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THE IMPACT OF INDOOR CYCLING TRAINING ON EXERCISE CAPACITY AND BLOOD LIPID PROFILE OF MEN WITH ISCHAEMIC HEART DISEASE OR AFTER MYOCARDIAL INFARCTION
Dagmara Gloc, Zbigniew Nowak
Aim. In the present study attempts to determine the impact of 1-month Indoor Cycling training on exercise capacity and blood lipid profile were made. Material and methods. The study group consisted of 50 men under the model A of the 2nd phase of cardiac rehabilitation (20 men of the Indoor Cycling group, IC, 20 men rehabilitated accordingly to the recommendations of the Polish Cardiac Society — a standard group, ST and 10 people who did not participate in any cardiac rehabilitation program — a control group, C). The average age of all subjects was 56,60±8,25 years, the average left ventricular ejection fraction was 56%±4,00. Results. In the IC group there was a significant increase in the test duration (8,47 vs 10,23 min; p<0,001), a significant increase in the MET value (10,86 vs 12,35; p=0,06) and VO2max (38,43 vs 48,25 ml/kg/min; p<0,001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (8,51 vs 9,96; p<0,001), MET value (10,57 vs 12,18; p=0,002) and VO2max (38,42 vs 46,24; p<0,001). No significant changes in rest and maximum heart rate as well as systolic and diastolic blood pressure parameters were found. In C group no significant changes in treadmill exercise test parameters were observed. Alike in the IC, ST as well as in the C group, positive modification of blood lipid profile was observed. The significant increase in the average value of HDL cholesterol in the control group (41,00 vs 49,52 mg/dl; p<0,05) was only found. Conclusion. Indoor Cycling training in the second phase of cardiac rehabilitation is a safe form of therapy and therefore may be an interesting alternative
method to the classic bicycle ergometer exercise in the stage of an early cardiac rehabilitation.
Russ J Cardiol 2016, 4 (132), Engl.: 153-159
http://dx.doi.org/10.15829/1560-4071-2016-4-eng-153-159
Key words: comprehensive cardiac rehabilitation, coronary heart disease, Indoor Cycling, Percutaneous Coronary Intervention, physical activity, myocardial infarction.
Faculty of Physiotherapy, Academy of Physical Education, Katowice, Poland.
Corresponding author. Dagmara Gloc, Faculty of Physiotherapy, Academy of Physical Education, Mikotowska str. 72a, 40-065 Katowice, Poland. e-mail: glocdag-mara@gmail.com
CABG — coronary artery bypass grafting, CHS — cardiac health status, PCI — percutaneous coronary intervention.
Received January 12, 2016. Revision received January 14, 2016. Accepted January 21, 2016.
ВЛИЯНИЕ ВЕЛОСПОРТИВНЫХ ТРЕНИРОВОК НА ТОЛЕРАНТНОСТЬ К ФИЗИЧЕСКОЙ НАГРУЗКЕ И ЛИПИДНЫЙ СПЕКТР КРОВИ У МУЖЧИН С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА ИЛИ ПОСЛЕ ИНФАРКТА МИОКАРДА
Dagmara Gloc, Zbigniew Nowak
Цель. В настоящем исследовании предпринята попытка определения влияния 1-го месяца велоспортивных тренировок на толерантность к физической нагрузке и липидный профиль крови.
Материал и методы. Исследовательская группа состояла из 50 человек проходила испытания по модели А 2-го этапа кардиологической реабилитации (20 человек группа велоспортивных тренировок (IC), 20 мужчин проходили реабилитацию соответственно рекомендациям польского кардиологического общества — стандартная группа (ST), группа 10 человек, которые не принимали участия ни в сердечной программе реабилитации — контрольная группа, С). Средний возраст всех испытуемых был 56,60±8,25 лет, средняя фракция выброса левого желудочка составляла 56%±4,00.
