title: Long-term lifestyle changes maintain the autonomic modulation induced by rehabilitation after myocardial infarction.
abstract: The altered autonomic balance observed after myocardial infarction is shifted toward a higher parasympathetic tone by rehabilitation. This effect persists after 1 year, however we observed a discrete variability in the long-term sympathovagal balance among patients. We postulated that such variability derives from the disparate adherence of patients to lifestyle prescriptions regarding exercise continuance and smoking avoidance. To test this hypothesis, we reviewed the data of 40 patients, who completed with a favourable autonomic modulation the initial rehabilitation phase after myocardial infarction and underwent the annual follow-up. One year after infarction, 23 patients complied to the advice about regular exercise and smoking avoidance (adherent, Group 1); 17 did not (non-adherent, Group 2). Groups were similar for age, site of infarction, left ventricular function, stress test duration and therapy. The ratio LF/HF, derived from the power spectral density of RR intervals variability, was used as an index of the sympathovagal balance. It was obtained from 15 min of ECG at rest, assessed 1 month after MI (baseline), and repeated 3 months (rehabilitation) and 1 year (follow-up) afterwards. Rehabilitation increased parasympathetic tone in all patients, reducing LF/HF by 33%. At follow-up, this potentially favourable autonomic profile persisted only in Group 1 patients. In conclusion, after a first myocardial infarction, the persistence of the potentially beneficial effect of rehabilitation on the sympathovagal balance depends on the compliance to the lifestyle changes proposed during the initial phase.
authors.affiliation: Divisione di Riabilitazione Cardiologica, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano IRCCS, via Spagnoletto, 3-20147, Milan, Italy. malfi@auxologico.it
authors.forename: G
authors.initials: G
authors.lastname: Malfatto
authors.forename: M
authors.initials: M
authors.lastname: Facchini
authors.forename: L
authors.initials: L
authors.lastname: Sala
authors.forename: R
authors.initials: R
authors.lastname: Bragato
authors.forename: G
authors.initials: G
authors.lastname: Branzi
authors.forename: G
authors.initials: G
authors.lastname: Leonetti
mesh_terms: D000704:Analysis of Variance; D001341:Autonomic Nervous System / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D010349:Patient Compliance; D011336:Probability; D013997:Time Factors