Question: Are there any patients after MI in whom the exercise component of cardiac rehabilitation is not safe?
33
Grading: 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
Reference number 631
Giannuzzi P;Temporelli PL;Corra U;Gattone M;Giordano A;Tavazzi L;
Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction: results of the Exercise in Left Ventricular Dysfunction (ELVD) trial.
199796Circulationpgs 1790 1797
Study Type: Randomised Controlled Trial
Patient Characteristics <40% ejection fraction after a first Q-wave myocardial infarction
Intervention 6 month exercise training program 30-minute bicycle ergometry at least 3x per week for 2 months, thereafter continuation of exercise program (30 minute bicycle ergometry 3x per week
Comparisons Exercise training vs usual care
Study Length 6 months
Outcomes Work capacity Left ventricular volumes Ejection fraction
Funding Minist-ero della Sanità, Rome, Italy. S. Maug-eri Found-ation, Pavia, Italy
Effect Significant increase in work capacity observed only in the training group (from 4.462±1.095 to 5.752±1.749 kilopond-meters [Kp-m], P < 0.01), not in the control group (from 4.375±1.143 to 4.388±1.199 Kp-m). Left ventricular volumes increased in the control group (end-diastolic volume, from 94±26 to 99±27 mL/m2, P < 0.01; end-systolic volume, from 62±20 to 67±23 mL/m2, P< 0.01) but not in the training group (end-diastolic volume, from 93±28 to 92±28 mL/m2, P = NS; end-systolic volume, from 61±22 to 57±23 mL/m2, P = NS). Ejection fraction improved in the training group (from 34±5% to 38±8%, P < 0.01) but not in the control group (from 34±5% to 33±7%, P = NS).
Reference number 1350
Marchionni N;Fattirolli F;Fumagalli S;Oldridge N;Del LF;Morosi L;Burgisser C;Masotti G;
Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardialinfarction: results of a randomized, controlled trial
2003107Circulationpgs 2201 2206
Study Type: Randomised Controlled Trial
Patient Characteristics Post MI patients: 3 age groups: middle aged (45–65 years), old (66–75 years), very old > 75
Intervention Hospital-based cardiac rehabilitation (Hos-CR), home-based cardiac rehabilitation (Home-CR), no cardiac rehabilitation (no CR).
Comparisons 3 interventions in each age group.
Study Length 14 months.
Outcomes Total work capacity (TWC), HRQoL.
Funding National Research -Council Florence Un. Reg. Gov. Tuscany Italy.
Effect TWC improved in the Hosp-CR and Home-CR groups but not in the controls. Treatment-time interactions showed a greater effect of both interventions compared with controls in middle aged (P = 0.002) and old patients (P < 0.001) but not in very old patients (P = 0.143). In middle aged and old patients, HRQoL improved significantly over the study period regardless of treatment assignment, whereas in very old patients, HRQoL improved with both Hosp-CR and Home-CR treatment (P = 0.013 and P < 0.035, respectively) but not with no CR (P = 0.079).
Reference number
Scottish Intercollegiate Guidelines Network (SIGN).;
Cardiac rehabilitation
200257 pgs
Study Type: Guideline
Patient Characteristics
Intervention
Comparisons
Study Length
Outcomes
Funding
Effect Contraindications to exercise training experienced a MI complicated by HF, cardiogenic shock and/or complex ventricular arrhythmias angina or breathlessness occurring at a low level of exercise, for example, inability to complete the first 4 minutes of the shuffle walking test. ST segment depression ≥ 1 mm on resting ECG. Undergone exercise testing with marked ST depression ≥ 2 mm or angina at < 5 METS (for example, 3 minutes of a Bruce protocol).
Grading: 2+ Well-conducted case–control or cohort studies with a low risk of confounding, bias or chance and a
Reference number 312
Otsuka Y;Takaki H;Okano Y;Satoh T;Aihara N;Matsumoto T;Yasumura Y;Morii I;Goto Y;
Exercise training without ventricular remodeling in patients with moderate to severe left ventricular dysfunction early after acute myocardial infarction
200387International Journal of Cardiologypgs 237 244
Study Type: Cohort
Patient Characteristics 74 patients with LVEF ≥ 45% (Group H), 35 patients with 35% LVEF ≤ 45% (Group M), 17 patients with LVEF < 35% (Group L).
Intervention Exercise program consisting of walking, cycling on an ergometer and aerobic dance (50–90 min/session), 3–5 sessions per week for 3 months.
Comparisons LVEF.
Study Length 3 months.
Outcomes Exercise capacity. Peak work rate. Rest heart rate. LV end-diastolic dimension.
Funding Not listed.
Effect After 3 months of exercise training, exercise capacity increased significantly in all 3 groups. Peak Vo2 increased from 1355±321 to 1575±336 ml/min (P < 0.01) in Group H, from 1278±332 to 1464±406 ml/min (P < 0.01) in Group M, and from 1248± 369 to 1454±424 ml/min in Group L (P < 0.01). Similarly, peak work rate increased from 122±35 to 144±34 W (P < 0.05) in group H, from 177±42 to 137±12 W in Group M (P < 0.05), and from 107±58 to 129±56 W (P < 0.01) in group L. Rest heart rate reduced from 75±13 to 72±11/ min (P < 0.05) in group H, from 76±13 to 72±12/min in Group M (P < 0.05), and from 80±15 to 75±10/min (NS) in group L. At 35±8 months follow-up there were no significant differences in the incidence of cardiac events among the 3 groups. There was also no significant change in LV end-diastolic dimension in each

From: Appendix C, Clinical Evidence Extractions

Cover of Post Myocardial Infarction
Post Myocardial Infarction: Secondary Prevention in Primary and Secondary Care for Patients Following a Myocardial Infarction [Internet].
NICE Clinical Guidelines, No. 48.
National Collaborating Centre for Primary Care (UK).
Copyright © 2007, National Collaborating Centre for Primary Care.

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