Результаты. В IC группе наблюдалось значительное увеличение продолжительности испытания (8,47 против 10,23 мин; р<0,001), значительное увеличение значения MET (10,86 против 12,35; р=0,06) и VO2max (38,43 против 48,25 мл/кг/мин; р<0,001). Параллельно наблюдались изменения в ST группе, где показатели улучшились: длительность теста (8,51 против 9,96; р<0,001), значения MET (10,57 против 12,18; р=0,002) и VO2max (38,42 против 46,24; р<0,001). Не было обнаружено значительных изменений показателей в покое, максимальной частоты сердечных сокращений,
а также систолического и диастолического артериального давления. В группе С никаких существенных изменений в на тредмиле не наблюдалось. Как в IC, так и в ST, а также в группе C, положительных изменений липидного профиля крови не наблюдалось. Было отмечено значительное увеличение среднего значения холестерина ЛПВП в группе контроля (41,00 против 49,52 мг/дл; p<0,05).
Заключение. Велоспортивные тренировки на втором этапе кардиологической реабилитации являются безопасной формой терапии и, следовательно, могут быть интересной альтернативой методу классической велоэргометр-велотренажер в стадии ранней кардиологической реабилитации.
Российский кардиологический журнал 2016, 4 (132), Англ.: 153-159
http://dx.doi.org/10.15829/1560-4071-2016-4-eng-153-159
Ключевые слова: комплексная реабилитация сердца, ишемическая болезнь сердца, езда на велосипеде, чрескожное коронарное вмешательство, физическая активность, инфаркт миокарда.
Faculty of Physiotherapy, Academy of Physical Education, Katowice, Польша.
The most commonly used, yet traditional training forms according to the Cardiac Rehabilitation Standards of Polish Cardiac Society, are aerobic (endurance) training in the form of walking on the treadmill or in the field, bicycle ergometer training, swimming, training on the bicycle, and anaerobic training (anaerobic resistance training) [1, 2]. Physical training, which is introduced in
the second stage of cardiac rehabilitation, is well understood and described, but rare publications on the use of modern, innovative forms of exercises for patients with cardiovascular diseases can be found. Younger age of the cardiac patients somehow necessitates the use of modern forms of physical training, which become alternative, interesting and engaging means to provide effective reha-
Table 1
Characteristics of the Indoor Cycling, standard and control group
Variable Indoor Cycling Standard Control
group group group
(n=20) (n=20) (n=10)
Age [years] 57,50±9,51 56,40±9,85 55,40±8,25
(39-72) (40-70) (46-67)
Body height [cm] 178±5,46 176,40±5,95 174,90±8,03
(168-191) (164-190) (164-190)
Body weight [kg] 84,15±9,35 87,02±14,08 81,15±16,27
(70-104) (66,90-117,90) (63,40-117,30)
BMI [kg/m2] 26,58±2,61 27,84±3,20 26,29±3,32
(21,20-32,60) (22,80-34,60) (22,60-32,50)
LVEF[%] 56,05±3,91 56,10±4,19 55,70±4,00
(50-60) (50-68) (50-62)
Abbreviations: BMI — body mass index, LVEF — left ventricular ejection fraction, n — the number of patients.
Table 2
The type of diseases in the Indoor Cycling, standard and control group
Type of disease Indoor Cycling Standard Control
group group group
n (%) n (%) n (%)
Ischemic heart disease 20 (100%) 20 (100%) 10 100%)
Type 2 diabetes 4 (20%) 5 (25%) 2 (20%)
Hyperlipidemia 6 (30%) 3 (15%) 0 (0%)
Hypertension 16 (80%) 17(85%) 8 (80%)
Miocardial infarction 16 (80% 16 (80%) 5 (50%)
Total 20 (100%) 20 (100%) 10 (100%)
Abbreviation: n — the number of patients.
