Kodis J, Smith K M, Arthur H M, Daniels C, Suskin N, McKelvie R S
Cardiac Health and Rehabilitation Centre, Hamilton Health Sciences Corporation, 237 Barton Street East, Hamilton, Ontario, Canada L8L2X2.
J Cardiopulm Rehabil. 2001 Jan-Feb;21(1):31-6. doi: 10.1097/00008483-200101000-00007.
Despite the documented benefits of participating in rehabilitation programs, access to cardiac rehabilitation is limited for a large number of people with coronary artery disease (CAD). There is potential to increase participation in exercise training if home-based exercise were a viable option.
We conducted a retrospective database review of 1,042 patients who took part in exercise rehabilitation following coronary artery bypass graft surgery (CABGS) between 1992 and 1998. Of these, 713 patients took part in supervised exercise, and 329 were in an unsupervised, home-based group. All exercise protocols were based upon American College of Sports Medicine guidelines, and patients in both groups received exercise prescriptions that were similar in intensity, frequency, and duration.
There were no differences between groups at baseline. Following 6 months of exercise training, there were substantial improvements in peak VO2, peak workload, and peak MET levels in both the supervised and unsupervised groups (P < 0.0001). Patients in the supervised group had significant improvements in both LDL and HDL-cholesterol, whereas the home-based group showed improvement in HDL-cholesterol only. When analyzed by sex, men performed better than women for all measures of exercise capacity; however, women in both groups showed approximate 20% improvements (P < 0.05) in exercise capacity as well as improvements in HDL-cholesterol.
Stable post CABGS patients who receive a detailed exercise prescription to follow at home do as well as those in supervised rehabilitation.
尽管有文献证明参与康复计划有益，但大量冠心病（CAD）患者获得心脏康复的机会有限。如果家庭锻炼是一个可行的选择，那么参与运动训练的人数有可能增加。
我们对1992年至1998年间接受冠状动脉搭桥手术（CABGS）后进行运动康复的1042例患者进行了回顾性数据库审查。其中，713例患者参加了有监督的运动，329例属于无监督的家庭组。所有运动方案均基于美国运动医学学院的指南，两组患者接受的运动处方在强度、频率和持续时间上相似。
两组在基线时无差异。经过6个月的运动训练，有监督组和无监督组的峰值摄氧量、峰值工作量和峰值代谢当量水平均有显著改善（P<0.0001）。有监督组患者的低密度脂蛋白和高密度脂蛋白胆固醇均有显著改善，而家庭组仅高密度脂蛋白胆固醇有所改善。按性别分析时，所有运动能力指标男性的表现均优于女性；然而，两组中的女性在运动能力方面均有近20%的改善（P<0.05），高密度脂蛋白胆固醇也有所改善。
接受详细家庭运动处方的CABGS术后稳定患者与接受有监督康复的患者效果相当。
