title: Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β-blocker therapy or both.
abstract: Heart rate recovery (HRR) is a strong mortality predictor. Exercise training (ET) and β-blocker therapy have significant impact on the HRR of patients following myocardial infarction (MI). However, the combination of ET and β-blocker therapy, as well as its effectiveness in patients with a more compromised HRR (≤12 bpm), has been under-studied. Male patients (n = 64) post-MI were divided: Training + β-blocker (n = 19), Training (n = 15), β-blocker (n = 11) and Control (n = 19). Participants performed an ergometric test before and after 3 months of intervention. HRR was obtained during 5 min of recovery and corrected by the cardiac reserve (HRRcorrCR). Compared to pre-intervention, HRRcorrCRwas significantly increased during the 1st and 2nd minutes of recovery in the Training + β-blocker group (70·5% and 37·5%, respectively; P<0·05). A significant improvement, lasting from the 1st to the 4th minute of recovery, was also observed in the Training group (47%, 50%, 25% and 8·7%, respectively; P<0·05). In contrast, the β-blocker group showed a reduction in HRRcorrCRduring the 2nd and 3rd minutes of recovery (-21·2% and -16·3%, respectively; P<0·05). In addition, interventions involving ET (Training + βb, Training) were significantly more effective in patients with a pre-intervention HRR ≤ 12 bpm than for patients with HRR > 12 bpm. Combination of β-blocker therapy with ET does not compromise the effect of training and instead promotes HRR and aerobic capacity improvement. In addition, this combination is particularly beneficial for individuals presenting with a more compromised HRR. However, chronic administration of β-blocker therapy alone did not promote improvement in HRR or aerobic capacity.
authors.affiliation: Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE), Department of Medicine and Physiotherapy, Santo Amaro University (UNISA), São Paulo, Brazil.|Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.|Department of Rehabilitation and Functional Capacity, School of Physiotherapy, Ibirapuera University (UNIB), São Paulo, Brazil.
authors.forename: Wladimir M
authors.initials: WM
authors.lastname: Medeiros
authors.affiliation: Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE), Department of Medicine and Physiotherapy, Santo Amaro University (UNISA), São Paulo, Brazil.
authors.forename: Fabio A
authors.initials: FA
authors.lastname: de Luca
authors.affiliation: Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Alcides R
authors.initials: AR
authors.lastname: de Figueredo Júnior
authors.affiliation: Department of Rehabilitation and Functional Capacity, School of Physiotherapy, Ibirapuera University (UNIB), São Paulo, Brazil.
authors.forename: Felipe A R
authors.initials: FAR
authors.lastname: Mendes
authors.affiliation: Laboratory of Exercise Physiology and Cardiac Rehabilitation (GERFE), Department of Medicine and Physiotherapy, Santo Amaro University (UNISA), São Paulo, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Gun
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000072038:Cardiac Rehabilitation / Q000009:adverse effects / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects; D017079:Exercise Tolerance / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: autonomic function; beta-blocker; cardiac rehabilitation; exercise testing; exercise training; heart disease; heart rate recovery