Table 3
The method of treatment in the Indoor Cycling, standard and control group
Method of treatment Indoor Cycling Standard Control
group group group
n (%) n (%) n (%)
PCI + STENT 16 (80%) 17 (85%) 8 (80%)
PCI 4 (20%) 3 (15%) 2 (20%)
Total 20 (100%) 20 (100%) 10 (100%)
Table 4
The number of stents implanted in the Indoor Cycling, standard and control group
Number of stents Indoor Cycling Standard Control
group group group
n (%) n (%) n (%)
0 4 (20%) 3 (15%) 2 (20%)
1 12 (60%) 10 (50%) 5 (50%)
2 1 (5%) 5 (25%) 3 (30%)
3 1 (5%) 1 (5%) 0 (0%)
4 and more 2 (10%) 1 (5%) 0 (%)
Total 20 (100%) 20(100%) 10 (100%)
Abbreviation: n — the number of patients.
Table 5
The protocol of the Indoor Cycling training unit
Part of the Time Borg RPM Position / technique
training session (min) scale
Warm-up 1-5 9-10 100-110 Position 2 (2/min)
Position 1 — SF (2/ min)
Appropriate 5-10 12-13 110 Position 1 (2 min)
training 110 Position 2 (2 min)
80 Position 2 — SC (1min)
10-17,5 12-14 80 Position 3 — StC (/ min)
100-110 Position 1 (2/ min)
100 Position 2 (2/ min)
80-100 Pozycja 2 — StF (/ min)
100 Position 1 (1 min)
17,5-22,5 13-14 60-80 Position 2 — SC (1min)
100 Position 2 (3/ min)
80 Position 3 — StC (/ min)
22,5-27,5 12-13 80 Position 2 (2 min)
80 Position 2 — SC (2 min)
100-110 Position 2 (1 min)
Cool down 27,5-30 9-10 100 Position 1 — SF
Stretching 30-35 9
Abbreviations: n — the number of patients, PCI — percutaneous coronary intervention/
bilitation [3]. One such form is endurance Indoor Cycling training. Properly conducted training consists of a warm-up, an appropriate training and an end portion — cool down and stretching, which concerns proper muscle groups and tendons. Indoor Cycling training can be carried out in three basic positions of the hands (open, close and forward), in sitting or standing techniques [4]. There are no reports on the possibilities of the use of Indoor Cycling as an alternative form to the traditional endurance cycle ergometer training of patients with cardiovascular diseases.
Abbreviations: min — minute, position 1 — close, position 2 — open, position 3 — forward, RPM — Revolutions Per Minute, SC — Seated Climb, SF -Seated Flat, StC — Standing Climb, StF — Standing Fl at.
In the present study attempts to determine the impact of 22 Indoor Cycling training units (1-month) on exercise capacity and blood lipid profile were made.
Material and methods
The study group consisted of 50 men under the model A of the second phase of cardiac rehabilitation (results of exercise treadmill test >7 MET or 100 W). Groups were comparable in terms of age, body height, body weight and left ventricular ejection fraction. Their characteristics are shown in Table 1. 100% of patients experienced ischemic heart disease, 74% of them had a myocardial infarction (Table 2). The prevailing type of treatment in the study population was percutaneous coronary intervention (PCI) combined with implantation of 1 stent (Table 3 and 4).
Table 6
Methodology of training according to the recommendations of the Section of Cardiac Rehabilitation and Physiology Effort Polish Cardiac Society
The type of training Methodology Workload
Endurance training Training on a bicycle ergometer, 5 times a week 30 minutes The workload applied on the basis of calculation of heart rate training, starting from 60% of heart rate reserve increased by 10% after 5 units of training, to 80% of heart rate reserve, 14 degrees of subjective scale effort assessment by the Borg scale
Resistance training Exercises in the form of training station, 5 times a week 30 minutes
General exercises Exercises in the gym — elements of aerobic and anaerobic training, stretching, breathing exercises, 5 times a week 30 minutes
Between November 2014 and January 2015, reducing the number of confounding factors such as age, sex, disease entity, method of treatment, the level of exercise capacity, 50 patients enrolled in the study were allocated according to random selection into the three groups: 20 men, members of the Indoor Cycling group, IC, 20 men rehabilitated accordingly to the recommendations of the Section of Cardiac Rehabilitation and Physiology Effort Polish Cardiac Society — a standard group, ST and 10 people who did not participate in any cardiac rehabilitation program — a control group, C). Patients (except from the C group) underwent 22 training units performed 5 times a week. In the ST group the training included: endurance exercise on a bicycle ergometer, resistance training and calisthenics (general exercises). Whereas men in the IC group, instead of the traditional interval training on the ergometer, participated in the Indoor Cycling lessons arranged by the same instructor (Table 5). That group also participated in the other two types of trainings (resistance and calisthenics) according to the standards (Table 6). Heart rate frequency was constantly individually monitored during each lesson by the heart rate monitor (Polar FT1), as well as by the instructor.
