Postoperative Cardiac Rehabilitation Research Articles

Inspiratory Muscle Training in Phase 1 and 2 Postoperative Cardiac Rehabilitation Following Coronary Artery Bypass Graft Surgery: Systematic Review with Meta-Analysis.

This study aimed to determine the effects of inspiratory muscle training (IMT) on exercise capacity, respiratory muscle strength, length of hospital stay (LOS), and quality of life (QOL) following coronary artery bypass graft surgery. The search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook and included the databases MEDLINE, EMBASE, CINAHL, Scopus, and CENTRAL. The review included randomized controlled trials utilizing IMT during phase 1 or 2 postoperative cardiac rehabilitation (PoCR) versus alternative treatment (active or passive control) in patients following coronary artery bypass graft surgery. Fifteen studies were included (11 phase 1 studies, 4 phase 2 studies) with no reported adverse events. In phase 1 PoCR, IMT reduced the LOS (-1.02days; 95% CI = -2.00 to -0.03) and increased exercise capacity (6-minute walk distance [6MWD]).(+75.46m; 95% CI = 52.34 to 98.57), and maximal inspiratory pressure (MIP) (10.46cm H2O; 95% CI = 2.83 to 18.10), but had no effect on maximal expiratory pressure. In phase 2 PoCR, IMT increased 6MWD (45.84m; 95% CI = 10.89 to 80.80), MIP (-23.19cm H2O; 95% CI = -31.31 to -15), maximal expiratory pressure (20.18cm H2O; 95% CI = 9.60 to 30.76), and QOL (-11.17; 95% CI = -17.98 to -4.36), with no effect on peak oxygen uptake. There was a high risk of bias for MIP (75% of the phase 1 studies) and 6MWT (1 of 4 phase 2 studies). The quality of the evidence ranged from very low to moderate. IMT significantly improves exercise capacity, respiratory muscle strength, LOS, and QOL in phase 1 and 2 PoCR. IMT may benefit patients during phase 1 and 2 of PoCR, considering the safety, low cost, and potential benefits.

Early Postoperative Cardiac Rehabilitation in LVAD Patients: A Case Report

This study emphasizes the crucial role of early mobilization and proactive physical therapy for individuals undergoing left ventricular assist device (LVAD) therapy in the context of chronic or end-stage heart failure. Given the intricate medical complexities and prolonged hospitalizations inherent in this patient cohort, specialized cardiac rehabilitation (CR) strategies emerge as indispensable components in cardiovascular medicine. Detailed herein is a case study featuring a 62-year-old male patient who underwent LVAD implantation and participated in a 7-week cardiac rehabilitation program. The observed outcomes revealed substantial improvements in exercise capacity and muscle strength, assessed through standardized physical assessments. Importantly, echocardiographic evaluation demonstrated no adverse effects on left ventricular function. This case underscores the pivotal significance of early rehabilitation intervention during the postoperative phase, particularly in patients exhibiting stable vital signs and hemodynamics. The findings contribute to the refinement of tailored rehabilitation approaches for LVAD recipients, thereby fostering enhanced clinical outcomes and an elevated quality of life in this specialized patient population. The study underscores the critical importance of implementing early rehabilitation strategies in the holistic care paradigm for LVAD recipients, with potential implications for optimizing therapeutic protocols and improving long-term patient outcomes in the field of cardiovascular rehabilitation.

Эффективность программы ранней реабилитации с применением дистанционных технологий на амбулаторном этапе у пациентов после хирургической коррекции приобретенных клапанных пороков сердца

