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The feasibility and safety of an unsupervised in home exercise program for patients with congestive heart failure
The 7th Annual Scientific Meeting
•
HFSA
S93
Clinical Care/Management Strategies 344
345
The Effect of a Family-Focused Intervention on Self Management of Diet, Medication-Taking, and Activity after Six Months Sandra B. Dunbar,1 Patricia C. Clark,1 Christi Deaton,1 Anindya De,3 Andrew L. Smith,2—1Nell Hodsgon Woodruff School of Nursing, Emory University, Atlanta, GA; 2Center for Heart Failure Therapy and School of Medicine, Emory University, Atlanta, GA; 3Centers for Disease Control, Atlanta, GA
The Feasibility and Safety of an Unsupervised in Home Exercise Program for Patients with Congestive Heart Failure Jennifer L. Dekerlegand,1 William H. Shull, Jr,1 Andrew Kao2—1Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
Persons with heart failure (HF) are expected to perform selected self care behaviors related to dietary sodium reduction, medication-taking, and physical activity, and most of these occur within a family context. This study evaluated the effect of two family-based education and support interventions on these self care behaviors. HF patients and a participating family member (FM) were randomized to receive either an indepth patient-FM education session (EDUC: n ⫽ 29 dyads) or in-depth patient-FM education plus a family partnership intervention (EDUC ⫹ FPI; n ⫽ 34 dyads). EDUC included general HF information, individual feedback on dietary habits, and counseling regarding medication-taking, and daily physical activity. The EDUC ⫹ FPI added communication strategies and partnership building to enhance family support and autonomous patient decision-making regarding self care. HF subjects were 53% male, mean age 61 ⫾ 12 yrs, 61% Caucasian, 78% NYHA Class II & III, LVEF 32 ⫾ 15%. All were in steady state on ACE inhibitors and diuretics; 67% were on beta blockers at baseline. FMs were 77% female, mean age 54 ⫾ 17 yrs and 67% spouses. Clinical, demographic, family functioning (Family APGAR) and depression (Beck Depression Inventory-II, BDI-II) were obtained at baseline. Variables and outcome measures at BL, and at 3 and 6 months after intervention were dietary sodium obtained by 24 hour urinary sodium; medication-taking behaviors obtained by self report using the Morisky scale, physical activity obtained by self report on the Physical Activity Scale for Elders (PASE) and distance walked during a 6-minute walk test. Data were analyzed with descriptive statistics, Chi square analysis to determine group differences in meeting dietary compliance criteria of ⬍2500mg Na/day, and generalized least squares regression to examine group differences in outcomes while controlling for body mass index (BMI), LVEF, APGAR and BDI-II. Between BL and 3 M, 36.8% of EDUC vs. 68% of EDUC ⫹ FPI met dietary compliance criteria (X2 ⫽ 4.22, p ⫽ .04). Over time, EDUC showed relatively little
Background: Exercise intolerance is a hallmark of congestive heart failure (CHF). Supervised exercise training in a cardiac rehabilitation (CR) program has demonstrated improvements in submaximal and maximal exercise tolerance. Unfortunately, most third party payors do not reimburse for continued supervised exercise after 6–12 weeks of CR. Therefore, the proper in-home regimen to maintain physical fitness after CR is not well delineated. The purpose of this pilot study was to prospectively examine the safety and efficacy of an in-home walking program after CR in pts with CHF. Methods: Pts with mild to moderate CHF who successfully completed a 12 week CR program were asked to complete a 12 week in-home exercise program (HEP), consisting of walking 5 days a week at a Borg Rate of Perceived Exertion between 10 and 13, with proper warm up and cool down stretching exercises. Initial exercise duration was 20 minutes, increasing by 5 minutes every 2 weeks until 40 minutes of exercise was achieved. General physical and mental QOL was assessed by the Medical Outcomes Survey Short Form-36 questionnaire (SF36P and SF36M, respectively), while disease-specific QOL was assessed by the Minnesota Living With Heart Failure Questionnaire (LWHF). Submaximal exercise capacity was evaluated by the 6-minute walk test (6MWT) and maximal exercise capacity was assessed with breath-by-breath expired gas measurements. Testing was performed before and after CR, and again after completion of the 12 week HEP. Comparisons between variables were assessed using paired t tests. Results: Six pts (mean age 45.0 ⫾ 15.6 yrs, 4 females, 4 African-Americans, NYHA class 2.8 ⫾ 0.4, 80% ACEI/ARB and 33% beta blocker) participated in this study. Adherence to the program was excellent, with pts exercising at least 4 days per week on average. The results of testing before and after CR and after HEP are shown in Table I. After CR, peak VO2 tended to increase (p ⫽ 0.07), while 6MWT increased significantly (p ⬍ 0.02). NYHA class also tended to decrease (p ⫽ 0.10). After HEP, peak VO2 was maintained (p ⫽ NS), while 6MWT tended to increase further (p ⫽ 0.06) and NYHA class tended to improve (p ⫽ 0.08). General and disease-specific QOL remained stable throughout the study. There were no exercise-related adverse events or hospitalizations/mortality throughout the study. Conclusion: This pilot study suggests that a simple home walking program after supervised CR is safe and maintains both submaximal and maximal exercise tolerance as well as QOL in patients with mild to moderate CHF.
