Koroner Arter Bypass Greft Cerrahisi Sonrası Fiziksel Aktivite Danışmanlığının Erken Dönem Sonuçlarının İncelenmesi

Yıl 2024, Cilt: 9 Sayı: 1, 105 - 113, 30.01.2024

Zehra Can Karahan Yasemin Buran Çırak Hülya Arıkan

https://doi.org/10.61399/ikcusbfd.1284133

Öz

Amaç: Koroner arter hastalığı için önemli bir risk faktörü olan fiziksel inaktivite, koroner arter bypass greft (KABG) ameliyatı sonrasında artırılmalıdır. Bu çalışmanın amacı, KABG ameliyatı geçirmiş hastalarda erken dönemdeki fiziksel aktivite (FA) danışmanlığının etkilerini incelemekti.
Gereç ve Yöntem: Çalışmaya dahil edilen 30 erkek hasta rastgele iki gruba ayrıldı. 15 hasta FA danışmanlığı ve rutin fizyoterapi alırken, diğerleri sadece rutin fizyoterapi aldı. FA, egzersiz kapasitesi, günlük yaşam aktiviteleri, uyku kalitesi, depresyon ve anksiyete ameliyattan önce ve iki hafta sonra değerlendirildi. Tüm hastalara taburcu olduktan sonra FA ve enerji harcaması değerlendirmesi için bir aktivite monitörü (MF-SenseWear Armband) takıldı. Enerji harcaması, ortalama MET değeri, FA süresi, yatma ve uyuma süresi ve günlük adım sayısı taburcu olduktan sonraki 7 gün boyunca izlendi.
Bulgular: 6 dakikalık yürüme mesafesi FA grubunda 507,87±77,70 m'den 470,46±69,83 m'ye (p=0,001) ve kontrol grubunda 499,80±82,93 m'den 448,00±64,25 m'ye (p=0,002) düşdü, ancak aradaki fark anlamlı değildi (p=0,610). FA danışmanlığı, toplam enerji harcamasını (8516.10±1489.75 karşı 8568.75±999.68 joule, p=0.910), aktif enerji harcamasını (307.43 joule (min 13.57-maks 3300.57) karşı 303.68 joule (min 30.71-maks 11.68), p=0. 412), ortalama metabolik eşdeğer (1.30±0.16 karşı 1.17±0.17, p=0.057), FA süresi (16.57 dakikaya (min 0.71- maks 180) karşı 16.85 dakika (min 3.57-maks 58.71), p=0.367), adım sayısı (723.86 adıma (min 198.57-maks 5944.14) karşı 796.28 (min73.86-maks 4217.86), p=1.000).
Sonuç: FA danışmanlığımız, CABG ameliyatı sonrası FA'yı ve klinik sonuçları geleneksel tedaviden daha fazla iyileştirmedi. Etkinliğin gösterilmesi için daha uzun takiplere ihtiyaç vardır.

Anahtar Kelimeler

Aktivite monitörü, enerji harcaması, fiziksel aktivite danışmanlığı, koroner arter bypass

Examination of Early Results of Physical Activity Counseling after Coronary Artery Bypass Graft Surgery

Öz

Objective: Physical inactivity, an important risk factor for coronary artery disease, should be increased after coronary artery bypass graft (CABG) surgery. The aim of this study was to examine the effects of early physical acitivity (PA) counseling in CABG patients.
Material and Method: Thirty male patients included in the study were randomly divided into two groups. Fifteen patients received PA counseling and routine physiotherapy, while the others received only standard physiotherapy. PA, exercise capacity, daily living activities, sleep quality, depression, and anxiety were assessed before and two weeks after surgery. All patients received an activity monitor (MF-SenseWear Armband) upon discharge for PA and energy expenditure evaluation. Energy expenditure, average MET, PA duration, laying and sleeping time, and daily steps were monitored for seven days after discharge.
Results: The 6-minute walking distance decreased from 507.87±77.70 m to 470.46±69.83 m in the PA group (p=0.001) and from 499.80±82.93 m to 448.00±64.25 m in the control group (p=0.002), but the difference was not significant (p=0.610). PA counseling did not significantly affect total energy expenditure (8516.10±1489.75 vs. 8568.75±999.68 joules, p=0.910), active energy expenditure (307.43 joules (min 13.57- max 3300.57) vs. 303.68 joules (min 30.71-max 11.68), p=0.412), mean metabolic equivalent (1.30±0.16 vs 1.17±0.17, p=0.057), PA duration (16.57 minutes (min 0.71-max 180) vs 16.85 minutes (min 3.57-max 58.71), p=0.367), the number of steps (723.86 steps (min 198.57-max 5944.14) vs 796.28 (min73.86-max 4217.86), p=1.000).
Conclusion: Our PA counseling did not improve PA and clinical outcomes after CABG surgery more than conventional treatment. Longer follow-ups are needed to demonstrate efficacy.