Inclusion criteria were: formal consent to participate in the study, stable coronary heart disease or uncomplicated course of myocardial infarction, time of last cardiovascular event not less than 2 months and not more than 6 months, an exercise test results >7MET / 100W, left ventricular ejection fraction >50%. Exclusion criteria were: lack of formal consent to participate in the study, recent myocar-dial infarction, <2 months of a cardiovascular event, left ventricular ejection fraction <50%, the surgical treatment of coronary artery disease (CABG), unregulated hypertension, unstable ischemic heart disease, arrhythmias, diagnosed cancer, diseases of the central or peripheral nervous system, varicose veins of the lower limbs, degenerative disease of the peripheral joints and spine, past unhealed injuries of the lower limbs, advanced peripheral vascular disease, age >75 and incomplete medical documentation. At the beginning and after 1-month in all groups submax-
imal exercise treadmill test according to the standard Bruce protocol was performed. The exercise test was terminated in case of a limit heart rate, fatigue, high blood pressure over 230/120 mmHg, ST-segment depression of at least 2 mm, coronary pain and blood pressure drop above 10 mmHg from baseline. Behind a positive exercise test criterion adopted horizontal or diagonal to the bottom depression of ST-segment at least 1 mm measured 80ms after the J point. The following parameters were evaluated: duration of the test exercise [minute], MET value, resting and maximum heart rate [beats/minute], resting and maximum blood pressure [mmHg], resting and maximum double product [mmHg x min], maximal oxygen uptake VO2max [ml/kg/min] due to the lack of directly measure instruments, the indirect method was appointed by the formula:
V02max = 13,3 - 0,03 (t) + 0,297(t2) - 0,0077(?) + 4,2 (CHS) where: t — time [min]
CHS (cardiac health status) — 1: patients with angina pectoris, myocardial infarction, revascularization, 0: patients without symptoms of angina, without a completed myocardial and without revascularization procedures performed) [5].
At the beginning and after 1-month total cholesterol, HDL and LDL fractions and triglycerides [mg/dl] were also analyzed. The assessment of blood lipid profile was made in the analytical laboratory.
The study was performed according to the Good Clinical Practice guidelines and the Declaration of Helsinki. The study protocol was approved by the local Committee of Ethics of the Academy of Physical Education in Katowice — Poland (The Resolution No. 6/2014 of 15.05.2014). Written informed consent was obtained from all participants prior to their inclusion in the study.
