Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients.
OBJECTIVE
Surgically treated type-A aortic dissection patients are often restricted from physical exercise due to a lack of knowledge about the blood pressure increase. Our aims were to evaluate the hemodynamic responses during exercise, and to assess changes in peak oxygen uptake, maximal workload, and quality-of-life after completion of an exercise-based cardiac rehabilitation program.


METHODS
Three subgroups were retrospectively identified based on their different eligibility criteria. Group I (n = 10) had performed an exercise-based cardiac rehabilitation program including exercise tests. Group II (n = 9) had followed the program without the tests. Group III (n = 10) had neither been rehabilitated nor tested. For evaluation of hemodynamic parameters, we included a group of surgically treated patients with aortic valve stenosis, group IV (n = 32). Questionnaires were obtained to measure quality-of-life.


RESULTS
At baseline the group I and IV mean systolic blood pressure changed from 143 ± 16 mmHg and 150 ± 16 mmHg to 200 ± 32 mmHg and 213 ± 27 mmHg, respectively. The group I mean peak oxygen uptake changed from 23.5 ± 7.9 ml/min/kg before rehabilitation to 28.6 ± 8.4 ml/min/kg, p = .001, after rehabilitation. The mean maximal workload changed from 143 ± 80 W before rehabilitation to 178 ± 97 W, p = .003, after rehabilitation. At follow-up, the groups I-III physical quality-of-life score was 45.1 ± 15.0, 40.0 ± 9.0, and 30.0 ± 11.3, p < .025, respectively, and the mental quality-of-life score was 51.1 ± 6, 41.7 ± 6.7, and 32.5 ± 13.3, p < .001, respectively.


CONCLUSIONS
Our results suggest that type-A aortic dissection patients have hemodynamic responses to exercise that are comparable to other cardiovascular patients. Moreover, we found significant increases in peak oxygen uptake, maximal workload, and quality-of-life after ended ECR.
a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital and Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.
Simon
S
Fuglsang
a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital and Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.
Johan
J
Heiberg
a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital and Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.
Vibeke E
VE
Hjortdal
b Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital & Centre of Research in Rehabilitation (CORIR) , Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.
Sussie
S
Laustsen
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000072038:Cardiac Rehabilitation / Q000009:adverse effects / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects; D017079:Exercise Tolerance; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010865:Pilot Projects; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Aortic dissection; cardiac rehabilitation; maximal cardiorespiratory incremental test