Restricted accessResearch articleFirst published online 2010-6
Physical training after percutaneous coronary intervention in patients with stable angina: effects on working capacity,metabolism,and markers of inflammation
Physical activity is effective in primary and secondary prevention of cardiovascular disease. In this study, we tested the hypothesis that exercise training improves glucose and lipid metabolism, the inflammatory/anti-inflammatory balance, and the outcome of elective percutaneous coronary intervention (PCI) in patients with stable coronary disease.
Methods
Sixty-two patients scheduled to undergo PCI for stable angina were randomized to intensive physical activity (n = 33) consisting of home-based exercise on a bicycle ergometer or maintain their usual sedentary life (n = 29). The training program started 2 months before PCI and terminated 6 months afterwards. Clinical examination, blood sampling (fasting glucose, glycated hemoglobin, lipid profile, apolipoprotein B, apolipoprotein A1, C-reactive protein, serum amyloid A, interleukin-6, interleukin-8, and interleukin-10), and maximal exercise tests were performed at inclusion, 1 week before PCI, and 3 and 6 months afterwards.
Results
Fifty-six patients [28 per group, 45 men, mean age 63 (SD 7.8) years] completed the follow-up. According to self-reports, patients in the training group exercised more often and longer [4.9 (SD 1.1) vs. 0.6 (SD 1.3) days/week, 36 (SD 12) vs. 15 (SD 31) min/session, P <0.0001]. Improvement in maximal exercise capacity was significantly better in the training group [27 (SD 27) vs. 9 (SD 27)W, P = 0.02]. Exercise had no significant effects on glucose and lipid metabolism, plasma cytokines, or acute-phase reactants.
ErikssenGLiestolKBjornholtJThaulowESandvikLErikssenJ.Changes in physical fitness and changes in mortality.Lancet1998; 352:759–762.
2.
RosengrenAWilhelmsenL.Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Goteborg.Ann Epidemiol1997; 7:69–75.
3.
TavazziLIgnoneG.Short-term haemodynamic evolution and late follow-up of post-infarct patients with left ventricular dysfunction undergoing a physical training programme.Eur Heart J1991; 12:657–665.
4.
NiebauerJHambrechtRVelichTHauerKMarburgerCKalbererB. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise.Circulation1997; 96:2534–2541.
5.
SchulerGHambrechtRSchlierfGNiebauerJHauerKNeumannJ. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease.Circulation1992; 86:1–11.
6.
BruunsgaardH.Physical activity and modulation of systemic low-level inflammation.J Leukoc Biol2005; 78:819–835.
7.
CesariMPenninxBWPahorMLauretaniFCorsiAMRhys WilliamsG. Inflammatory markers and physical performance in older persons: the InCHIANTI study.J Gerontol2004; 59:242–248.
8.
MattuschFDufauxBHeineOMertensIRostR.Reduction of the plasma concentration of C-reactive protein following nine months of endurance training.Int J Sports Med2000; 21:21–24.
9.
MoraSCookNBuringJERidkerPMLeeIM.Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms.Circulation2007; 116:2110–2118.
10.
WannametheeSGLoweGDWhincupPHRumleyAWalkerMLennonL.Physical activity and hemostatic and inflammatory variables in elderly men.Circulation2002; 105:1785–1790.
11.
BelardinelliRPaoliniICianciGPivaRGeorgiouDPurcaroA.Exercise training intervention after coronary angioplasty: the ETICA trial.J Am Coll Cardiol2001; 37:1891–1900.
12.
HambrechtRWaltherCMobius-WinklerSGielenSLinkeAConradiK. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial.Circulation2004; 109:1371–1378.
13.
BarmeyerAMeinertzT.Anaerobic threshold and maximal oxygen uptake in patients with coronary artery disease and stable angina before and after percutaneous transluminal coronary angioplasty.Cardiology2002; 98:127–131.
14.
BackMWennerblomBWittboldtSCiderA.Effects of high frequency exercise in patients before and after elective percutaneous coronary intervention.Eur J Cardiovasc Nurs2008; 7:307–313.
15.
MarwickTHHordernMDMillerTChyunDABertoniAGBlumenthalRS. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association.Circulation2009; 119:3244–3262.
16.
KelleyGAKelleyKSTranZV.Aerobic exercise and lipids and lipoproteins in women: a meta-analysis of randomized controlled trials.J Women Health (2002)2004; 13: 1148–1164.
17.
PanagiotakosDBPitsavosCChrysohoouCKavourasSStefanadisC.The associations between leisure-time physical activity and inflammatory and coagulation markers related to cardiovascular disease: the ATTICA Study.Prev Med2005; 40:432–437.
18.
TomaszewskiMCharcharFJPrzybycinMCrawfordLWallaceAMGosekK. Strikingly low circulating CRP concentrations in ultramarathon runners independent of markers of adiposity: how low can you go?Arterioscler Thromb Vasc Biol2003; 23:1640–1644.
19.
FredriksonGNHedbladBNilssonJAAlmRBerglundGNilssonJ.Association between diet, lifestyle, metabolic cardiovascular risk factors, and plasma C-reactive protein levels.Metabol Clin Exp2004; 53:1436–1442.
20.
RawsonESFreedsonPSOsganianSKMatthewsCEReedGOckeneIS.Body mass index, but not physical activity, is associated with C-reactive protein.Med Sci Sports Exerc2003; 35:1160–1166.
21.
VerdaetDDendalePDe BacquerDDelangheJBlockPDe BackerG.Association between leisure time physical activity and markers of chronic inflammation related to coronary heart disease.Atherosclerosis2004; 176:303–310.
22.
AdamopoulosSParissisJKroupisCGeorgiadisMKaratzasDKaravoliasG. Physical training reduces peripheral markers of inflammation in patients with chronic heart failure.Eur Heart J2001; 22:791–797.
23.
GoldhammerETanchilevitchAMaorIBeniaminiYRosenscheinUSagivM.Exercise training modulates cytokines activity in coronary heart disease patients.Int J Cardiol2005; 100:93–99.
24.
FerrierKENestelPTaylorADrewBGKingwellBA.Diet but not aerobic exercise training reduces skeletal muscle TNF-alpha in overweight humans.Diabetologia2004; 47:630–637.
25.
GielenSAdamsVMobius-WinklerSLinkeAErbsSYuJ. Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure.J Am Coll Cardiol2003; 42:861–868.
26.
PeschelTSixtSBeitzFSonnabendMMuthGThieleH. High, but not moderate frequency and duration of exercise training induces downregulation of the expression of inflammatory and atherogenic adhesion molecules.Eur J Cardiovasc Prev Rehabil2007; 14:476–482.
27.
WaltherCMobius-WinklerSLinkeABruegelMThieryJSchulerG. Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease.Eur J Cardiovasc Prev Rehabil2008; 15:107–112.
