an exercise test following the modified Bruce protocol, a six-minute walk test and a test assessing physical performance (Fullerton test). 10 subjects were assigned to a control group, which followed a standard training program, and 20 patients to a group which additionally performed a march training using the Nordic Walking method 5 times a week. Each session of the march training lasted 40 minutes and consisted of a 3-kilometer walk interrupted by breaks during which respiratory and stretching exercises were performed. During the march and exercises patients used special poles for Nordic Walking.Results: Exercise tolerance improved in both study groups. However, the increase in the exercise tolerance was greater in the group performing Nordic Walking than in the control group (30% vs. 14%, respectively; P < 0.05). The rate-pressure product during the exercise test increased significantly only in the group performing Nordic Walking (from 18.2 x 103 ± 3.3 x 103 to 20.7 x 103 ± 4.4 x 103; P < 0.05). The improvement in the results of the six-minute walk test was greater in the group performing Nordic Walking (22% in comparison with 17% in the control group; P < 0.05). The results of the test assessing physical performance (Fullerton test) improved in both study groups.Conclusion: The results of this preliminary study indicate that march training using the Nordic Walking method effectively increases exercise tolerance and physical fitness in patients after myocardial infarction. If these findings are confirmed by the results of larger studies, Nordic Walking could be widely used in the early phases of cardiac rehabilitation. The influence of Nordic Walking on the cardiovascular risk factors and quality of life parameters should be investigated.

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2 Medical Rehabilitation

1 2009

1 2005

2 Dylewicz P.

2 Przywarska I.

2 Wilk M.

1 Borowicz-Bienkowska S.

1 Borowicz-Bieńkowska S.

1 Brychcy A.

1 Deskur-Smielecka E.

1 Deskur-Śmielecka E.

1 Kocur P.

1 Owczarski T.

1 Różańska A.

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The influence of extending early stationary rehabilitation by ambulatory form in patients treated interventionally after ACS on the exercise capacity on the components of psychic state of mind and quality of life

Assessment of the selected physiological effects of Nordic Walking performed as a part of a physical exercise program during the second phase of rehabilitation after a myocardial infarction