Dania Mubashar  ( Department of Physical Therapy, University of Lahore, Raiwind Campus, Lahore, Pakistan. )
Arooj Fatima  ( University of Lahore, Raiwind Campus, Lahore, Pakistan. )

Objective: To determine the frequency, intensity and duration of routine rehabilitation exercises practiced by patients with coronary artery disease.

Method: The cross-sectional descriptive study was conducted from February to June 2019 in different hospitals of Lahore, Pakistan, and comprised coronary artery disease patients of either gender aged 35-65 years. Data was collected using an interview-based questionnaire. Data was analysed using SPSS 25.

Results: Of the 186 subjects, 105(56.5%) were males and 81(43.5%) were females. Overall, 72(38.7%) subjects were aged 52-62 years. Of the total, 117(62.9%) subjects practiced brisk walking as their routine rehabilitation exercise; 57(48.7%) doing it 3 times per week. All of these 117(100%) subjects practiced it for 10-20 minutes.

Conclusion: Brisk walking was mostly practiced by coronary artery disease patients for 10-20 minutes 3 times per week.

Keywords: Coronary artery disease, Exercise-based cardiac rehabilitation, Aerobic exercise. (JPMA 71: 1399; 2021)

DOI: https://doi.org/10.47391/JPMA.1389

 

Introduction

 

Cardiovascular diseases (CVDs) remain the leading cause of physical disability and deaths worldwide. Approximately 40% of these deaths are ascribed to coronary artery disease (CAD).¹ It is one of the major causes of morbidity and mortality rates in the elderly population. Even the World Health Organisation (WHO) estimated that around 17.5 million, or around 31%, deaths per year are credited to CVDs out of which 85% occur due to heart attacks and stroke.^2,3 There are many risk factors both adjustable and non-adjustable that are attributed to CAD and are also well-documented in many areas.^4,5 One of the chief causes of CAD-related morbidity is atherosclerosis, which is a long-term process that begins with fatty lesions progressing to stenosis of coronary arteries that later exhibit as angina, or chest pain, or myocardial infarction (MI), or heart attack, and if this blockage reaches the brain, it can lead to stroke.^6,7

Other risk factors include physical inactivity, tobacco use, alcohol abuse and inadequate diet. Physical activity plays a crucial role in health improvement and enhancement. Other than physical inactivity, another primary cause that can lead to CAD is inappropriate diet which will ultimately result in conditions like obesity or overweight.⁸ The prevalence of obesity is drastically increasing, with 5.2% females and 1.6% males being obese at the minor age of 15 years.⁹

Regardless, of being preventable and treatable, CAD is still one of the major causes of mortality rates and this burden is likely to increase two-fold which is an alarming situation.¹⁰ CAD prevalence among Pakistani population is higher and 30% of the population age >40 are most likely to be affected by the disease.¹¹ Exercise-based cardiac rehabilitation (CR) has been known to be favourable in CAD patients and it improves their quality of life (QOL), exercise tolerance, measured through aerobic capacity (peakVO2) and cardiac-related morbidity and mortality rates in which men, with a peakVO2 (mL·kg-1·min-1) below ~15 were more prone to higher risk, whereas a peakVO2 above ~19 were associated with a low rate. Similarly, among women, a peakVO2 below ~12 were more prone to higher risk, whereas those with peakVO2 above ~16.5 were associated with the lowest rate.¹²

Frequency, intensity and duration of exercise are important factors for CR, but intensity is an important predictor of determining the effectiveness of an exercise programme.¹³ Studies have shown that higher intensity interval training (HIIT) is more effective than continuous training at moderate level.^14-16

Physical fitness is also important for CAD patients and is also one of the basics of CR. It helps in decreasing morbidity and mortality rates in cardiac patients. Physical fitness can be determined by different scales, such as Patient Specific Functional Scale (PSFS) and Disability Rating Index (DRI).¹⁷

Patients with CAD are often stressed out, and CR is introduced in such cases. The main goal of CR is to improve QOL by reducing stresses that will ultimately improve cardiac function.¹⁸

The American Heart Association (AHA) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and other well-established organisations also recommend providing comprehensive CR. The aim included patient's assessment, weight control, blood pressure (BP) management, lipid profile, management of diabetes, smoking cessation, psychosocial management and an adequate exercise training programme. The goal is optimising CVD risks reduction, reducing chances of disabilities and motivating patients to live active and healthy lifestyle.¹⁹

