title: Impact of cardiac rehabilitation on peripheral circulation as assessed by impedance plethysmography: a randomized clinical trial.
abstract: BACKGROUND
  It's known, controlled physical exercise which is a part of cardiac rehabilitation lead to positive changes in coronary circulation and contributes to minimizing other risk factors, such as lipid concentration in the blood or body weight as well as decreases the risk of another acute coronary disease. Monitoring cardiovascular activity is a necessary element of supervising the patient during cardiac rehabilitation. This supervision is primarily concerned with coronary circulation, bypassing the peripheral circulation which may seem like an important part of properly reacts to physical activity.
  
  
  OBJECTIVE
  The aim of the study was to evaluate changes in the peripheral circulation in the calf, induced by controlled physical exercise performed within a standard rehabilitation procedure in patients with acute coronary disease, with the use of impedance plethysmography.
  
  
  METHODS
  Clinical trial (CT).
  All the patients were referred to be cardiologically rehabilitated to the hospital in the Clinic of Internal Diseases and Cardiological Rehabilitation of the Medical University of Łodz not later than one month following the occurrence of acute coronary disease.
  
  
  METHODS
  Forty-seven patients with acute coronary disease were divided into two study groups. Group I (N.=23) participated in a two-week and Group II in a four-week cardiac rehabilitation.
  
  
  METHODS
  Forty-seven patients participated in interval training on a cycle ergometer and exercise improving general physical state held five times a week. All the patients underwent impedance plethysmography test before and after the training session in order to evaluate peripheral circulation in lower limbs.
  
  
  RESULTS
  The authors of the study observed changes in plethysmographic parameters. After two weeks of performing physical exercise Group I demonstrated an increase in the following parameters: PSlope by 3.8%, PAmpl by 1.7%, CT by 3.3% and PT by 1% (p>0.05). With regards to Group II, the parameters increased respectively by: 23.8% (PSlope), 20.4% (PAmpl), 11.6% (CT) and 6.8% (PT) (p<0.05). The authors also noted a complete correlation between the results of the plethysmographic parameters and cardiac stroke volume (Pearson=1).
  
  
  CONCLUSIONS
  Findings of the studies confirm that cardiac rehabilitation improves blood flow in lower limbs vessels in patients with acute coronary disease. Impedance plethysmography allows for non-invasive monitoring of local blood flow and is a precise and repeated method of evaluating peripheral circulation in patients during cardiac rehabilitation.
  
  
  CONCLUSIONS
  The results indicate the role of the length of the training time, which has a beneficial effect on the peripheral circulation of the lower limbs. That could help change the rehabilitation program in other rehabilitation clinic.
authors.affiliation: Laboratory of Ergonomics and Exercise Physiology Medical University of Lodz, Lodz, Poland - ireneusz.jurczak@e.umed.lodz.pl.
authors.forename: I
authors.initials: I
authors.lastname: Jurczak
authors.forename: J
authors.initials: J
authors.lastname: Kowalski
authors.forename: R
authors.initials: R
authors.lastname: Irzmański
mesh_terms: D000208:Acute Disease; D000368:Aged; D001775:Blood Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010992:Plethysmography, Impedance; D011044:Poland