Comprehensive assessment of physical cardiac rehabilitation in the early post-infarction period: results of a prospective study

Myocardial infarction (MI) remains one of the main causes of premature mortality and disability in patients worldwide, despite the widespread implementation of modern reperfusion treatment methods, such as percutaneous coronary interventions (PCI). The most crucial component of comprehensive management for patients after MI is cardiac rehabilitation, which includes structured physical training aimed at restoring the body's functional capabilities, reducing the risk of recurrent cardiovascular complications, and improving patients' quality of life. The purpose of this study was to analyze the effectiveness of physical cardiac rehabilitation in patients after MI and PCI based on the assessment of changes in functional, hemodynamic, metabolic, and psycho-emotional parameters. Materials and methods. The study included 68 patients (41 men and 27 women) aged 40-75 years who were receiving standard pharmacological therapy and underwent a 4-week physical rehabilitation program. The protocol was based on moderate-intensity aerobic exercises (walking, stationary cycling), breathing exercises, and elements of therapeutic physical training. The effectiveness of the program was assessed using a 6-minute walk test, echocardiography, monitoring of heart rate and blood pressure, analysis of heart rate variability (SDNN), lipid profile indicators and the level of high-sensitivity C-reactive protein, as well as psycho-emotional status according to the HADS scale. Results. Upon completion of the 4-week cardiac rehabilitation program, a significant improvement in all analyzed parameters was observed in most patients. The distance covered in the 6-minute walk test increased from 320 m to 420 m (p < 0.001), indicating an increase in physical endurance. Left ventricular ejection fraction improved from 49.5% to 53.1% (p = 0.002), with especially significant improvement in the group of patients with initial systolic dysfunction. Autonomic homeostasis improved, as evidenced by an increase in SDNN from 72 to 93 ms (p < 0.001). Positive changes in lipid metabolism were also recorded in response to physical training: LDL levels decreased by 0.8 mmol/L (p < 0.01), and the proportion of patients achieving target values (<1.8 mmol/L) doubled. The hs-CRP level decreased from 4.8 to 2.9 mg/L (p = 0.001), indicating a reduction in inflammation. Additionally, an improvement in psycho-emotional well-being was noted, reflected by a decrease in anxiety and depression scores on the HADS scale by 2.7-2.9 points (p < 0.001).

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