change whereas the EDUC ⫹ FPI group significantly reduced dietary sodium at 3 months (p ⫽ .03) and at 6 months remained below their baseline levels with BMI an independent predictor (p ⫽ .000). Models analyzing the Morisky, and 6-minute walk revealed no significant difference between groups in change from BL to 6 months although the PASE showed change in the hypothesized direction (p ⫽ .10). Conclusions: These data reflect the overall benefit of a family focused intervention in reducing dietary sodium intake in the initiation phase and suggest that the effects of the intervention wan over time. The impact on dietary behaviors was most salient with diet patterns the most amenable behavior to change through the family focused education and partnership interventions. Additional emphasis on increaseing physical activity and improving medication taking is required. Exploration of greater intervention intensity and/or booster family interventions are warranted to affect long-term change in HF self management.
346 Magnetic Resonance Imaging Provides Accurate Noninvasive Hemodynamic Assessment in Heart Failure: Correlation with Invasive Hemodynamic Measurements Biljana Pavlovic-Surjancev,1 Stephanie M. Shors,2 William G. Cotts,1 Scott Pereles,2 James Carr,2 Maryl R. Johnson,3 Mihai Gheorghiade,1 Robert O. Bonow,1 John Paul Finn4—1Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL; 3Cardiology, University of Wisconsin, Madison, WI; 4Radiology, University of California at Los Angeles, Los Angeles, CA Background: Right heart catheterization (RHC) is a standard invasive method of hemodynamic cardiac assessment. Cardiac magnetic resonance imaging (MRI) is emerging as a noninvasive method capable of assessing cardiac anatomy and function. Hypothesis: We hypothesized that cardiac index (CI) and transit time (TT) by MRI would correlate with CI, pulmonary artery (PA) and pulmonary capillary wedge (PCW) pressure by RHC; PA and PCW pressure could be inferred from TT. Methods: 18 subjects (10M, 8F, age 24-80 yrs) with heart failure and ejection fraction 8-75% were prospectively studied with MRI and RHC. MRI consisted of cine cardiac imaging and time-resolved 3D MR angiography with 6 ml gadolinium IV bolus. Time-intensity curves were generated for gadolinium transit from PA to pulmonary vein (PV). PA-to-PV TT was calculated by subtracting the time of peak signal intensity (PSI) on the PA curve from the time of PSI on the PV curve. Using dedicated software, cardiac output was obtained from the cine images and divided by body surface area to obtain CI. The strength of relationship between hemodynamic parameters obtained by MRI and RHC was assessed by correlation coefficient (r). The degree of agreement was assessed by Bland-Altman method. Results: Broad range of CI by MRI(1.73-4.84 L/min/m2) showed statistically significant correlation (r ⫽ 0.81, p ⫽ 0.0001) with thermodilution CI by RHC (1.91-3.99 L/min/m2). CI by MRI showed an excellent agreement with CI by RHC using Bland-Altman plot. PA-to-PV TT by MRI ranged from 3.3 to 9.6 s and correlated positively with PA mean (range 11-44 mmHg, r ⫽ 0.47, p ⬍ 0.05) and PCW pressure (range 3-32 mmHg, r ⫽ 0.56, p ⫽ 0.01) by RHC. PCW and PA pressure could be calculated from TT by linear regression. For example, PA diastolic pressure calculated from TT by MRI showed good agreement with PA diastolic pressure measured by RHC, as shown in Bland-Altman plot here. Conclusions: 1. Cardiac index by MRI correlates well with CI by RHC. 2. The longer the pulmonary transit time by MRI, the higher the PA and PCW pressure by RHC. 3. Cardiac MRI shows promise for accurate assessment of hemodynamics such as CI, PCW and PA pressure; large scale validation is warranted to assess clinical applicability of MRI for hemodynamic assessment in heart failure.
