Moneruzzaman Md, Sun Wei-Zhen, Changwe Geoffrey J, Wang Yong-Hui
Rehabilitation Center, Qilu Hospital of Shandong University, 250012 Jinan, Shandong, China.
Department of Cardiac Surgery, Qilu Hospital of Shandong University, 250012 Jinan, Shandong, China.
Rev Cardiovasc Med. 2023 May 9;24(5):141. doi: 10.31083/j.rcm2405141. eCollection 2023 May.
Coronary artery bypass graft (CABG) is intended to restore myocardial perfusion and alleviate morbidity among patients suffering from coronary artery disease. Due to procedural complexity, and anesthetic medications, post-operative complications are more prevalent, requiring the integration of rehabilitation strategies. This review aimed to determine the effect of single and multiple exercise therapy on rehabilitation after CABG surgery.
We conducted a systematic search of databases (EBSCOhost, Scopus, PubMed, and Web of Science) from 01 January 2000 to 15 September 2022. The protocol of this systematic review is registered to PROSPERO.
We found nine randomized control trials composed of 599 CABG patients. In-patient cardiac rehabilitation (CR), a combination of inspiratory muscle training, mobilization, active upper and lower limb exercise, and aerobic exercise as multiple exercise therapy, found significant improvement in 6-minute walking distance (6MWD) than single exercise therapy (breathing exercise) at discharge and follow-up (moderate quality evidence). Contrary, multiple exercises group compared to single exercise groups did not improve the peak volume of oxygen ( ) at discharge. Still, significant improvement was found at follow-up (moderate quality of evidence). On the other hand, the out-patient CR made up of high-intensity inspiratory muscle training, upper and lower limbs resistance training, and aerobic exercise as multiple exercise therapy significantly improved 6MWD and peak at discharge (High-quality evidence).
Our review revealed that multiple exercise therapy significantly improves functional and exercise capacity in in-patient and out-patient cardiac rehabilitation settings than single exercise therapy, but more than double exercise therapy protocol may be inefficient for improvement of quality of life. Inspiratory muscle training and resistance training in exercise therapy protocols significantly supplant the outcome, which requires further investigation.
冠状动脉旁路移植术（CABG）旨在恢复心肌灌注并减轻冠心病患者的发病率。由于手术复杂性和麻醉药物的使用，术后并发症更为普遍，需要综合康复策略。本综述旨在确定单次和多次运动疗法对冠状动脉旁路移植术（CABG）后康复的影响。
我们对2000年1月1日至2022年9月15日的数据库（EBSCOhost、Scopus、PubMed和Web of Science）进行了系统检索。本系统综述的方案已在PROSPERO注册。
我们发现了9项随机对照试验，共599名CABG患者。住院心脏康复（CR），即吸气肌训练、活动、主动上肢和下肢运动以及有氧运动相结合作为多次运动疗法，发现在出院时和随访时，6分钟步行距离（6MWD）比单次运动疗法（呼吸运动）有显著改善（中等质量证据）。相反，与单次运动组相比，多次运动组在出院时并未改善氧峰值（ ）。不过，在随访时发现有显著改善（中等质量证据）。另一方面，由高强度吸气肌训练、上肢和下肢阻力训练以及有氧运动组成的门诊CR作为多次运动疗法，在出院时显著改善了6MWD和峰值（高质量证据）。
我们的综述表明，在住院和门诊心脏康复环境中，多次运动疗法比单次运动疗法能显著提高功能和运动能力，但超过两倍的运动疗法方案可能对改善生活质量无效。运动疗法方案中的吸气肌训练和阻力训练显著替代了结果，这需要进一步研究。