Aim: to investigate the clinical safety and efficacy of a combined rehabilitation consisting of early rehabilitation with physical training in the hospital and remote rehabilitation using a mobile application in the outpatient setting after surgery for acquired valvular heart disease (VHD) using bypass Patients and Methods: the study involved 68 patients who underwent surgery for VHD, with 34 patients in the study group and 34 patients in the control group, based on their rehabilitation approach The study group consisted of two subgroups based on the type of rehabilitation. The subgroup that underwent complex rehabilitation (n=16) participated in treadmill training for 2 weeks in the inpatient setting at least 8 days after surgery, followed by remote rehabilitation in the outpatient setting using a mobile application. The subgroup that underwent remote rehabilitation (n=18) did not undergo early inpatient treadmill training. The control group only received standard cardiac rehabilitation methods Results: there were no significant differences in the rate or type of complications during the early postoperative period A more significant improvement in functional status was reported in the subgroup that underwent complex rehabilitation 24 days after surgery, compared to patients who did not receive early physical training as part of their rehabilitation program. The subgroup undergoing complex rehabilitation showed a significantly greater improvement in exercise tolerance (p=0.03) and peak oxygen uptake (p=0.04) 24 days after surgery. These indices continued to increase (p=0.04; p=0.03) by month 4 of the follow-up compared to postoperative day 7. These changes were more significant in the complex rehabilitation group than in the remote rehabilitation group. Patients who underwent complex rehabilitation showed better adherence to using the mobile application for remote rehabilitation than patients who underwent remote rehabilitation (50% vs. 38.8%; p=0.04). Conclusion: the rehabilitation program for patients after surgery for VHD, which includes early moderate-intensity physical treadmill training followed by outpatient distance rehabilitation using a mobile application, is safe and effective This is demonstrated by a significant improvement in functional status Additionally, early initiation of physical training is associated with better adherence to further use of distance rehabilitation technologies KEYWORDS: valvular heart disease, heart surgery, postoperative cardiac rehabilitation, early rehabilitation, remote rehabilitation FOR CITATION: Lyapina I.N., Argunova Yu.A., Dren E.V.', Chereneva L.A., Barbarash O.L. Effectiveness of early rehabilitation program with remote technologies in the outpatient setting after surgery for acquired valvular heart disease. Russian Medical Inquiry. 2024;8(1):16–25 (in Russ.). DOI: 10.32364/2587-6821-2024-8-1-3.

Evaluation on effeteness of Baduanjin exercise on postoperative cardiac rehabilitation of patients with percutaneous coronary intervention for acute coronary syndrome

Evaluation on effeteness of Baduanjin exercise on postoperative cardiac rehabilitation of patients with percutaneous coronary intervention for acute coronary syndrome

The Effect and Possible Mechanism of Cardiac Rehabilitation in Partial Revascularization Performed on Multiple Coronary Artery Lesions.

To observe the effect of cardiac rehabilitation (CR) in patients with partial revascularization performed on multiple coronary artery lesions and explore its possible mechanism. A total of 400 patients with multiple coronary artery lesions were enrolled and randomly divided into a complete revascularization group and a CR group, with 200 cases in each group. Target lesion revascularization was performed radically in the complete revascularization group, while it was partially completed in the CR group, and postoperative CR was performed. All the patients were put under conventional treatment. Left ventricular end diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), 6-minute walking distance (6-MWD), quality-of-life scores, safety and levels of serum nitric oxide (NO), nitric oxide synthase (NOS), superoxide dismutase (SOD), and vascular endothelial growth factor (VEGF) were evaluated and compared between two groups before and after training. There was no significant difference in LVEDD, LVEF, 6-MWD, quality-of-life scores, levels of serum NO, NOS, SOD, and VEGF between two groups before training (p>0.05). 1 year later, compared with the complete revascularization group, the occurrence of major adverse events in the CR group declined (p>0.05); the measurements of LVEDD decreased and LVEF increased (p>0.05), 6-MWD increased significantly (p<0.05), quality-of-life scores were higher (p<0.05), the levels of serum NO, NOS, and SOD increased noticeably, and the levels of serum VEGF decreased significantly in the CR group (p<0.05). There were significant differences within the same group, before and after training (p<0.05). Cardiac rehabilitation training, not increase in the incidence of adverse events, is effective and safe after partial revascularization in patients with multiple coronary artery lesions, which has notable clinical advantages in promoting patients' exercise endurance and quality-of-life by improving the nitric oxide synthase system and antioxidant system and reducing the level of VEGF.

