title: Effect of cardiac rehabilitation on muscle mass, muscle strength, and exercise tolerance in diabetic patients after coronary artery bypass grafting.
abstract: BACKGROUND
  The effects of cardiac rehabilitation (CR) on muscle mass, muscle strength, and exercise tolerance in patients with diabetes mellitus (DM) who received CR after coronary artery bypass grafting (CABG) have not been fully elucidated.
  
  
  METHODS
  We enrolled 78 consecutive patients who completed a supervised CR for 6 months after CABG (DM group, n=37; non-DM group, n=41). We measured mid-upper arm muscle area (MAMA), handgrip power (HGP), muscle strength of the knee extensor (Ext) and flexor (Flex), and exercise tolerance at the beginning and end of CR.
  
  
  RESULTS
  No significant differences in confounding factors, including age, gender, ejection fraction, or number of CR sessions, were observed between the two groups. At the beginning of CR, the levels of Ext muscle strength and peak VO2 were significantly lower in the DM group than in the non-DM group. At the end of CR, significant improvement in the levels of muscle strength, HGP, and exercise tolerance was observed in both groups. However, the levels of Ext muscle strength, HGP, peak VO2, thigh circumference, and MAMA were significantly lower in the DM group than in the non-DM group. In addition, no significant improvement in thigh circumference and MAMA was observed in the DM group. At the end of CR, the levels of thigh circumference and MAMA correlated with Ext and Flex muscle strength as well as with HGP. Percent changes in the levels of Ext muscle strength were significantly correlated with those of MAMA and hemoglobin A1c.
  
  
  CONCLUSIONS
  These data suggest that improvement in muscle strength may be influenced by changes in muscle mass and high glucose levels in DM patients undergoing CR after CABG. A CR program, including muscle mass intervention and blood glucose control, may improve deterioration in exercise tolerance in DM patients after CABG.
authors: Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
authors: Miho
authors: M
authors: Nishitani
authors: Kazunori
authors: K
authors: Shimada
authors: Masayuki
authors: M
authors: Masaki
authors: Satoshi
authors: S
authors: Sunayama
authors: Atsumi
authors: A
authors: Kume
authors: Kosuke
authors: K
authors: Fukao
authors: Eiryu
authors: E
authors: Sai
authors: Tomo
authors: T
authors: Onishi
authors: Miki
authors: M
authors: Shioya
authors: Hiroyuki
authors: H
authors: Sato
authors: Taira
authors: T
authors: Yamamoto
authors: Atsushi
authors: A
authors: Amano
authors: Hiroyuki
authors: H
authors: Daida
mesh_terms: D000368:Aged; D001132:Arm; D001786:Blood Glucose; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D003920:Diabetes Mellitus / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D017079:Exercise Tolerance; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D018737:Hand Strength; D006801:Humans; D007717:Knee; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000473:pathology*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human