Vnitr Lek 2005, 51(1):41-47

Power training at the patients after acute myocardial infarction with decreased left ventricular ejection fraction

L. Elbl^1,*, V. Chaloupka¹, I. Tomášková¹, F. Jedlička¹, S. Nehyba¹, P. Kala², J. Schildberger², M. Poloczek², Š. Chaloupková³, M. Hudcová³

¹ Oddělení funkčního vyšetřování FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Václav Chaloupka, CSc.

² Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

³ Oddělení rehabilitace FN Brno, pracoviště Bohunice, přednosta prim. MUDr. Jana Roubalová

Intention of the work:
Cardiovascular rehabilitation programme is an important and indivisible part of care of the patients after acute myocardial infarction. The basis of the rehabilitation programme in patients at rehabilitation phase II is an anaerobic training recently combined with the training with power moves. The submitted work addresses the evaluation of the training safety in patients with decreased left ventricular ejection fraction (EF).

Patients and methods:
The authors have involved 109 patients (18 women, 91 men) in the age of 58 ± 9 years (median 58 years) to the ambulantory controlled rehabilitation programme. 11 patients (10 %) had an induced myocardial ischaemia at the entry load test. 34 patients (32 %) had decreased EF < 50 % (38 ± 6 %, median 41 %). The time from the development of myocardial infarction to the initiation of rehabilitation was 31 ± 7 days (median 29 days), at the patients after aortal coronary bypass it was 45 ± 19 days (median 33 days). Before and after rehabilitation the patients had echocardiographically determined left ventricular EF and there was made a spiroergometry with determination of peak oxygen intake (pVO₂). They attended the rehabilitation programme 3 times a week during 8 weeks. There was made an aerobic exercise at the pulse frequency corresponding 60 % pVO₂ and 14 days later it was supplemented with power exercises. Patients with normal EF made power exercises at 50% 1 RM level (one repetition maximum), the patients with decreased EF started at the value of 30% 1-RM intending to reach the values of 50% 1-RM.

Results:
In both subgroups of the patients the rehabilitation programme led to a significant increase of pVO₂, load tolerance and training load tolerance, no significant differences between the subgroups were observed. In the subgroup with decreased EF the EF values moderately improved (38 ± 6 % versus 45 ± 6 %, p < 0.007). Before the rehabilitation, total muscular power was moderately but not significantly decreased in the subgroup with decreased EF (p < 0.09). In both subgroups the total power significantly increased (p < 0.0001) without mutual difference, total power increase was higher in the subgroup with decreased EF (p < 0.004. The relationship among total power, EF and pVO₂ was not found, but there exists a correlation to the age before rehabilitation (r = -0.43, p < 0.003) and after rehabilitation (r = -0.41, p < 0.001).

Conclusion:
Isometric exercise in patients after accute myocardial infarction is safe, it did not led to the development of myocardial ischemia, haemodynamic changes or arrhytmia. The authors initiate the ambulatory rehabilitation programme within 3-4 weeks after the development of accute myocardial infarction involving the power exercises after 2 weeks of initial aerobic training.

Keywords: accute myocardial infarction; rehabilitation; power exercise

Received: February 24, 2004; Accepted: April 2, 2004; Published: January 1, 2005  Show citation