For all numerical parameters the arithmetic mean, minimum, maximum and standard deviation were calculated. For the presentation of qualitative data the prevalence of studied traits were used. In order to verify assumptions of tests the Shapiro-Wilk normality test was performed. For the analysis of relationships between variables
Table 7
Results of the treadmill exercise test in three groups of patients before (I) and at the end (II) of cardiac rehabilitation
Variable Indoor Cycling group (n = 20) p Standard group (n = 20) p Control group (n = 10) p
Time I 8,47±1,22 0,000 8,51±0,89 0,000 8,76±1,11 0,815
Time II 10,23±1,66 9,96±1,12 8,27±1,40
A 1,76*** 1,45** -0,49
[min]
MET I 10,86±1,20 0,006 10,57±0,95 0,002 11,06±2,31 0,433
MET II 12,35±1,43 12,18±1,42 10,00±1,68
A 1,50## 1,62## -1,06
HRrest I 65,55±9,06 0,454 72,10±9,15 0,790 78,60±7,09 0,975
HRrest II 69,40±10,31 69,40±9,73 76,40±4,99
A 3,85 -2,70 -2,20
[beats/minute]
HRmax I 123,50±14,99 0,169 124,75±14,69 0,264 132,20±15,88 0,999
HRmax II 131,15±13,37 131,65±14,20 132,80±8,95
A 7,65 6,90 0,60
[beats/minute]
RRSrest I 127,00±15,59 0,999 125,00±13,96 0,996 129,00±12,64 0,298
RRSrest II 126,25±13,16 126,50±9,88 138,50±16,50
A -0,75 1,50 9,50
[mmHg]
RRDrest I 81,00±8,52 0,994 78,75±6,66 0,998 77,50±7,16 0,992
RRDrest II 80,00±10,26 78,00±5,23 79,00±9,66
A -1,00 -0,75 1,50
[mmHg]
RRSmax I 167,25±18,60 0,762 152,50±19,15 0,800 161,00±15,42 0,309
RRSmax II 172,00±18,45 157,00±17,50 171,50±20,00
A 4,75 4,50 10,50
[mmHg]
RRDmax I 85,25±9,38 0,954 82,75±8,50 0,954 84,50±7,61 0,999
RRDmax II 83,50±9,33 81,00±7,18 85,00±11,05
A -1,75 -1,75 0,50
[mmHg]
DPrest I 8355,50±1790,45 0,917 9055,50±1785,57 0,983 10164,50±1530,31 0,954
DPrest II 8734,25±1418,03 8798,00±1532,69 10626,00±1685,71
A 378,75 -257,50 461,50
DPmax I 20693,75±3563,36 0,067 19171,00±3909,31 0,247 21204,00±2601,58 0,550
DPmax II 22577,25±3475,53 20643,00±2950,12 22779,00±3139,70
A 1883,50 1472,00 1575,00
VO2max I 38,43±6,24 0,000 38,42±4,34 0,000 39,75±5,55 0,921
VO^ax II 48,25±9,97 46,24±6,54 37,54±6,12
A 9,82&& 7,81&& -2,21
[ml/kg/min]
Annotations: all data are presented as means ± standard deviation and the difference (A — delta). *** — 0,000 IC vs C, ** — 0,003 ST vs C, ## — 0,007 IC vs C and 0,004 ST vs C, && — 0,001 IC vs C and 0,008 ST vs C.
Abbreviations: p — level of statistical significance (p <0,05 for the lowest accepted), DPmax — maximum double product, DPrest — resting double product, HRmax — maximum heart rate, HRrest — resting heart rate, MET — metabolic equivalent, RRDmax — maximum diastolic blood pressure, RRDrest — resting diastolic blood pressure, RRSmax — maximum systolic blood pressure, RRSrest — resting systolic blood pressure, VO2max — maximal oxygen uptake, n — the number of patients.
ANOVA Kruskall-Wallis analysis was used. Assessing the relevance between arithmetic's the Tukey post hoc test was made. The obtained data was statistically analyzed by Sta-tistica 12 (StatSoft), assuming a statistically significant result with a value of p<0,05.
