Razi Journal of Medical Sciences

fa تاثیر یک دوره تمرین توان‌بخشی قلبی هوازی و ترکیبی بر برخی متغیرهای همودینامیکی مردان میانسال بیمار آنژیوپلاستی عروق کرونری (PCI) Effects of an Aerobic and Combined Cardiac Rehabilitation Training Program on Selected Hemodynamic Variables in Middle-Aged Men After Percutaneous Coronary Intervention (PCI) فیزیولوژی ورزش Exercise Physiology پژوهشي Research <div style="text-align: justify;">زمینه و هدف: با توجه به اینکه بیماری‌های قلبی-عروقی یکی از علل اصلی مرگ‌ومیر در جهان هستند، هدف از این پژوهش بررسی اثر یک دوره تمرین توان‌بخشی قلبی هوازی و ترکیبی بر برخی متغیرهای همودینامیکی در بیماران مرد میانسال تحت آنژیوپلاستی عروق کرونر (PCI)  بود. روش کار: در این مطالعه نیمه‌آزمایشگاهی با طرح پیش‌آزمون–پس‌آزمون، 22 بیمار مرد 45 تا 65 ساله مبتلا به PCI به صورت در دسترس انتخاب و به‌طور تصادفی به دو گروه تمرین هوازی و تمرین ترکیبی تقسیم شدند. پروتکل تمرینی به مدت 8 هفته، سه جلسه در هفته و هر جلسه 45 تا 60 دقیقه اجرا شد. متغیرهای همودینامیکی قبل و بعد از مداخله اندازه‌گیری شدند. داده‌ها با استفاده از آزمون t وابسته و مستقل در نرم‌افزار SPSS تحلیل شدند. یافته‌ها: نتایج نشان داد تمرین هوازی باعث بهبود معنادار در متغیرهای EDV، ESV، SV و HR شد، در حالی‌که تأثیر معناداری بر SBP و DBP نداشت. همچنین تمرین ترکیبی موجب بهبود معنادار EDV، ESV، SV، DBP و HR گردید اما بر SBP تأثیر معناداری نداشت. مقایسه بین گروهی نشان داد تنها در متغیرهای EDV و ESV تفاوت معنادار بین دو روش تمرینی وجود دارد. نتیجه‌گیری: یافته‌های اگرچه موید بهبود عملکرد همودینامیکی بیماران PCI بعد از اعمال هر یک از برنامه های تمرین هوازی و ترکیبی  بود، با این حال تمرین ترکیبی اثر بیشتری بر شاخص‌های حجم قلبی را نشان دارد. بنابراین استفاده از برنامه‌های توان‌بخشی ورزشی ساختارمند تحت نظر پزشک توصیه می‌شود. </div> <pre style="text-align: justify;"> Background & Aims: Cardiovascular diseases remain a major cause of morbidity and mortality worldwide, with coronary artery disease (CAD) representing one of the most important cardiovascular conditions. Percutaneous coronary intervention (PCI) is widely used to restore coronary blood flow in patients with obstructive coronary artery disease. Although pharmacological and interventional treatments play an essential role in the management of these patients, cardiac rehabilitation is an important component of secondary prevention and functional recovery. Exercise-based cardiac rehabilitation can improve cardiovascular function, exercise capacity, autonomic regulation, and several cardiovascular risk factors. Aerobic exercise is a commonly prescribed component of cardiac rehabilitation, whereas combined aerobic–resistance exercise may provide additional physiological stimuli by incorporating both endurance and resistance training. Nevertheless, evidence regarding the comparative effects of these two exercise approaches on hemodynamic and cardiac structural indices in patients following PCI remains limited, particularly regarding ventricular volume parameters. Therefore, the present study aimed to compare the effects of eight weeks of aerobic exercise and combined aerobic–resistance exercise on selected hemodynamic and cardiac functional variables in middle-aged men following coronary angioplasty. Methods: This quasi-experimental study used a pretest–posttest design. Twenty-two middle-aged men aged 45–65 years who had experienced a myocardial infarction and subsequently undergone coronary angioplasty were recruited by convenience sampling approximately one month after the cardiac event or medical intervention. All participants had been referred to the cardiac rehabilitation unit of Sadr Heart Clinic, Tehran, following evaluation and recommendation by a cardiologist. Participants were randomly assigned to either an aerobic exercise group (n = 11) or a combined aerobic–resistance exercise group (n = 11). The study participants were selected according to predefined eligibility criteria, including the absence of smoking, alcohol consumption, and medications that could substantially affect the study variables. Anthropometric characteristics were assessed using standard procedures. Echocardiographic assessment was performed using a Doppler echocardiography system to determine end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and resting heart rate (Resting HR) were also assessed. Both groups participated in an eight-week cardiac rehabilitation program consisting of three sessions per week. The aerobic component included activities such as treadmill walking, stationary cycling, upper- and lower-extremity cycling, elliptical exercise, and related aerobic modalities. Exercise intensity was individually prescribed using the Karvonen method based on heart-rate reserve and was progressively increased according to the participants’ adaptation to exercise. Heart rate, blood pressure, and potential electrocardiographic changes were monitored during exercise. The combined training group performed the same aerobic program and additionally participated