ASSESSING QUALITY OF LIFE IN PATIENTS WITH SURGICALLY CORRECTED VALVULOPATHIES AFTER CARDIAC REHABILITATION

Valvulopathy is a valvular disease that causes changes in the structure and dysfunction of the valvular system with impaired individual functionality and social impact. Surgical treatment consists in replacing the heart valve with a prosthesis using extracorporeal circulation. The most used prostheses are biological and mechanical, while homografts are less commonly used. Continuous progress in prosthesis valve technology has forced a reorientation towards conservative surgery and thus led to a new development of the cardiac rehabilitation process. An important aspect is the increasing proportion of patients with valvulopathies in general and particularly those which surgery, which raises the importance of postoperative cardiac rehabilitation. After surgical correction, even if the patient is sedated and intubated, the physiotherapist initiates the cardiac rehabilitation programme in accordance with the principle of early kinetic intervention so that recovery is achieved as quickly as possible at parameters that allow reintegration into family and socio-professional life. In this context, the aim of this research is to assess the quality of life of patients with surgically corrected valvulopathies after applying the cardiac rehabilitation programme to a sample of 30 people included in the case study. The methods used in this scientific research are: documentation, questionnaire (QLHR-Q10), observation and data processing. The findings highlight that the quality of life of patients with surgically corrected valvulopathies is average but it constantly improves as a result of adopting a healthy lifestyle and applying the cardiac rehabilitation programme.

In hospital phase of postoperative cardiac rehabilitation in elderly patient with aortic valve replacement: A case report

In hospital phase of postoperative cardiac rehabilitation in elderly patient with aortic valve replacement: A case report

An observational study examining utilization of prehabilitation and its association with postoperative cardiac rehabilitation participation and risk factors following coronary artery bypass grafting

BackgroundGrowing evidence supports the use of prehabilitation before coronary artery bypass grafting (CABG) to improve surgical outcomes, but its feasibility and impact on risk factor management in real-world clinical settings remain unknown. This observational study examined prehabilitation utilization and its association with postoperative cardiac rehabilitation (CR) participation and cardiovascular risk profile. MethodsAs standard care in a large Canadian city, eligible patients were referred to prehabilitation upon entering the elective CABG waitlist then were re-referred to CR following surgery. Prehabilitation consisted of medically supervised exercise training and multidisciplinary support with health behavior change until the scheduled surgery. An assessment of cardiorespiratory fitness, blood pressure, body habitus, psychological distress, lipids, glycated hemoglobin, and smoking status was completed during a prehabilitation intake visit then was repeated after surgery prior to starting CR. ResultsAmong 97 prehabilitation referrals over a 20-month period, only 49% attended an intake visit. Most patients who enrolled (n = 39) also completed (n = 37) prehabilitation. Completion of prehabilitation was significantly associated with higher CR referral (OR = 6.92, 95% CI 1.50–32.00), enrollment (OR = 14.08, 95% CI 5.09–38.94) and attendance [t(62) = 4.48, p < .001], and with improvements in cardiorespiratory fitness, body mass index, and symptoms of depression and anxiety (p < .004). ConclusionsPrehabilitation may improve CR participation and risk factors among individuals undergoing elective CABG, but more work is needed to disseminate this service to eligible patients.

Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection

Introduction: Surgically treated acute type A aortic dissection (ATAAD) patients are often restricted from physical exercise due to a lack of knowledge about safe blood pressure (BP) ranges. The aim of this study was to describe the evolution of early postoperative cardiac rehabilitation (CR) for patients with ATAAD. Methods: This is a retrospective study of 73 patients with ATAAD who were referred to the CR department after surgery. An incremental symptom-limited exercise stress test (ExT) on a cyclo-ergometer was performed before and after CR, which included continuous training and segmental muscle strengthening (five sessions/week). Systolic and diastolic blood pressure (SBP and DBP) were monitored before and after all exercise sessions. Results: The patients (78.1% male; 62.2 ± 12.7 years old; 54.8% hypertensive) started CR 26.2 ± 17.3 days after surgery. During 30.4 ±11.6 days, they underwent 14.5 ± 4.7 sessions of endurance cycling training, and 11.8 ± 4.3 sessions of segmental muscle strengthening. At the end of CR, the gain of workload during endurance training and functional capacity during ExT were 19.6 ± 10.2 watts and 1.2 ± 0.6 METs, respectively. The maximal BP reached during endurance training was 143 ± 14/88 ± 14 mmHg. The heart rate (HR) reserve improved from 20.2 ± 13.9 bpm to 33.2 ± 16.8 bpm while the resting HR decreased from 86.1 ± 17.4 bpm to 76.4 ± 13.3 bpm. Conclusion: Early post-operative exercise-based CR is feasible and safe in patients with surgically treated ATAAD. The CR effect is remarkable, but it requires a close BP monitoring and supervision by a cardiologist and physical therapist during training.