Results
The Table 7 shows results of the treadmill exercise test in the three groups of patients before (I) and at the end (II)
of cardiac rehabilitation. Compared to the initial result in the field of treadmill exercise test parameters in the IC group there was a significant increase in the test duration (8,47 vs 10,23 min; p<0,001), a significant increase in the MET value (10,86 vs 12,35; p=0,06) and VO2max (38,43 vs 48,25 ml/kg/min; p<0,001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (8,51 vs 9,96; p<0,001), MET value (10,57 vs 12,18; p=0,002) and the rate of VO2max
Table 8
Results of the blood lipid profile in three groups of patients before (I) and at the end (II) of cardiac rehabilitation
Variable Indoor Cycling p Standard p Control p
group group group
(n=20) (n=20) (n=10)
TC I 172,12±38,80 0,339 173,59±36,44 0,113 184,30±32,59 0,961
TC II 160,60±30,13 158,77±26,95 177,70±13,65
A -11,51 -14,82 -6,60
[mg/dl]
HDL I 46,35±13,11 0,312 46,84±11,79 0,808 41,00±12,29 0,018
HDL II 50,11±12,79 49,09±13,81 49,52±13,95
A 3,75 2,25 8,52
[mg/dl]
LDL I 108,05±29,91 0,399 97,17±31,79 0,626 126,60±22,59 0,357
LDL II 97,02±24,69 88,22±24,96 110,40±12,60
A -11,03 -8,95 -16,20
[mg/dl]
TG I 118,05±40,11 0,931 122,79±50,17 0,928 138,30±50,53 0,999
TG II 111,12±26,02 115,78±39,46 135,10±36,16
A -6,93 -7,01 -3,20
[mg/dl]
Annotations: all data are presented as means ± standard deviation and the difference (A — delta).
Abbreviations: p — level statistically significant (p<0,05 for the lowest accepted), HDL — high density lipoprotein, LDL — low density lipoprotein, TC — total cholesterol, TG — triglycerides, n — the number of patients.
(38,42 vs 46,24; p<0,001). No significant changes in rest and maximum heart rate as well as systolic and diastolic blood pressure parameters were found. In C group no significant changes in treadmill exercise test parameters were observed.
The analysis also showed significant differences in A results between groups (A of test duration between IC, S and C group, MET value as well as in VO2max).
Table 8 presents the results of the blood lipid profile in three groups of patients before (I) and at the end (II) of cardiac rehabilitation. Alike in the IC, ST as well as in the C group, positive modifications of blood lipid profile — a reduction of total cholesterol level and triglycerides were observed. Preferable changes in the total cholesterol fractions — HDL and LDL were also noted. Besides the significant increase in the average value of HDL cholesterol in the control group (41,00 vs 49,52 mg/dl; p<0,05), another changes in the lipid profile of the groups were not statistically significant.
Discussion
Results presented in this study reveals the positive influence of application new, alternative strategy of the Indoor Cycling training on men with ischemic heart disease or after myocardial infarction. To our knowledge, this study shows for the first time in the literature the use of this type of physical activity in cardiology patients. Predominantly, in the literature attention is paid to improving exercise tolerance by the influence of standard forms of physical training in patients after myocardial infarction — improvement of the treadmill test time and distance, increase in MET value [6].
Analysis of obtained results before and after the Indoor Cycling training shows its positive effect on physical capacity in patients. After training a significant increase in exercise capacity took place. In the final test in both groups of patients underwent cardiac rehabilitation parallel values of test duration, MET value and VO2max were reported. Similarly, after 1-month of cardiac rehabilitation results were significantly improved in comparison with no rehabilitated group of patients. Maximum and resting heart rate, as well as maximum and resting systolic and diastolic blood pressure not changed significantly. No significantly changes of the treadmill exercise test were reported in control group.