Table I
Pre CR Post CR Post HEP
NYHA Class
Peak VO2
6MWT
SF36P
SF36M
LHFQ
2.8 ⫾ 0.4 2.2 ⫾ 1.0 1.7 ⫾ 0.8
14.6 ⫾ 4.3 17.0 ⫾ 5.6 16.2 ⫾ 6.6
351.6 ⫾ 94.3 421.7 ⫾ 84.4 450.6 ⫾ 105.0
33.1 ⫾ 7.6 33.9 ⫾ 6.6 41.6 ⫾ 11.7
47.5 ⫾ 6.8 51.6 ⫾ 7.1 52.4 ⫾ 9.1
44 ⫾ 15 37 ⫾ 15 26 ⫾ 23
347 Impact of Exercise Training on the Clinical Course of Left Ventricular Systolic Dysfunction in Post-CABG Patients Robert M. Siegel,1 Ambika Bhaskaran,1 Barbara Barker,1 Alvin W. Nuttall,1 Charles Jost,2 Robert Gervais,1 Steve J. Shimamoto,1 Jennifer C. Vermillion1— 1 Cardiovascular Research, Advanced Cardiac Specialists, Gilbert, AZ; 2Mesa General Hospital, Mesa, AZ Background: Patients with ischemic cardiomyopathy (LVEF ⬍40%) undergoing CABG surgery represent a high-risk clinical subset, with greater overall morbidity and mortality than patients without LV dysfunction (LVD). Frequently, they show symptoms of CHF and signs of persistent LVD, despite effective mechanical revascularization. Recent studies suggest that exercise training modifies LV geometry and may have beneficial effects on contractile dysfunction, caused by ischemia as well as reperfusion. We evaluated the effects of a 12-week physical training program in patients with impaired global LV systolic performance (LVEF ⬍40%), initiated 10-14 days after CABG. From 1/2000 to 12/2002, 138 patients (mean age 67.25 years; 13% female) with ischemic cardiomyopathy (CMP) underwent successful revascularization by CABG, and were enrolled in a supervised exercise program. Of these, 10.9% had prior MI and 88.3% had multivessel CAD. The exercise prescription used a preset protocol and consisted of ECG-monitored, symptom-limited cycle ergometry and treadmill walking up to 60 minutes per session, 3 days a week for 12 weeks, at 6070% of heart rate reserve (calculated by Karvonen’s formula based on resting HR, maximum predicted HR, and “conditioning intensity”). Multiple indices of exercise tolerance, echo-based LVEF and metabolic parameters were recorded at the time of entry into and at completion of (Phase II) cardiac rehabilitation. Conclusions: (1) In selected patients with persistent moderate-tosevere LVD following mechanical revascularization by CABG, a supervised exercise training program significantly improves multiple indices of functional capacity, and major metabolic parameters that are known to add to comorbidity. (2) This is paralleled by significant improvement in global LV systolic and diastolic performance. (3) Our data demonstrates that exercise training may be an important factor in the course and progression of ischemic CMP following CABG. These promising results should stimulate a wider and more aggressive use of exercise training in patients with LVD. Results Variable
Pre-Rehab
Post-Rehab
‘P’ Value
Weight (lb) NYHA Class Resting HR (bpm) Exercise HR (bpm) Treadmill Time (min) TM Workload (METS) Cycle Ergometry Time (min) GXT Workload (METS) GXT Double Product LVEF (%) Diastolic dysfunction Total Cholesterol (mg/dL) HDL (mg/dL) LDL (mg/dL) FBS (mg/dL)
177.4 3.4 84.93 98.24 12.22 2.51 9.78 3.52 15,476 32.48 39.1% 180.7 37.65 106.35 122.48
172.36 1.12 74.38 90.93 21.00 4.56 20.85 8.29 23,555 39.38 12.4% 167.7 39.66 100.63 101.60
⬍0.0001* 0.003** ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* 0.002** 0.001** ⬍0.0001* ⬍0.0001* ⬍0.0001* 0.001**
*: P value significant at ⬍0.0001
**: P value significant at ⬍0.05; FBS: fasting blood sugar
•
HFSA
S93
Clinical Care/Management Strategies 344
345
The Effect of a Family-Focused Intervention on Self Management of Diet, Medication-Taking, and Activity after Six Months Sandra B. Dunbar,1 Patricia C. Clark,1 Christi Deaton,1 Anindya De,3 Andrew L. Smith,2—1Nell Hodsgon Woodruff School of Nursing, Emory University, Atlanta, GA; 2Center for Heart Failure Therapy and School of Medicine, Emory University, Atlanta, GA; 3Centers for Disease Control, Atlanta, GA
The Feasibility and Safety of an Unsupervised in Home Exercise Program for Patients with Congestive Heart Failure Jennifer L. Dekerlegand,1 William H. Shull, Jr,1 Andrew Kao2—1Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; 2Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