Liou K. et al. compared HIIT with moderate-intensity continuous training (MICT) to see which had better effect on CAD patients. There was incremental increase in VO2 in those who performed HIIT rather than MICT.¹⁶

Armstrong M.J., et al. reported that patients with diabetes could not complete the programme. Those who completed CR despite having diabetes had reduced mortality rates.²⁰

Szylinska A. et al. concluded that InPhysio patients showed better improvements with very less decrease in forced vital capacity (FVC) between initial and final tests.²¹

The current study was planned to determine routine rehabilitation exercises of CAD patients.

 

Patients and Methods

 

Cross-sectional descriptive study was conducted in University of Lahore, while patients were recruited from different settings of Lahore such as Jinnah Hospital and Punjab institute of cardiology. The sample size was calculated using the formula n = Z2 *P*(1-P)/d2, with anticipated population proportion (P) 86%, absolute precision required (d) 5% and significance (a) 5%.

Those included were patients of either gender aged 35-65 years having myocardial infarction (MI), post-coronary artery bypass grafting (CABG) surgery and stable angina. Patients having unstable angina, exertional angina and multiple organ failure were excluded. Data was collected using an interview-based questionnaire. This questionnaire was specifically designed to determine frequency, intensity and duration of exercise practiced by CAD patients according to their condition. Age, occupation, physical activities, BP, blood cholesterol, family history of chronic disease, patient history were noted. Also, search engines, such as Google Scholar, PubMed and PEDro, were used to retrieve information regarding the current research on the topic.

Data was analysed using SPSS 25. Descriptive statistics, including frequencies and percentages, were calculated for each variable.

 

Results

 

Of the 186 subjects, 105(56.5%) were males and 81(43.5%) were females. Overall, 72(38.7%) subjects were aged 52-62 years. Of the total, 117(62.9%) subjects practiced brisk walking as their routine rehabilitation exercise; 57(48.7%) doing it 3 times per week. All of these 117(100%) subjects practised it for 10-20 minutes(Table).

 

 

Besides, 69(37.1%) subjects faced difficulties in performing certain activities of daily life, such as domestic duties involving grocery, work etc., while 63(33.9%) faced problems while performing household chores (Figure).

 

 

Discussion

 

Findings showed 62.9% of the CAD patients preferred brisk walking as their routine rehabilitation exercise.

Conraads VM et. al. concluded that aerobic interval training was considered the best for such patients.¹⁵ It was also noted in the current study that many CAD patients were not very fond of CR. Cesar LAM et. al.said higher intellectual level or family income was directly related with better knowledge on the efficacy of CR.²² Anderson et al. supported the idea of exercise-based CR for reducing mortality rate and improving QOL.²³ Diabetes and hypertension are consistent risk factors for this malady accompanied with physical inactivity and unhealthy diet. Diabetes is considered the root cause of CAD, accounting for 80% of CVD deaths.²⁴ On the other hand, hypertension is also considered a menace. It can lead to major diseases, such as cerebrovascular disease and chronic kidney disease (CKD). Its prevalence rate is more than its control rate. It is known that hypertension causes 45% of CAD and is also the leading cause of stroke.^25,26 The current study showed many subjects (24.7%) were diabetic, many were bound to bed-rest due to society norms of cardiac patients, while 30.1% subjects were hypertensive.

Physical inactivity and smoking also play significant roles in this regard. Pakistan has been ranked 9th in terms of obesity, and there are greater chances of its rise in the near future. Obesity engulfs every category, including child, adult and older people, regardless of gender.²⁷

A study stated that from the past decades, cardiologists have provided acute management and now it involves multidisciplinary approach, including acute management, life-saving management and pharmacological treatment.²⁸ It also suggested the need for CR as it covers every boundary to enhance health-related QOL in cardiac patients. It proposed establishment of CR centres across the country in every hospital unit as cardiac diseases are now increasing at an alarming pace.²⁸

 

Conclusion

 

Brisk walking was the CVR of choice for most CAD patients among whom many were facing difficulties in performing simple domestic activities. Exercise-based CR is a must for cardiac patients and the study population was not found to be particularly inclined towards CR.

 

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

 

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