Влияние курения на клинические эффекты годичной программы физической реабилитации больных трудоспособного возраста, перенесших острый инфаркт миокарда

Abstract

Purpose. Study of the clinical effectiveness of a long-term (one-year) physical rehabilitation program with the inclusion of physical training (PT) in the III (polyclinic) stage of cardiac rehabilitation in patients with ischemic heart disease of working age who underwent acute myocardial infarction (AMI), depending on the status of smoking. Materials and methods. The study included men (n = 241, mean age 51.3 ± 2.2 years) who underwent AMI (no earlier than 3 weeks from the event). Patients were randomized into 2 groups: the main (O) - 126 people and the control (K) - 115 participants. All patients received standard medication. In the O group, PT was used in the medium intensity regime (50-60% of the fulfilled capacity with a load sample) 3 times a week for one year. Each of the groups was divided into two subgroups, depending on the status of smoking. Effectiveness of the effect was assessed by clinical data and results of instrumental-laboratory analysis. Results. After a yearly PT, a significant increase in physical performance was observed in smokers (n=41) and nonsmokers (n=41) and nonsmokers (n=85) after IMI: an increase in the duration of the load (by 30.3%, p<0.001 and 28.4%, p<0.001) and its power (by 31.2%, p<0.001 and 30.8%, p<0.001) against the backdrop of an increase (by 3.8%, p<0.01) in the economics of physical work, but only for smokers. In the absence of PT, only in nonsmokers (n=72) after AMI, there was an increase in the duration of the load (by 10.1%, p<0.01) and its power (by 11.1%, p<0.05), but to a lesser extent than non-smoking trained patients. In smoking patients (n=43), in the absence of PT, there was no change in the Fed indicators, on the contrary, there was a decrease in the cost-effectiveness of the work performed (by 13.3%, p<0.05). The level of daily motor activity increased only against the background of PT among smokers by 22.2% (p<0.001) and non-smokers by 19.4% (p<0.01). This was combined with a decrease in heart size and increased contractility of the left ventricular myocardium in smokers and non-smokers, but more pronounced positive changes in the background of PT were seen in non-smoking patients. There was no positive dynamics of echocardiographic parameters in the absence of PT, although a slight increase (by 1.9%, p<0.05) of the left ventricular ejection fraction was observed in nonsmokers. Only in the background of PT, smoking and non-smoking patients (equally) had a decrease in the levels of atherogenic lipids and an increase in the concentration of high-density lipoprotein cholesterol by 18.2% (p<0.05) and 20% (p<0.05), respectively. In smoking patients without PT, on the contrary, there was an increase (by 12.5%, p<0.05) of the level of triglycerides. PT had anti-ischemic effects, manifested in a reduction in angina attacks and the need for nitroglycerin consumftion in smokers and non-smokers, in contrast to untrained patients. After the year of PT, the development of all cases of cardiovascular complications significantly decreased in the subgroup of smokers by 44.8% (p<0.05) and the non-smoking group by 50.9% (p<0.05), and the number of days of temporary incapacity for work Per patient decreased by 2 days for smokers and 2.6 days for non-smokers. The conclusion. Long-term (annual) PT of medium intensity at the third outpatient stage of cardiac rehabilitation in both smokers and non-smokers who underwent AMI provides a stable course of the disease, reduces the likelihood of developing cardiovascular complications, improves the patient's quality of life and is safe in the vast majority. At the same time, smoking should be considered as a factor that reduces the rehabilitation potential of the patient who has undergone AMI and prevents better results in cardiac rehabilitation.