Persons with heart failure (HF) are expected to perform selected self care behaviors related to dietary sodium reduction, medication-taking, and physical activity, and most of these occur within a family context. This study evaluated the effect of two family-based education and support interventions on these self care behaviors. HF patients and a participating family member (FM) were randomized to receive either an indepth patient-FM education session (EDUC: n ⫽ 29 dyads) or in-depth patient-FM education plus a family partnership intervention (EDUC ⫹ FPI; n ⫽ 34 dyads). EDUC included general HF information, individual feedback on dietary habits, and counseling regarding medication-taking, and daily physical activity. The EDUC ⫹ FPI added communication strategies and partnership building to enhance family support and autonomous patient decision-making regarding self care. HF subjects were 53% male, mean age 61 ⫾ 12 yrs, 61% Caucasian, 78% NYHA Class II & III, LVEF 32 ⫾ 15%. All were in steady state on ACE inhibitors and diuretics; 67% were on beta blockers at baseline. FMs were 77% female, mean age 54 ⫾ 17 yrs and 67% spouses. Clinical, demographic, family functioning (Family APGAR) and depression (Beck Depression Inventory-II, BDI-II) were obtained at baseline. Variables and outcome measures at BL, and at 3 and 6 months after intervention were dietary sodium obtained by 24 hour urinary sodium; medication-taking behaviors obtained by self report using the Morisky scale, physical activity obtained by self report on the Physical Activity Scale for Elders (PASE) and distance walked during a 6-minute walk test. Data were analyzed with descriptive statistics, Chi square analysis to determine group differences in meeting dietary compliance criteria of ⬍2500mg Na/day, and generalized least squares regression to examine group differences in outcomes while controlling for body mass index (BMI), LVEF, APGAR and BDI-II. Between BL and 3 M, 36.8% of EDUC vs. 68% of EDUC ⫹ FPI met dietary compliance criteria (X2 ⫽ 4.22, p ⫽ .04). Over time, EDUC showed relatively little
Background: Exercise intolerance is a hallmark of congestive heart failure (CHF). Supervised exercise training in a cardiac rehabilitation (CR) program has demonstrated improvements in submaximal and maximal exercise tolerance. Unfortunately, most third party payors do not reimburse for continued supervised exercise after 6–12 weeks of CR. Therefore, the proper in-home regimen to maintain physical fitness after CR is not well delineated. The purpose of this pilot study was to prospectively examine the safety and efficacy of an in-home walking program after CR in pts with CHF. Methods: Pts with mild to moderate CHF who successfully completed a 12 week CR program were asked to complete a 12 week in-home exercise program (HEP), consisting of walking 5 days a week at a Borg Rate of Perceived Exertion between 10 and 13, with proper warm up and cool down stretching exercises. Initial exercise duration was 20 minutes, increasing by 5 minutes every 2 weeks until 40 minutes of exercise was achieved. General physical and mental QOL was assessed by the Medical Outcomes Survey Short Form-36 questionnaire (SF36P and SF36M, respectively), while disease-specific QOL was assessed by the Minnesota Living With Heart Failure Questionnaire (LWHF). Submaximal exercise capacity was evaluated by the 6-minute walk test (6MWT) and maximal exercise capacity was assessed with breath-by-breath expired gas measurements. Testing was performed before and after CR, and again after completion of the 12 week HEP. Comparisons between variables were assessed using paired t tests. Results: Six pts (mean age 45.0 ⫾ 15.6 yrs, 4 females, 4 African-Americans, NYHA class 2.8 ⫾ 0.4, 80% ACEI/ARB and 33% beta blocker) participated in this study. Adherence to the program was excellent, with pts exercising at least 4 days per week on average. The results of testing before and after CR and after HEP are shown in Table I. After CR, peak VO2 tended to increase (p ⫽ 0.07), while 6MWT increased significantly (p ⬍ 0.02). NYHA class also tended to decrease (p ⫽ 0.10). After HEP, peak VO2 was maintained (p ⫽ NS), while 6MWT tended to increase further (p ⫽ 0.06) and NYHA class tended to improve (p ⫽ 0.08). General and disease-specific QOL remained stable throughout the study. There were no exercise-related adverse events or hospitalizations/mortality throughout the study. Conclusion: This pilot study suggests that a simple home walking program after supervised CR is safe and maintains both submaximal and maximal exercise tolerance as well as QOL in patients with mild to moderate CHF.
