Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery--a randomised controlled trial.
OBJECTIVE
Coronary artery bypass grafting (CABG) is accompanied by severe impairment of cardiac autonomous regulation (CAR). This study aimed to determine whether a short-term physiotherapy exercise protocol post-CABG, during inpatient cardiac rehabilitation (CR), might improve CAR.


METHODS
Seventy-four patients eligible for CABG were recruited and randomised into physiotherapy exercise group (EG) or physiotherapy usual care group (UCG). EG patients underwent a short-term supervised inpatient physiotherapy exercise protocol consisting of an early mobilisation with progressive exercises plus usual care (respiratory exercises). UCG only received respiratory exercises. Forty-seven patients (24 EG and 23 UGC) completed the study. Outcome measures of CAR included linear and non-linear measures of heart rate variability (HRV) assessed before discharge.


RESULTS
By hospital discharge, EG presented significantly higher parasympathetic HRV values [rMSSD, high frequency (HF), SD1)], global power (STD RR, SD2), non-linear HRV indexes [detrended fluctuation analysis (DFA)alpha1, DFAalpha2, approximate entropy (ApEn)] and mean RR compared to UCG (p<0.05). Conversely, higher values of mean HR, low frequency (LF) (sympathetic activity) and the LF/HF (global sympatho-vagal balance) were found in the UCG.


CONCLUSIONS
A short-term supervised physiotherapy exercise protocol during inpatient CR improves CAR at the time of discharge. Thus, exercise-based inpatient CR might be an effective non-pharmacological tool to improve autonomic cardiac tone in patient's post-CABG.
Department of Physiotherapy, Federal University of Sao Carlos, São Carlos, SP, Brazil. mendesrg@hotmail.com
Renata Gonçalves
RG
Mendes
Rodrigo Polaquini
RP
Simões
Fernando
F
De Souza Melo Costa
Camila Bianca Falasco
CB
Pantoni
Luciana
L
Di Thommazo
Sérgio
S
Luzzi
Aparecida Maria
AM
Catai
Ross
R
Arena
Audrey
A
Borghi-Silva
D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D015444:Exercise; D005260:Female; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D056152:Respiratory Rate; D012138:Respiratory Therapy