Effect of residential cardiac rehabilitation following bypass surgery. Observations in Switzerland.
BACKGROUND
Cardiac rehabilitation in central Europe traditionally involves isolating patients in a residential idyllic setting where exercise is performed frequently but in a relatively unstructured fashion. Few studies have been performed on the effects of these programs among patients who have undergone bypass surgery. Recent data suggest that postbypass patients may enter these programs too soon after surgery or that exercise is not structured enough to distinguish the benefits of rehabilitation from those experienced by a control group.


METHODS
Forty-two male patients (mean age, 58 +/- 7 years) were divided into exercise and control groups approximately 1 month after undergoing bypass surgery. Exercise training consisted of 1 h of group walking twice daily, with the intensity stratified into four levels based on initial exercise capacity. Using a crossover design, patients in the exercise group participated in rehabilitation for 1 month, followed by 1 month of usual care, while control patients underwent the opposite sequence. At 1, 2, and 3 months, patients in both groups underwent pulmonary function testing and maximal ramp exercise testing using lactate and gas exchange analysis.


RESULTS
A main effect for maximal oxygen uptake was observed; significant improvements within each group occurred across each testing period (range, 5 to 13%; p < 0.05). However, there was no significant interaction between groups. Mean lactate levels throughout exercise were reduced within both groups (p < 0.01). A reduction in oxygen uptake for test 2 at the lactate threshold in the exercise group resulted in differences between groups in lactate, heart rate, and other gas exchange variables at this point.


CONCLUSIONS
Similar changes occur in the functional status of postbypass surgery patients regardless of their participation in the short but concentrated programs common in central Europe. This suggests that a significant spontaneous effect of healing occurs in the recovery phase after surgery. These programs may have greater efficacy if they began later after surgery, lasted longer, or were more structured, and studies are needed to determine their effect on psychosocial factors and return to work.
Dubach
P
P
Cardiology Division, Kantonsspital, Chur, Switzerland.
Myers
J
J
Dziekan
G
G
Goerre
S
S
Buser
P
P
Laske
A
A
D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000534:rehabilitation*; D018592:Cross-Over Studies; D015444:Exercise / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D013557:Switzerland