change whereas the EDUC ⫹ FPI group significantly reduced dietary sodium at 3 months (p ⫽ .03) and at 6 months remained below their baseline levels with BMI an independent predictor (p ⫽ .000). Models analyzing the Morisky, and 6-minute walk revealed no significant difference between groups in change from BL to 6 months although the PASE showed change in the hypothesized direction (p ⫽ .10). Conclusions: These data reflect the overall benefit of a family focused intervention in reducing dietary sodium intake in the initiation phase and suggest that the effects of the intervention wan over time. The impact on dietary behaviors was most salient with diet patterns the most amenable behavior to change through the family focused education and partnership interventions. Additional emphasis on increaseing physical activity and improving medication taking is required. Exploration of greater intervention intensity and/or booster family interventions are warranted to affect long-term change in HF self management.
346 Magnetic Resonance Imaging Provides Accurate Noninvasive Hemodynamic Assessment in Heart Failure: Correlation with Invasive Hemodynamic Measurements Biljana Pavlovic-Surjancev,1 Stephanie M. Shors,2 William G. Cotts,1 Scott Pereles,2 James Carr,2 Maryl R. Johnson,3 Mihai Gheorghiade,1 Robert O. Bonow,1 John Paul Finn4—1Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL; 3Cardiology, University of Wisconsin, Madison, WI; 4Radiology, University of California at Los Angeles, Los Angeles, CA Background: Right heart catheterization (RHC) is a standard invasive method of hemodynamic cardiac assessment. Cardiac magnetic resonance imaging (MRI) is emerging as a noninvasive method capable of assessing cardiac anatomy and function. Hypothesis: We hypothesized that cardiac index (CI) and transit time (TT) by MRI would correlate with CI, pulmonary artery (PA) and pulmonary capillary wedge (PCW) pressure by RHC; PA and PCW pressure could be inferred from TT. Methods: 18 subjects (10M, 8F, age 24-80 yrs) with heart failure and ejection fraction 8-75% were prospectively studied with MRI and RHC. MRI consisted of cine cardiac imaging and time-resolved 3D MR angiography with 6 ml gadolinium IV bolus. Time-intensity curves were generated for gadolinium transit from PA to pulmonary vein (PV). PA-to-PV TT was calculated by subtracting the time of peak signal intensity (PSI) on the PA curve from the time of PSI on the PV curve. Using dedicated software, cardiac output was obtained from the cine images and divided by body surface area to obtain CI. The strength of relationship between hemodynamic parameters obtained by MRI and RHC was assessed by correlation coefficient (r). The degree of agreement was assessed by Bland-Altman method. Results: Broad range of CI by MRI(1.73-4.84 L/min/m2) showed statistically significant correlation (r ⫽ 0.81, p ⫽ 0.0001) with thermodilution CI by RHC (1.91-3.99 L/min/m2). CI by MRI showed an excellent agreement with CI by RHC using Bland-Altman plot. PA-to-PV TT by MRI ranged from 3.3 to 9.6 s and correlated positively with PA mean (range 11-44 mmHg, r ⫽ 0.47, p ⬍ 0.05) and PCW pressure (range 3-32 mmHg, r ⫽ 0.56, p ⫽ 0.01) by RHC. PCW and PA pressure could be calculated from TT by linear regression. For example, PA diastolic pressure calculated from TT by MRI showed good agreement with PA diastolic pressure measured by RHC, as shown in Bland-Altman plot here. Conclusions: 1. Cardiac index by MRI correlates well with CI by RHC. 2. The longer the pulmonary transit time by MRI, the higher the PA and PCW pressure by RHC. 3. Cardiac MRI shows promise for accurate assessment of hemodynamics such as CI, PCW and PA pressure; large scale validation is warranted to assess clinical applicability of MRI for hemodynamic assessment in heart failure.