Anahtar Kelimeler

Activity monitor, energy expenditure, physical activity counseling, coronary artery bypass

Kaynakça

• Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020 Mar 3;141(9):e139-e596. DOI: 10.1161/CIR.0000000000000757.
• Hall SL, Lorenc T. Secondary prevention of coronary artery disease. Am Fam Physician. 2020 ;81 (3):289-296.
• Patel S, Adams MR. Prevention of cardiac disease: lifestyle modification or pharmacotherapy? Intern Med J. 2008;38 (3):199-203. DOI: 10.1111/j.1445-5994.2007.01616.x.
• Bailly L, Mossé P, Diagana S, Fournier M, d'Arripe-Longueville F, Diagana O, at al. "As du Coeur" study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease. BMC Cardiovasc Disord. 2018 Dec 6;18(1):225. DOI: 10.1186/s12872-018-0973-3.
• Biscaglia S, Campo G, Sorbets E, Ford I, Fox KM, Greenlaw N, Parkhomenko A, at al. CLARIFY investigators. Relationship between physical activity and long-term outcomes in patients with stable coronary artery disease. Eur J Prev Cardiol. 2020 Mar;27(4):426-436. DOI: 10.1177/2047487319871217. Epub 2019 Sep 26. PMID: 31558054.
• Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? Eur J Prev Cardiol. 2016;23(16):1715-1733. DOI:10.1177/2047487316657669.
• Santos PMR, Ricci NA, Suster ÉAB, Paisani DM, Chiavegato LD. Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy. 2017; 103(1): 1-12. DOI: 10.1016/j. physio.2016.08.003.
• Charlson ME, Isom OW. Clinical practice. Care after coronary-artery bypass surgery. N Engl J Med. 2003; 348 (15): 1456-1463. DOI: 10.1056/ NEJMcp010691.
• Niramayee VP, Arun GM, Nivedita SP. Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review. Cardiol Res Pract. vol. 2020, 8-9. DOI: 10.1155/2020/1236968.
• Ennis S, Lobley G, Worrall S, Evans B, Kimani PK, Khan A, Powell R, Banerjee P, Barker T, McGregor G. Effectiveness and Safety of Early Initiation of Poststernotomy Cardiac Rehabilitation Exercise Training: The SCAR Randomized Clinical Trial. JAMA Cardiol. 2022 Aug 1;7(8):817- 824. DOI: 10.1001/jamacardio.2022.1651.
• Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. Am J Respir Crit Care Med. 2003;167(9):1287. DOI: 10.1164/ ajrccm.167.9.950.
• Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E. et al. International physical activity questionnaire: reliability and validity of the turkish version 1. Percept Mot Skills. 2010;111 (1):278- 284. DOI: 10.2466/06.08.PMS.111.4.278-284.
• Buysse DJ, Reynolds CF., Monk, T.H., Berman, S.R.,Kupfer, D.J. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28 (2): 193-213. DOI: 10.1016/0165-1781(89)90047-4.
• Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane Anksiyete ve Depresyon Ölçeği Türkçe Formunun Geçerlik Güvenirlilik Çalışması. Türk Psikiyatri Dergisi. 1997;8:280-287.
• Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23 (2):137-145. DOI: 10.1002/ art.1780230202.
• Fruin ML, Rankin JW. Validity of a multi-sensor armband in estimating rest and exercise energy expenditure. Med Sci Sports Exerc. 2004;36 (6): 1063-1069. DOI: 10.1249/01.mss.0000128144.91337.38.