Management and Rehabilitation Post Median Sternotomy in Queensland

Following median sternotomy, postoperative management and cardiac rehabilitation (CR) services advise limits to upper limb activity and lifting, due to concerns about wound dehiscence and sternal instability. With emerging evidence, post-surgical advice is transitioning from non-standardised, historical and load restricting guidelines toward an approach based on ergonomic and kinesiological principles; “Keep Your Move in the Tube (KMIT®)” [1]. The aim of this project was to evaluate current post-operative management and CR practice across Queensland, determine clinician knowledge of KMIT and identify willingness to change practice.

Low skeletal muscle density combined with muscle dysfunction predicts adverse events after adult cardiovascular surgery

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was supported by the Grant for Japan Society for the Promotion of Science (JSPS) KAKENHI. Introduction Although muscle dysfunction is widely known as a poor prognostic factor in patients with cardiovascular disease, no study has examined whether the addition of low skeletal muscle density (SMD) assessed by computed tomography (CT) to muscle dysfunction is useful. Purpose The present study aimed to examine whether SMDs can strengthen the predictive ability of muscle dysfunction for adverse events in patients who underwent cardiovascular surgery. Methods We retrospectively reviewed 853 patients (median age: 69 years, 65.1% male) aged ≥40 years who had preoperative CT for risk management purposes and muscle dysfunctions measured during postoperative cardiac rehabilitation. Muscle dysfunctions were determined from weakness (low grip strength) and slowness (slow gait speed) based on the Asia Working Group for Sarcopenia. Low SMD based on transverse abdominal CT images was defined as a mean Hounsfield unit of the psoas muscle &amp;lt;45. To examine the complementary prognostic value for all-cause deaths, all-cause events, and cardiovascular-related events when low SMDs were added to four patterns of muscle dysfunction (weakness only, slowness only, weakness or slowness, and weakness and slowness), the continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) index were calculated. Results For all definitions of muscle dysfunction, the addition of SMDs was shown to significantly improve the cNRI (estimates: 0.377 to 0.468 for all-cause death, 0.220 to 0.248 for all-cause events, 0.308 to 0.322 for cardiovascular-related events) and IDI (estimates: 0.005 to 0.011 for all-cause death, 0.005 to 0.010 for all-cause events, 0.009 to 0.012 for cardiovascular-related events) in all analyses. Low SMDs combined with muscle dysfunctions were associated with the highest risk of all-cause death (Figure 1: A-D). Patients with neither low SMDs nor muscle dysfunction had the lowest risk of all-cause events and cardiovascular-related events (Figure1: E-L). Conclusion The predictive ability of muscle dysfunction for adverse events was consistently increased by addition of SMDs in patients who underwent cardiovascular surgery. Our results suggest that when CT is performed for any clinical investigation, the addition of the organic assessment of skeletal muscle can strengthen the diagnostic accuracy of muscle wasting. Abstract Figure 1

Impact of cardiac rehabilitation on ventricular repolarization indices following coronary artery bypass grafting.

Background The aim of this study was to evaluate the effect of cardiac rehabilitation on electrocardiographic changes in patients undergoing isolated coronary artery bypass grafting. Methods Between January 2016 and July 2019, a total of 625 patients (485 males, 140 females; mean age: 59.6 years; range, 50.6 to 68.6 years) who underwent isolated coronary artery bypass grafting and survived were retrospectively analyzed. The patients were divided into two groups according to the participation in the cardiac rehabilitation program as follows: the Rehab(+) group (n=363) and the Rehab(-) group (n=262). Electrocardiographic parameters of both groups were compared. Results There was a significant decrease in the electrocardiographic findings of heart rate (p<0.001), QTc (p<0.001), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001) in the Rehab(+) group before and after surgery. There was a significant decrease in the Rehab(+) group, compared to the Rehab(-) group, in terms of parameters of QT interval (p=0.001), QTc (p=0.017), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001). Conclusion Cardiac rehabilitation program after coronary artery bypass grafting decreases ventricular repolarization indices of electrocardiography. Based on these changes, postoperative cardiac rehabilitation program may reduce the risk of ventricular arrhythmia and sudden cardiac death during follow-up.

