Effectiveness of cardiac rehabilitation in angina pectoris

Currently, most patients with angina pectoris can cope with the symptoms of the disease using drug therapy or myocardial revascularization with PTCA or CS. Most of the evidence (with rare exceptions) that physical exercise (PT) increases exercise tolerance (TFN) in patients with angina pectoris, was obtained before 1990. FT increases the duration of FN before the onset of angina pectoris or completely eliminates angina pectoris by at least least two mechanisms.

First, physical training (PT) reduces the oxygen demand of the myocardium during submaximal FN. FT endurance increase VO2max. Since the change in HR and SAD during an FN is associated more with the degree of increase in VO2max (depending on the nature of the FN, and not from its absolute value), an increase in VO2max with FT leads to a decrease in the increase in HR and SAD per submaximal load. This reduction in double work reduces myocardial oxygen demand and retards the onset of an attack of angina.

Secondly, physical exercise (TF) reduces ED. Normal CAs in response to FNs expand, and for atherosclerotic-affected CAs, ED is manifested, which is manifested in FN by vasoconstriction. According to continuous coronary angiography performed on the background of the introduction of endothelial acetylcholine agonist to patients, FN reduce ED. The fact that in some patients at the very beginning of the FN an increase in blood pressure is observed also confirms the concept of the significance of endothelial function.

Physical training (FT) is considered to be shown (at least in the USA) to patients with angina in cases where it is impractical or impossible to perform surgical interventions on spacecraft. However, a recent clinical study led to a reconsideration of this approach. Hambrecht S. et al. studied the dynamics of physical performance, anatomical features of spacecraft and clinical outcomes in 101 men <70 years old with stable angina, who were randomized into 2 groups: in the first group, PT was performed during the year, and the second group of patients underwent PTCA.

Physical training (FT) was performed for 2 weeks, 6 days a week. TF included a 10-minute FN with training heart rate = 70% of the maximum in combination with daily 20-minute home TF iodine weekly 60-minute controlled TF.

In each group, 47 patients completed the study. The level of physical performance increased by 30% in trained patients and by 20% in those who underwent PTCA. Moreover, the differences were not significant, however, the increase in the maximum physical performance (20% vs 0%) and VO2max (16% vs 2%) were significantly higher in the trained patients. In the latter, the degree of spacecraft lesion did not change, and among patients who underwent PTCA, only 15% had restenosis, defined as a narrowing (> 50%) of the vessel at the site of angioplasty.

The progression of coronary heart disease (CHD), as measured by angiography, was lower in the FT group. 88% of patients from the PTCA group and only 70% of the patients from the TF group suffered acute Ssob, including myocardial infarction, stroke, revascularization procedure, or hospitalization for angina pectoris. Moreover, the difference was statistically significant. These results require confirmation. Due to the specificity of the selection criteria, they cannot be applied to all patients with stable angina. However, these results clearly demonstrated that PT can make a definite contribution to the treatment of patients with angina.

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