Table I
Pre CR Post CR Post HEP
NYHA Class
Peak VO2
6MWT
SF36P
SF36M
LHFQ
2.8 ⫾ 0.4 2.2 ⫾ 1.0 1.7 ⫾ 0.8
14.6 ⫾ 4.3 17.0 ⫾ 5.6 16.2 ⫾ 6.6
351.6 ⫾ 94.3 421.7 ⫾ 84.4 450.6 ⫾ 105.0
33.1 ⫾ 7.6 33.9 ⫾ 6.6 41.6 ⫾ 11.7
47.5 ⫾ 6.8 51.6 ⫾ 7.1 52.4 ⫾ 9.1
44 ⫾ 15 37 ⫾ 15 26 ⫾ 23
347 Impact of Exercise Training on the Clinical Course of Left Ventricular Systolic Dysfunction in Post-CABG Patients Robert M. Siegel,1 Ambika Bhaskaran,1 Barbara Barker,1 Alvin W. Nuttall,1 Charles Jost,2 Robert Gervais,1 Steve J. Shimamoto,1 Jennifer C. Vermillion1— 1 Cardiovascular Research, Advanced Cardiac Specialists, Gilbert, AZ; 2Mesa General Hospital, Mesa, AZ Background: Patients with ischemic cardiomyopathy (LVEF ⬍40%) undergoing CABG surgery represent a high-risk clinical subset, with greater overall morbidity and mortality than patients without LV dysfunction (LVD). Frequently, they show symptoms of CHF and signs of persistent LVD, despite effective mechanical revascularization. Recent studies suggest that exercise training modifies LV geometry and may have beneficial effects on contractile dysfunction, caused by ischemia as well as reperfusion. We evaluated the effects of a 12-week physical training program in patients with impaired global LV systolic performance (LVEF ⬍40%), initiated 10-14 days after CABG. From 1/2000 to 12/2002, 138 patients (mean age 67.25 years; 13% female) with ischemic cardiomyopathy (CMP) underwent successful revascularization by CABG, and were enrolled in a supervised exercise program. Of these, 10.9% had prior MI and 88.3% had multivessel CAD. The exercise prescription used a preset protocol and consisted of ECG-monitored, symptom-limited cycle ergometry and treadmill walking up to 60 minutes per session, 3 days a week for 12 weeks, at 6070% of heart rate reserve (calculated by Karvonen’s formula based on resting HR, maximum predicted HR, and “conditioning intensity”). Multiple indices of exercise tolerance, echo-based LVEF and metabolic parameters were recorded at the time of entry into and at completion of (Phase II) cardiac rehabilitation. Conclusions: (1) In selected patients with persistent moderate-tosevere LVD following mechanical revascularization by CABG, a supervised exercise training program significantly improves multiple indices of functional capacity, and major metabolic parameters that are known to add to comorbidity. (2) This is paralleled by significant improvement in global LV systolic and diastolic performance. (3) Our data demonstrates that exercise training may be an important factor in the course and progression of ischemic CMP following CABG. These promising results should stimulate a wider and more aggressive use of exercise training in patients with LVD. Results Variable
Pre-Rehab
Post-Rehab
‘P’ Value
Weight (lb) NYHA Class Resting HR (bpm) Exercise HR (bpm) Treadmill Time (min) TM Workload (METS) Cycle Ergometry Time (min) GXT Workload (METS) GXT Double Product LVEF (%) Diastolic dysfunction Total Cholesterol (mg/dL) HDL (mg/dL) LDL (mg/dL) FBS (mg/dL)
177.4 3.4 84.93 98.24 12.22 2.51 9.78 3.52 15,476 32.48 39.1% 180.7 37.65 106.35 122.48
172.36 1.12 74.38 90.93 21.00 4.56 20.85 8.29 23,555 39.38 12.4% 167.7 39.66 100.63 101.60
⬍0.0001* 0.003** ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* ⬍0.0001* 0.002** 0.001** ⬍0.0001* ⬍0.0001* ⬍0.0001* 0.001**
*: P value significant at ⬍0.0001
**: P value significant at ⬍0.05; FBS: fasting blood sugar