Effect of Cardiac Rehabilitation on Sexual Satisfaction of Patients After Coronary Artery Bypass Graft Surgery

Background: Providing sexual counseling in cardiac rehabilitation program can improve patients’ sexual satisfaction and performance after Coronary Artery Bypass Graft (CABG) surgery. Objective This study aims to determine the effect of cardiac rehabilitation on sexual satisfaction of patients after CABG surgery. Materials and Methods: This descriptive-analytical study with a cross-sectional design was conducted on 108 patients with CABG surgery referred to cardiac rehabilitation centers in Rasht and Tehran, Iran in 2017-2018. A demographic form and Larsson’s sexual satisfaction questionnaire were used for data collection before and after 10 sessions of cardiac rehabilitation program. The collected data were analyzed in SPSS v. 18 software using paired t-test, Wilcoxon test, and ANCOVA considering a significance level at P&lt;0.05. Results: The mean age of participants was 58.60±6.37 years. Their sexual satisfaction score significantly increased after the intervention and there was a statistically significant difference in sexual satisfaction before and after the intervention (P&lt;0.001). The pre-test and post-test sexual satisfaction scores had no significant relationship with age, gender, years of marriage, duration of heart disease, comorbidities, occupational status, educational level, and economic status (P&gt;0.05). Conclusion: It is necessary to pay attention to the sexual satisfaction of patients after CABG surgery to improve their sexual function and quality of life by creating an opportunity for them to participate in postoperative cardiac rehabilitation programs.

Impact of cardiac surgery-associated acute kidney injury on activities of daily living at discharge in elderly cardiac surgery patients.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a critical complication associated with mortality and morbidity. This study aimed to clarify the impact of CSA-AKI on activities of daily living (ADL) at discharge in elderly cardiac surgery patients. We included 122 cardiac patients who underwent coronary artery bypass surgery, valve surgery, or combined surgery by mid-line incision followed by postoperative cardiac rehabilitation (CR) from March 2015 to May 2020. CSA-AKI was based on KDIGO criteria. The index of ADL was the Functional Independence Measure (FIM). We compared background factors, clinical parameters, activity level before hospitalization, CR progress, and FIM in patients with or without CSA-AKI. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with p < 0.01 in bivariate correlation as independent variables. Ultimately, 122 patients were divided into the non-CSA-AKI group (n = 84) and CSA-AKI group (n = 38). CR progression in the CSA-AKI group was significantly slower and FIM was lower than that in the non-CSA-AKI group. Moreover, even after adjustment for confounding factors, CSA-AKI (β = -0.18), start day of walking (β = -0.34), postoperative atrial fibrillation (β = -0.15), and activity level before hospitalization (β = -0.37) were predictive factors of ADL decline at discharge (adjusted R2 = 0.52). CSA-AKI of elderly cardiac surgery patients was a predictive factor of ADL decline at discharge.

Preoperative frailty is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery.

Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR. Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100m walking within 7days after surgery (successful CR group) and 31 patients who achieved 100m walking later than 8days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale. The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18-1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30-10.51, p = 0.014). Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.

Pre-Operative Frailty Status Is Associated with Cardiac Rehabilitation Completion: A Retrospective Cohort Study.

While previous investigations have demonstrated the benefit of cardiac rehabilitation (CR) on outcomes after cardiac surgery, the association between pre-operative frailty and post-operative CR completion is unclear. The purpose of this retrospective cohort study was to determine if pre-operative frailty scores impacted CR completion post-operatively and if CR completion influenced frailty scores in 114 cardiac surgery patients. Frailty was assessed with the use of the Clinical Frailty Scale (CFS), the Modified Fried Criteria (MFC), the Short Physical Performance Battery (SPPB), and the Functional Frailty Index (FFI). A Mann-Whitney test was used to compare frailty scores between CR completers and non-completers and changes in frailty scores from baseline to 1-year post-operation. CR non-completers were more frail than CR completers at pre-operative baseline based on the CFS (p = 0.01), MFC (p < 0.001), SPPB (p = 0.007), and the FFI (p < 0.001). A change in frailty scores from baseline to 1-year post-operation was not detected in either group using any of the four frailty assessments. However, greater improvements from baseline to 1-year post-operation in two MFC domains (cognitive impairment and low physical activity) and the physical domain of the FFI were found in CR completers as compared to CR non-completers. These data suggest that pre-operative frailty assessments have the potential to identify participants who are less likely to attend and complete CR. The data also suggest that frailty assessment tools need further refinement, as physical domains of frailty function appear to be more sensitive to change following CR than other domains of frailty.

Preoperative nutritional status is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery.