In 2001 Belardinelli et al. analyzed the impact 6-month exercise training on functional parameters and quality of life of patients after PTCI or after applying stent. Patients were divided into two groups — practicing exercises (correspond to 2n stage of cardiac rehabilitation and included training on the ergometer three times a week) and those who prefer sedentary lifestyle, with the recommendation of irregular physical activity. The authors showed insignificant decrease in resting heart rate and a slight increase in peak heart rate in both groups. The mean systolic blood pressure were significantly (p<0,01) decreased in the training group (128 vs 122 mmHg), while in the group without the elements of regular physical activity systolic blood pressure significantly increased (125 vs 131 mmHg; p<0,01). In our analysis, in turn, showed no significant difference in resting and maximum systolic and diastolic blood pressure which can be associated with shorter period of our observation. Moreover, authors highlighted, that only trained patients had significant improvements in
VO2peak (18,6 vs 23,7 ml/kg/min; p<0,001), which is consistent with our test results [7]. After the comprehensive cardiac rehabilitation sessions maximal oxygen uptake increased significantly only in participants, which confirms that only primarily programmed and systematic program of physical activity can contribute to positive changes in capacity. The same conclusion was reached in 2010 Korzeniowska-Kubacka et al. who analyzed the effect of 4,5-month exercise training on diastolic function of the left ventricle in 32 after myocardial infarction (16 men refused to participate — a control group) treated with percutaneous coronary intervention with preserved systolic function and mild diastolic dysfunction of the left ventricle. Authors observed a significant increase in the maximum consumption of oxygen in training group from 26,66 to 28,79 ml/kg/min; p<0,0001 and no significant change in this parameter in the control group (26,23 vs 26,34 ml/kg/min) [8].
In 2013 Paduch also noted the positive impact of 23-days cardiac rehabilitation (an A model of the 2n stage) on exercise capacity of patients after myocardial infarction. Author assessed, VO2max which after rehabilitation program differ significantly from the result achieved prior to the initial test (52,50 vs 57,48; p<0,01). Correspondingly, author received a significant improvement in MET value (8,57 vs 8,68; p<0,01). The author received a significant increase in maximal heart rate (128,14 vs 128,85 beats/minute; p<0,05) and time of test duration (670,42 vs 707 s; p<0,001), as well as reduction of maximal diastolic blood pressure (88,57 vs. 85,71 mmHg; p<0,001). No significant changes in resting heart rate, resting systolic and diastolic, maximal systolic blood pressure were revealed
[9].
In 2012 Rankovic et al. investigated the effects of aerobic exercise training on cardiovascular parameters, lipid profile and endothelial function in seventy patients during second phase of cardiac rehabilitation with stable coronary artery disease. Authors divided patients into the two groups: the group I — 33 patients with coronary artery disease and with regular aerobic training for 3 weeks in the center and 3 weeks after that in their home setting, and the group II (control) — 37 patients with ischaemic disease and sedentary lifestyle. Exercise training consisted of continual aerobic exercise for 45 minutes on a treadmill, bicycle ergometer or walking, three times a week. Authors noted that physical training induced significant reduction of systolic and diastolic blood pressure and heart rate after 6 weeks of cardiovascular rehabilitation (p<0,05). Such positive modifications were not registered in the control group. In patients with moderate aerobic physical training significantly lower heart rate was registered after a 6-week follow-up compared to the group with sedentary lifestyle (p<0,05). Authors highlighted that moderate aerobic physical training reduced systolic and diastolic blood pressure. In our observation we do not find significantly alterations in these parameters [10].
In 2009 Toufan and Afrasiabi evaluated effects of cardiac rehabilitation in 65 patients (50 males and 15 females) on functional capacity, maximum heart rate on exercise treadmill test and serum lipid profile. All of patients practiced aerobic training on bicycle or treadmill 30-40 minutes, 3 times a week for 8-12 weeks. After rehabilitation program 83% of patients improved their functional capacity — MET value increased from 8,7 to 10,8; p<0,001. Also mean time of the tolerance exercise test improved from 7,76 to 9,56 minutes; p<0,001. Average left ventricular ejection fraction was 41% before program and in 72% of patients slightly improved. Alterations obtained by the authors are similar to ours. Maximal heart rate in 72% of patients decreased and in the rest of the population was unchanged or increased [11].
In our study the blood lipid profile was also analyzed. Before analysis, the total cholesterol, triglycerides, as well as the HDL fraction were normal in all of groups. Only in the control group the level of LDL cholesterol significantly different from the reference values.
