title: A novel model of exercise walking training in patients after coronary artery bypass grafting.
abstract: BACKGROUND
  Exercise training is an established, guideline-recommended treatment approach in cardiovascular disease. Designing novel methods of exercise training that would be accepted by the patients seems to be a way to increase patient attendance at cardiac rehabilitation (CR). The 6-min walking test (6-MWT) is a simple, safe and objective method to assess exercise capacity. In patients without heart failure, oxygen consumption after 6 min of walking reaches the ventilatory threshold (VT) level. Training up to the VT level is recommended in CR. Theoretical grounds exist for designing a novel model of CR based on diagnostic 6-MWT.
  
  
  OBJECTIVE
  Pilot implementation and evaluation of the effectiveness of a new form of walking training based on 6-MWT in low-risk patients after coronary artery bypass grafting (CABG).
  
  
  METHODS
  The study included 119 men after CABG undergoing phase II CR. Depending on whether patients granted a consent to undergo home-based electrocardiography (ECG) telemonitored CR or not, they were divided into two groups: group A (60 patients) - standard CR combined with the new model (walking 6 times for 6 min with 3-min intervals) for 5 days a week; and group B (59 controls) - standard CR. At baseline and after 3 and 12 months, the patients underwent the following tests: 6-MWT, 24-h Holter ECG monitoring (including evaluation of heart rate variability), and biochemical laboratory tests.
  
  
  RESULTS
  No significant differences in 6-MWT distance were found between the groups at baseline and at 3 and 12 months. At 3 months, 6-MWT distance increased significantly in both groups (group A: 419 ± 73 vs. 515 ± 70 m, p < 0.02; group B: 422 ± 86 vs. 519 ± 73 m, p < 0.02). At 3 and 12 months, body mass was higher in group B controls (p < 0.05). At 3 months, glycaemia and high-sensitivity C-reactive protein (hsCRP) levels were significantly lower in group A patients (p < 0.05). At 12 months, triglyceride levels were higher in group B (p < 0.05). At 3 months, SDNN was higher in group A. After 12 months, LF was lower in group A. At baseline, the LF/HF ratio was significantly higher in group A (p < 0.05) but during further follow-up, favourable changes in the LF/HF ratio were noted only in group A.
  
  
  CONCLUSIONS
  The novel model of exercise walking training had a favourable effect on body mass, glycaemia and hsCRP level reduction, and induced favourable changes of the sympathovagal balance.
authors.affiliation: Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, National Institute of Cardiology, Warsaw, Poland. jwolszakiewicz@ikard.pl.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Wolszakiewicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Piotrowicz
authors.forename: Bogna
authors.initials: B
authors.lastname: Foss-Nieradko
authors.forename: Barbara
authors.initials: B
authors.lastname: Dobraszkiewicz-Wasilewska
authors.forename: Ryszard
authors.initials: R
authors.lastname: Piotrowicz
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D020127:Recovery of Function