• Malavolti M, Pietrobelli A, Dugoni M, Poli M, Romagnoli E, De Cristofaro P at al. A new device for measuring resting energy expenditure (REE) in healthy subjects. Nutrition, Nutr Metab Cardiovasc Dis. 2007; 17 (5): 338-343. DOI: 10.1016/j.numecd.2005.12.009.
• Cole P, LeMura L, Klinger T, Strohecker K, McConnell T. Measuring energy expenditure in cardiac patients using the Body Media (TM) Armband versus indirect calorimetry: A validation study. J Sports Med Phys Fitness. 2004; 44 (3): 262.
• Bäcklund C, Sundelin G, Larsson C. Validity of an armband measuring energy expenditure in overweight and obese children. Med Sci Sports Exerc. 2010; 42 (6): 1154-1161. DOI: 10.1249/MSS.0b013e3181c84091.
• Örücü MÇ. Değişime hız kazandıracak bir yöntem: Motivasyonel Görüşme. Dicle Üniversitesi Ziya Gökalp Eğitim Fakültesi Dergisi, 2020, 1.37: 20-34.
• McGrane N, Galvin R, Cusack T, Stokes E. Addition of motivational interventions to exercise and traditional physiotherapy: a review and meta-analysis. Physiotherapy. 2015 Mar;101(1):1-12. DOI: 10.1016/j. physio.2014.04.009.
• Huang HY, Lin YS, Chuang YC, Lin WH, Kuo LY, Chen JC, Hsu CL, Chen BY, Tsai HY, Cheng FH, Tsai MW. Application of the Transtheoretical Model to Exercise Behavior and Physical Activity in Patients after Open Heart Surgery. Acta Cardiol Sin. 2015 May;31(3):202-8. DOI: 10.6515/ acs20150204a.
• Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003; 290 (7): 898-904. DOI: 10.1001/jama.290.7.898.
• Krannich JHA, Weyers P, Lueger S, Herzog M, Bohrer T, Elert O. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry. 2007; 7 (1): 47. DOI: 10.1186/1471-244X-7-47.
• Yilmaz H, Iskesen I. Objective and subjective characteristics of sleep after coronary artery bypass graft surgery in the early period: a prospective study with healthy subjects. Heart Surg Forum. 2007; 10 (1): 16-20. DOI: 10.1532/HSF98.20061128.
• Verrill DE, Fox L, Moore JB, Miller J, Belles C, Barrier J at al. Validity and reliability of the North Carolina 6-minute cycle test. J Cardiopulm Rehabil. 2006; 26 (4): 224-230. DOI: 10.1097/00008483-200607000- 00005.
• Koivula M, Tarkka MT, Tarkka M, Laippala P, Paunonen-Ilmonen M. Fear and anxiety in patients at different time-points in the coronary artery bypass process. Int J Nurs Stud. 2002; 39 (8): 811-822. DOI: 10.1016/s0020-7489(02)00022-6.
• Lie I, Bunch EH, Smeby NA, Arnesen H, Hamilton G. Patients' experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting. Eur J Cardiovasc Nurs. 2012 Mar;11(1):14-24. DOI: 10.1016/j.ejcnurse.2010.09.004.
• Izawa KP, Watanabe S, Hiraki K, Morio Y, Kasahara Y, Takeichi N. et al. Determination of the effectiveness of accelerometer use in the promotion of physical activity in cardiac patients: a randomized controlled trial. Arch Phys Med Rehabil. 2012; 93 (11): 1896-1902. DOI: 10.1016/j.apmr.2012.06.015.
• Eshah NF. Predischarge education improves adherence to a healthy lifestyle among Jordanian patients with acute coronary syndrome. Nurs Health Sci. 2013; 15 (3): 273-279. DOI: 10.1111/nhs.12018.