Cardiac responses during rehabilitation in patients undergoing cardiac surgery

• Register: REBEC
• Last refreshed on: 27 May 2013
• Main ID: RBR-5d877q
• Date of registration: 04/04/2012
• Primary sponsor: Universidade Federal de São Carlos - São Carlos, SP, Brazil
• Public title: Cardiac responses during rehabilitation in patients undergoing cardiac surgery
• Scientific title: Study of cardiac autonomic modulation and pulmonary function in patients undergoing coronary artery bypass grafting and physiotherapy program: phase I of cardiac rehabilitation. - : Cardiac Autonomic Responses Exercise-Induced
• Date of first enrolment: 01/06/2011
• Target sample size: 44
• Recruitment status: data analysis completed
• URL: http://www.ensaiosclinicos.gov.br/rg/RBR-5d877q/
• Study type: Intervention
• Study design: Therapeutic, parallel, with 2 arms, open, non randomized clinical trial.

Countries of recruitment

Brazil

Contacts

• Name: Renata Mendes
• Affiliation: Universidade Federal de São Carlos

• Name: Renata Mendes
• Affiliation: Universidade Federal de São Carlos

Key inclusion & exclusion criteria

Inclusion criteria: Coronary artery disease (CAD)
Elective coronary artery bypass surgery (CABG) carried out with cardiopulmonary bypass (CPB).
Exclusion criteria: Patients who had undergone coronary artery bypass surgery (CABG) without cardiopulmonar bypass (CPB) or concomitant surgery;
History of myocardial infarction < 6 months before CABG, severely depressed LVF (left ventricular ejection fraction <30%), acute significant arrhythmias, coexisting chronic obstructive pulmonary disease (COPD), autonomic neuropathy, severe non-cardiac disease;
Inability or refuse to perform the proposed protocol.

Age minimum: 40Y
Age maximum: 80Y
Gender: -

Health Condition(s) or Problem(s) studied

patients undergoing coronary artery bypass surgery, exercise autonomic responses
I97.1

Intervention(s)

Postoperatively, the patients of LVF normal group (LVFN, n=23) and the patients of LVF reduced group (LVFR, n=21)followed the supervised once-daily physiotherapy program (in the afternoon) of early mobilization as described previously from first day after surgery (PO1) to hospital discharge (about 5 days). The program began with extremity range of moviment (ROM) exercises on PO1 and ambulation along hospital corridor from the third day post surgery (PO3), lasting 5 minutes progressing to 10 minutes for the subsequent days of hospitalization. Exercise intensity ranged between 2-4 METs and the heart rate (HR) during exercise did not exceed 20 bpm above HR rest.
In addition, the patients performed voluntary deep-breathing exercises from functional residual capacity to total lung capacity (40 deep breaths in four sets of 10, each breath included a 5 s hold at end inspiration) followed by coughs or huffs (with wound support) supervised once daily starting on PO1. Patients were instructed to perform these breathing and coughing exercises independently every waking hour.

Primary Outcome(s)

Reduced heart rate variability (HRV)indices during physical exercise in hospital, but the magnitude of autonomic response different between the groups with normal and reduced ventricular function, assessed by the nonlinear properties of heart rate variability (HRV), as the complexity (irregularity) of the dynamic process of heart rate were analyzed by indices such as: - correlation dimension (CD); Shannon entropy and sample entropy; and - Poincare indices: SD1 and SD2 interpreted as a measure of both short and long-term HRV (overall HRV.

Secondary Outcome(s)

Reduced heart rate variability (HRV)indices during physical exercise in hospital, but the magnitude of autonomic response different between the groups with normal and reduced ventricular function, assessed by the linear measures of HRV evaluated by calculating the following indices: - mean of RR and its standard deviation (STD RR), - integral of the RR histogram divided by the height of the histogram (RR tri) index and - baseline width of the RR histogram (TINN)and - square root of the mean squared differences of successive RR (rMSSD).

Secondary ID(s)

0095.0.135.000-05

197/2005

Source(s) of Monetary Support

Fundação de Amparo a pesquisa do estado de São Paulo - São Paulo, SP, Brazil

Secondary Sponsor(s)

Irmandade Santa Casa de Misericórdia de Araraquara - Araraquara, SP, Brazil