Progression of cardiac rehabilitation after cardiovascular surgery can be affected by frailty. The nutritional status of the patient has been proposed as an indicator of frailty. In this study, we aimed to evaluate the influence of preoperative nutritional status on the progress of postoperative cardiac rehabilitation. This study included 146 patients (82 males, 64 females, average age 71.9 ± 12.0years) who underwent elective cardiovascular surgery. In-hospital mortality cases were excluded to focus on postoperative cardiac rehabilitation. We classified patients with a Geriatric Nutritional Risk Index of 92 or higher as the good nutrition group and those with a Geriatric Nutritional Risk Index less than 92 as the malnutrition group. Preoperative patient characteristics and postoperative cardiac rehabilitation progress were compared between the good nutrition (n = 93) and malnutrition (n = 53) groups. The patients in the good nutrition group had an earlier progression to walking after postoperative rehabilitation (p = 0.002), a shorter postoperative hospital stay (p = 0.004), and a higher rate of discharge home (p = 0.028) than those in the malnutrition group. Multivariable analysis demonstrated preoperative malnutrition to be an independent predictor for the day to 100m walking (p = 0.010). Preoperative nutritional status was associated with progression of postoperative cardiac rehabilitation.

Yoga-Based Postoperative Cardiac Rehabilitation Program for Improving Quality of Life and Stress Levels: Fifth-Year Follow-up through a Randomized Controlled Trial.

Objectives:This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP) in improving quality of life (QOL) and stress levels in patients after 5 years of coronary artery bypass graft (CABG).Methodology:Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP), and follow-up was done for 5 years.Intervention:In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation. The control group (CLSP) continued conventional cardiac rehabilitation only.Outcome Measures:World Health Organization (WHO)-QOL BREF Questionnaire, Perceived Stress Scale, Positive and Negative Affect Scale (PANAS), and Hospital Anxiety and Depression Scale (HADS) were assessed before surgery and at the end of the 5th year after CABG. As data were not normally distributed, Mann–Whitney U-test was used for between-group comparisons and Wilcoxon's signed-rank test was used for within-group comparisons.Results:At the end of 5 years, mental health (P = 0.05), perceived stress (P = 0.01), and negative affect (NA) (P = 0.05) have shown significant improvements. WHO-QOL BREF score has shown improvements in physical health (P = 0.046), environmental health (P = 0.04), perceived stress (P = 0.001), and NA (P = 0.02) in YLSP than CLSP. Positive affect has significantly improved in CLSP than YLSP. Other domains of WHO-QOL-BREF, PANAS, and HADS did not reveal any significant between-group differences.Conclusion:Addition of long-term YLSP to conventional cardiac rehabilitation brings better improvements in QOL and reduction in stress levels at the end of 5 years after CABG.

In-hospital Phase of Postoperative Cardiac Rehabilitation in Elderly Patients with Aortic Stenosis

Purpose: The aim of this study was to evaluate the progress of postoperative cardiac rehabilitation and physical function in elderly patients after transcatheter aortic valve replacement (TAVR). Methods: One hundred thirty-nine patients aged over 65 years with severe aortic stenosis (54 males and 85 females, aged 77 ± 7 years) who underwent elective conventional open heart AVR or TAVR were selected and divided into 3 groups; group A (AVR, < 80 years), group B (AVR ≥ 80 years), group C (TAVR). We evaluated the progress of postoperative cardiac rehabilitation and physical function at discharge. We assessed the ability of 100-m unassisted walk as a progress criterion of cardiac rehabilitation, and the short physical performance battery (SPPB) as an indicator of physical function before cardiac surgery and at discharge. Results: Preoperative and postoperative SPPB score in group C were significantly lower than that in groups A and B (p < 0.05). Additionally, achievement of 100-m unassisted walk was significantly delayed in group C compared with groups A and B, although postoperative hospital stay was not significantly different among 3 groups. Conclusion: Physical function of patients who underwent TAVR was considerably lower than elderly patients who had conventional open heart AVR. Similarly, progress of postoperative cardiac rehabilitation was delayed in patients who underwent TAVR compared with those who underwent conventional open heart AVR.

In-hospital Phase of Postoperative Cardiac Rehabilitation in Elderly Patients with Aortic Stenosis

In-hospital Phase of Postoperative Cardiac Rehabilitation in Elderly Patients with Aortic Stenosis