Two models of early cardiac rehabilitation in male patients after myocardial infarction with preserved left ventricular function: comparison of standard out-patient versus hybrid training programmes.

Background: The key to increase the percentage of cardiac patients undergoing cardiac rehabilitation is to follow a well-designed exercise programme at home. To maximise the benefits while minimising the risks of aggravating health status, home-based exercise should be tele-monitored. Aim: To compare the effects on physical capacity and sympatho-vagal balance of two types of early cardiac rehabilitation in post-myocardial infarction (MI) male patients: the hybrid model, partly out-patient and partly home-based and tele-monitored vs standard rehabilitation performed only in the out-patient setting. Methods: Sixty two male patients aged 54.7 +/- 6.9 years, mean 27.3 +/- 13.5 days after MI with preserved left ventricular systolic function (EF > 50%) underwent an eight-week training programme consisting of 24 training sessions. After performing the first ten interval trainings on a cycloergometer, 30 patients (the hybrid group) exercised at home while being monitored via TeleECG, while 32 patients (the out-patient group) continued their rehabilitation in the out-patient clinic. At entry and after completion of the rehabilitation programme, all patients underwent a symptom-limited treadmill stress test. The following parameters were analysed: maximal workload (METs), exercise duration (ED, min), heart rate (HR, bpm), blood pressure (BP, mm Hg), double product i.e. product of HR and systolic BP at rest and at peak exercise (DP, mm Hg/min, HR x systolic BP), and HR recovery (HRR) in the first and second minute of the recovery period. Results: Maximal workload (out-patient: 7.3 +/- 1.4 vs 7.8 +/- 1.2, p < 0.05; hybrid: 8.5 +/- 1.8 vs 9.9 +/- 2.2, p < 0.01) and ED (out-patient: 10.1 +/- 2.0 vs 13.5 +/- 1.4, p < 0.001; hybrid: 10.9 +/- 3.6 vs 12.5 +/- 4.1, p < 0.05) increased significantly in both study groups. The remaining parameters did not change significantly, except for HRR, (22.1 +/- 8.7 vs 29.5 +/- 10.7, p < 0.01) and HRR(2) (37.9 +/- 9.5 vs 43.8 +/- 10.7, p < 0.01), which improved in the hybrid group only. Moreover, there were no significant differences between the study groups when comparing the training-induced percentage changes in the analysed parameters. Conclusions: 1. Hybrid rehabilitation improved physical capacity and positively influenced the sympatho-vagal balance in post-MI male patients with preserved left ventricular systolic function. 2. The hybrid model was effective and comparable with standard out-patient-based programme.