in resistance exercise twice per week. Resistance exercise initially consisted of low-load exercises using 1-kg weights and an abdominal exercise device, with progressive increases in resistance and exercise duration during the intervention. Each training session included warm-up, main exercise, and cool-down phases. Pretest measurements were obtained before the intervention and the same variables were reassessed after eight weeks. Data were analyzed using descriptive statistics, the Shapiro–Wilk test for assessment of normality, paired-samples t-tests for within-group comparisons, and independent-samples t-tests for between-group comparisons. Statistical analyses were performed using SPSS version 22. Results: Following the eight-week intervention, aerobic exercise was associated with significant changes in several cardiovascular variables. EDV significantly decreased from 143.18 ± 12.40 to 134.81 ± 11.30, while ESV decreased from 73.29 ± 19.67 to 62.00 ± 16.89. SV significantly increased from 70.09 ± 10.84 to 72.81 ± 8.97, and resting heart rate decreased from 71.18 ± 11.04 to 63.36 ± 8.68 beats/min. In contrast, changes in SBP and DBP were not statistically significant in the aerobic group. In the combined aerobic–resistance group, EDV decreased significantly from 141.18 ± 8.61 to 127.81 ± 6.39, and ESV decreased from 72.54 ± 17.15 to 55.27 ± 13.46. SV increased significantly from 68.72 ± 10.35 to 72.54 ± 8.34, while resting heart rate decreased from 67.90 ± 13.82 to 59.09 ± 8.31 beats/min. DBP also decreased significantly from 77.27 ± 4.67 to 73.63 ± 3.23 mmHg, whereas the change in SBP was not statistically significant. Between-group analysis demonstrated statistically significant differences between the two exercise programs in EDV (t = 5.06, p = 0.001) and ESV (t = 4.044, p = 0.001). However, no statistically significant between-group differences were observed for SV (t = 0.968, p = 0.345), SBP (t = 0.808, p = 0.429), DBP (t = 1.614, p = 0.122), or resting heart rate (t = 1.617, p = 0.122). Conclusion: Both aerobic exercise and combined aerobic–resistance exercise were associated with favorable changes in several cardiovascular and hemodynamic variables in middle-aged men undergoing cardiac rehabilitation following PCI. Both exercise approaches were accompanied by significant reductions in EDV, ESV, and resting heart rate and a significant increase in stroke volume. A significant reduction in DBP was also observed following combined training, whereas SBP did not change significantly in either group. Importantly, direct comparison of the two exercise approaches demonstrated significant between-group differences only for EDV and ESV, while the responses of SV, SBP, DBP, and resting heart rate did not differ significantly between the groups. These findings indicate that both exercise modalities may be incorporated into supervised cardiac rehabilitation programs for patients following PCI, although the present study does not establish an overall superiority of one approach over the other. The observed differences in ventricular volume indices warrant further investigation in adequately powered controlled trials. The relatively small sample size and the absence of a non-exercising control group should also be considered when interpreting the findings. Future studies involving larger samples, appropriate control conditions, longer follow-up periods, and standardized exercise prescriptions are needed to clarify the comparative effects of aerobic and combined training on cardiac function and hemodynamic adaptation after PCI. </pre> توان‌بخشی قلبی, تمرین هوازی, تمرین ترکیبی, متغیرهای همودینامیکی, بیماران با آنژیوپلاستی عروق کرونر Coronary artery disease, Percutaneous coronary intervention, Cardiac rehabilitation, Aerobic exercise, Combined exercise, Resistance exercise, Hemodynamic variables, End-diastolic volume, End-systolic volume, Stroke volume, Resting heart rate 1 11 http://rjms.iums.ac.ir/browse.php?a_code=A-10-6059-1&slc_lang=fa&sid=1 Mohadeseh Jafari Rajeouni محدثه جعفری راجعونی 3900319475328460091692 3900319475328460091692 No M.Sc. Student, Department of Sports Biomechanics and Sports Injury, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran دانشجوی کارشناسی ارشد، گروه بیومکانیک ورزشی و آسیب شناسی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه خوارزمی تهران، ایران Heidar Sadeghi حیدر صادقی H.sadeghi@khu.ac.ir 3900319475328460091693 3900319475328460091693 Yes Professor, Department of Sports Biomechanics and Sports Injury, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran, & Department of Sports Biomechanics and Sports Rehabilitation, Research Institute of Human Movement Sciences, Kharazmi University, Tehran, Iran استاد، گروه بیومکانیک ورزشی و آسیب شناسی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه خوارزمی، تهران، ایران، و استاد پژوهشکده علوم حرکتی، گروه بیومکانیک و توانبخشی ورزشی، دانشگاه خوارزمی تهران، ایران