Cardiac Rehabilitation in coronary ischemic patients: determination of exercise capacity
DOI:
https://doi.org/10.33194/rper.2025.40863Keywords:
Coronary disease, Cardiac rehabilitation, Walking test, Functional capacity and healthAbstract
Introduction: Ischemic heart disease presents a high rate of mortality and associated disability. Determining exercise capacity is a fundamental step in planning exercise training throughout the cardiac rehabilitation program, thus allowing the reduction of the negative impact of this disease. The aim of this study is to determine the capacity for exercise after an acute ischemic event and to understand if it is significantly altered compared to the reference values.
Methodology: Retrospective cross-sectional study, with non-probabilistic convenience sampling, evaluating the 6-minute walk test after acute coronary syndrome with and without ST-segment elevation, to characterize exercise capacity in patients after an acute event. The distance walked was compared with the theoretically predicted distance based on the Enright equation, and it was verified whether the resulting difference between these two parameters was different for patients with and without ST-segment elevation.
Results: A total of 315 patients were included in the study, 76.2% male (n=240), with a mean age of 62 years (SD=11.6). A decrease in the distance walked compared to the predicted distance was observed in both groups (with and without ST-elevation), being more pronounced in the group with ST-elevation (p=0.039).
Discussion: The difference resulting from the assessments suggests a functional loss, probably due to hospitalization for the acute event. Thus, a real determination of the functional level will allow a more adjusted planning of the exercise training plan, considering the event that led to hospitalization. The use of reference values based on existing equations does not seem to be adjusted to the reality and needs of patients.
Conclusion: Existing predictive equations overestimate exercise capacity in patients after an acute ischemic coronary event. It is suggested to determine a new equation that allows estimating the real exercise capacity for this type of patient.
Downloads
References
World Health Organization. Top 10 causes of death. WHO Web Site. Accessed August 10, 2024. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, et al. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J. 2024;88(5):763-842. https://doi.org/10.1253/circj.CJ-23-0285
Visseren FL, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–3337. https://doi.org/10.1093/eurheartj/ehab484
Moreira J, Bravo J, Aguiar P, Delgado B, Raimundo A, Boto P. Physical and Mental Components of Quality of Life after a Cardiac Rehabilitation Intervention: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(18):5576. http://doi.org/10.3390/jcm13185576
Delgado BM, Lopes I, Gomes B, Novo A. Early rehabilitation in cardiology - heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation. Eur J Cardiovasc Nurs. 2020;19(7):592-599. http://doi.org/10.1177/1474515120913806
Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2020;42(1):17–68. https://doi.org/10.1093/eurheartj/ehaa605
Abreu A, Mendes M, Dores H, Silveira C, Fontes P, Teixeira M, et al. Mandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of Cardiology. Rev Port Cardiol. 2018;37(5):363-373. https://doi.org/10.1016/j.repc.2018.02.006
Costa MB, Rebelo C, Marques F, Pestana S, Ferreira, V. Guia Orientador de Boa Prática em Enfermagem de Reabilitação Cardíaca. Ordem dos Enfermeiros. 2020. Accessed August 10, 2024. https://www.flipsnack.com/ordemenfermeiros/gobper/full-view.html
Silva VM, Cintra VM, Silva ML, Meneguci J, Silva FS, Carvalho EE, et al. Assessment of detraining through a six-minute walk test in patients with heart disease. Sao Paulo Med J. 2024;143(1):e2023334. http://doi.org/10.1590/1516-3180.2023.0334.R1.03072024
Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Phys Ther. 2020;100(1):14-43. http://doi.org/10.1093/ptj/pzz127
Tonet E, Boccadoro A, Berloni ML, Amantea V, Grazzi G, Mazzoni G, et al. Effect of physical activity on left ventricular dimensions and function after myocardial infarction: a systematic review. Minerva Cardiol Angiol. 2025;73(2):238-244. http://doi.org/10.23736/S2724-5683.23.06356-1
Delgado B, Novo A, Lopes I, Rebelo C, Almeida C, Pestana S, et al. The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: Results of a multicenter randomized controlled trial (ERIC-HF study). Clin Rehabil. 2022;36(6):813-821. http://doi.org/10.1177/02692155221088684
Moreira JM, Grilo EN. Quality of life after coronary artery bypass graft surgery - results of cardiac rehabilitation programme. J Exerc Rehabil. 2019; 28;15(5):715-722. http://doi.org/10.12965/jer.1938444.222
Levin KA. Study design III: Cross-sectional studies. Evid Based Dent. 2006;7(1):24-5. http://doi.org/10.1038/sj.ebd.6400375
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. PLoS Med. 2007;4(10): e296. http://doi.org/10.1371/journal.pmed.0040296
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7. http://doi.org/10.1164/ajrccm.166.1.at1102
Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158(5):1384-7. http://doi.org/10.1164/ajrccm.158.5.9710086
Enright PL. The six-minute walk test. Respir Care. 2003;48(8):783-5.
Norman GR, Streiner DL. Biostatistics: The Bare Essentials. 4th ed. 2014. PMPH-USA
Rosa SA. Prognóstico após Infarto do Miocárdio – Um Olhar Profundo sobre o Tecido Miocárdico. Arq. Bras. Cardiol. 2022;119(6):958-9.
Gonçalves C, Raimundo A, Abreu A, Pais J, Bravo J. Effects of High-Intensity Interval Training vs Moderate-Intensity Continuous Training on Body Composition and Blood Biomarkers in Coronary Artery Disease Patients: A Randomized Controlled Trial. Rev Cardiovasc Med. 2024;25(3):102. http://doi.org/10.31083/j.rcm2503102
Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, et al. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation. 2024;149(3):e217-e231. http://doi.org/10.1161/CIR.0000000000001189
Liang H, Hu X, Liao H. Effects of different early cardiac rehabilitation exercise treatments on the prognosis of acute myocardial infarction patients receiving percutaneous coronary intervention. Clinics. 2024;79:100408. http://doi.org/10.1016/j.clinsp.2024.100408
Saito H, Maeda D, Kagiyama N, Sunayama T, Dotare T, Fujimoto Y, et al. Prognostic Value of Borg Scale Following Six-minute Walk Test in Hospitalized Older Patients with Heart Failure. Eur J Prev Cardiol. 2024;zwae291.
Saarikoski EO, Roiha ET, Kiviniemi AM, Cerdán-De-Las-Heras J, Perkiömäki J, Kaikkonen KS, et al. Adherence to exercise after an acute coronary syndrome: a 6-month randomized controlled trial. Front Physiol. 2024;15:1319907. http://doi.org/10.3389/fphys.2024.1319907
Brown TM, Pack QR, Aberegg E, Brewer LC, Ford YR, Forman DE, et al. Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2024;150(18):e328-e347. http://doi.org/10.1161/CIR.0000000000001289.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Portuguese Rehabilitation Nursing Journal

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.









