title: Influence of a hybrid form of cardiac rehabilitation on exercise tolerance in coronary artery disease patients with and without diabetes.
abstract: BACKGROUND
  The effectiveness of stationary and ambulatory cardiac rehabilitation of patients with coronary artery disease (CAD) and diabetes has been proven by some authors, but data concerning the effects of hybrid forms of cardiac rehabilitation (HCR) in this population are lacking. A home-based telerehabilitation is a promising form of secondary prevention of cardiovascular diseases in this group of patients.
  
  
  OBJECTIVE
  The objective of the study was to compare the effects of HCR in CAD patients with and without diabetes mellitus (DM). The secondary endpoint was the assessment of CAD risk factors like low exercise capacity and obesity, in both groups of patients.
  
  
  METHODS
  This was a retrospective study, which comprised 125 patients with CAD aged 57.31 ± 5.61 years referred for HCR. They were assigned to Group D (with diabetes; n = 37) or Group C (without diabetes; n = 88). HCR was carried out as a comprehensive procedure that included all core components of cardiac rehabilitation according to guidelines. Before and after HCR all patients underwent a symptom-limited exercise test performed according to the Bruce protocol on a treadmill.
  
  
  RESULTS
  Before HCR the maximal workload was higher in Group C than in Group D (8.13 ± 2.82 METs vs. 6.77 ± 1.88 METs; p = 0.023), but after HCR the difference was not significant. In both groups an increase in the maximal workload after HCR was observed (Group D: before HCR 6.81 ± 1.91 METs, after HCR 8.30 ± 2.04 METs; p < 0.001; Group C: before HCR 8.31 ± 2.71 METs, after HCR 9.13 ± 2.87 METs; p = 0.001). Resting heart rate, double product, and heart rate recovery 1 (HRR1) declined in both groups. No significant differences in changes in exercise test parameters between both groups' parameters were found.
  
  
  CONCLUSIONS
  HCR was effective in patients with DM. The adherence was high. Patients with DM had higher rates of obesity and significantly lower exercise tolerance than patients without DM. Patients from both groups gained similar benefit from HCR in terms of physical capacity, resting heart rate, and heart rate recovery.
authors.affiliation: Department of Rehabilitation, Medical University of Gdansk, Gdansk, Poland. dziel@gumed.edu.pl.
authors.forename: Dominika
authors.initials: D
authors.lastname: Szalewska
authors.forename: Jarosław
authors.initials: J
authors.lastname: Tomaszewski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Kusiak-Kaczmarek
authors.forename: Piotr
authors.initials: P
authors.lastname: Niedoszytko
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gierat-Haponiuk
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.forename: Stanisław
authors.initials: S
authors.lastname: Bakuła
mesh_terms: D000072038:Cardiac Rehabilitation; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D003920:Diabetes Mellitus / Q000534:rehabilitation; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D012189:Retrospective Studies
keywords: cardiac rehabilitation; diabetes; telerehabilitation