The mechanism of regular physical activity of the LDL reduction, HDL cholesterol increased and lowering triglycerides most likely associated with an increased sensitivity to insulin, which enhances the expression of lipopro-tein lipase in adipose tissue and skeletal muscle of physically active people [12]. Physical exercise may include a decrease in triglycerides and increase HDL level but little specific effect is seen in LDL cholesterol and total cholesterol (TC) [12]. The described changes in the blood lipid profile are important for the prevention and treatment of cardiovascular diseases, including coronary heart disease [13]. High HDL levels acts protectively [12] — an inverse relationship between HDL serum and the risk of coronary artery disease was demonstrated [14]. In this work, except for positive, significantly modification of the HDL fraction in control group, no noteworthy changes of the blood lipid profile were found.
Mentioned before Belardinelli et al. also made the blood lipid profile analysis of cardiac patients. In patients undergoing physical training value of total cholesterol significantly decreased from 235 to 212 mg/dl, as well as the LDL cholesterol 148 vs 131 mg/dl (both changes in the level of p<0,001) and the value of TG (178 vs 155 mg/dl; p=0,02). HDL cholesterol in turn increased but not significantly (34 vs 39,2 mg/dl). In our study results were no significantly different after 1-month of patients practiced the Indoor Cycling training, which can be caused by to short time of observation (in opposite to 6-months of Balardinelli et al. However, among patients who did not practice regular physical activity after 6 months a significant increase in total cholesterol in blood serum (225 vs 255 mg/dl; p<0,001), LDL cholesterol (138 vs 148 mg/dl; p<0,001) and TG (181 vs 189 mg/dl) were noted. HDH fraction of cholesterol decreased from 32 to 28 mg/dl. Significant changes between two groups occurred in the total cholesterol and LDL values (p<0,001) [8].
Quoted above Rankovic et al. also investigated lipid profile and they noticed that effects of a 6-week cardiovascular rehabilitation on lipid parameters were visible in a significant reduction in triglycerides and significant increase in HDL cholesterol concentration (p<0,05). The concentrations of triglycerides were significantly lower and HDL cholesterol significantly higher after in the exercise training group as compared to sedentary patients (p<0,05). Conclusions obtained by authors are different from our findings, which can caused by shorter follow-up time and lower population in our study [10].
Toufan and Afrasiabi in their study also received significant improvement in plasma lipid profile. Total cholesterol and LDL reduced in 75% of patients as well as triglycerides in 95% of population during the rehabilitation program. Findings obtained by the authors are consistent with ours. [11].
In 2009 Damijan, in turn, analyzed the possibility of applying vibration training in cardiac rehabilitation. The author studied changes in total cholesterol level in blood serum and HDL cholesterol in 24 students, healthy subjects. The analysis showed that in 76% of population the total cholesterol significantly reduced from 4,53 to 4,30 mmol/l (p=0,044), and 76% of study population HDL cholesterol significantly increased from 1,26 to 1,33 mmol/l (p=0,038). According to the author insignificant decrease in patients' triglycerides (1,149 vs 0,980 mmol/l) is valuable in terms of prevention of atherosclerosis as an independent risk factor [15].
References
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Our study presents some limitations that are worth to be highlighted. For instance relatively small number of patients. Additionally, we investigated only men patients between 39-72 years which can be the most important factor of disturbing results. In fact, groups were similar to each other in characteristics. Finally, study lasted only 1-month, which is a short period of time to achieve stable changes in the physical performance and blood lipid profile of cardiology treated patients.
Conclusion
This study adds an important piece of evidence to the substantiation for exercise training in patients with coronary artery disease or after myocardial infarction. Study reports, that Indoor Cycling training can improve exercise capacity, have a favorable effect on blood lipid profile. Indoor Cycling training in the second phase of cardiac rehabilitation in patients with ischemic heart disease or after myocardial infarction is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of an early cardiac rehabilitation.
Acknowledgement. The results of the paper are part of PhD thesis of Dagmara Gloc. There were no grants, no external financial or technical support or other assistance during the evaluation of the paper. None of the authors declare conflict of interests.
9. Paduch P. The influence of outpatient cardiac rehabilitation on physical efficiency of patients subjected to myocardial infarction. Postçpy rehabilitacji 2013; 3: 21-6.
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