The effect of obesity on functional capacity, anxiety and daily life activities in patients with coronary artery disease and phase II cardiac rehabilitation

Abstract

Objective. The aim of our study was to investigate the effect of cardiac rehabilitation (CR) program on obese and non-obese patients with coronary artery disease. Methods. The records of 60 coronary artery disease patients aged between 18-75 years, who were included in CR were evaluated. Of the study subjects, 20 had undergone coronary artery bypass grafting (CABG) and 40 had undergone percutaneous coronary intervention (PCI). The patients were divided into two groups by body mass index (BMI), with Group I being non-obese (BMI < 30 kg/m²) and Group 2 being obese (BMI ≥ 30 kg/m²). The effect of 30 session CR on the two groups were evaluated with 6-min walk test (6MWT), Short Form-36 (SF-36) and Beck Anxiety Inventory (BAI). Results. Baseline characteristics of the group 1 (39 patients) and group 2 (21 patients) were similar. Statistically significant improvement was detected in group 1 and group 2 patients by CR program in 6MWT, BAI and SF-36 parameters (p < 0.05). 6MWT, BAI and SF-36 parameters changes by cardiac rehabilitation were compared between the two groups. According to the comparison 6MWT (group 1; 60 (20-183) vs group 2; 34 (15-180), p = 0.012) and MET (group 1; 1.44 ± 0.56 vs group 2; 1.09 ± 0.41, p = 0.015 changes were significantly higher in group 1 than in group 2. However, the changes of BAI and SF-36 parameters were similar in two groups (p > 0.05). Conclusion. CR was found to be effective and safe in terms of functional capacity, daily life activities and anxiety in both obese and non-obese patients. Functional capacity gain in the obese group was less than non-obese patients. 

Keywords

• cardiac rehabilitation,obesity,quality of life,functional capacity,anxiety

References

1. [1] Onat A, Albayrak S, Karabulut A, Ayhan E, Kaya Z, Küçükdurmaz Z, et al. Mortality and coronary events in the Turkish adult risk factor survey 2006: mortality is declining in women whereas overall prevelence of coronery heart disease is on the incline. Arch Turk Soc Cardiol 2007;35:149-53.
2. [2] Jehn M, Schmidt-Trucksass A, Schuster T, Weis M, Hanssen H, Halle M, et al. Daily walking performance as an independent predictor of advanced heart failure: Prediction of exercise capacity in chronic heart failure. Am Heart J 2009;157:292-8.
3. [3] Ades PA, Waldmann ML, Meyer WL, Brown KA, Poehlman ET, Pendlebury WW, et al. Skeletal muscle and cardiovascular adaptations to exercise conditioning in older coronary patients. Circulation 1996;94:323-30.
4. [4] Manson JE, Lee IM. Exercise for women-how much pain for optimal gain? N Engl J Med 1996;334:1325-7.
5. [5] Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-7.
6. [6] World Health Organization Expert Comittee. Rehabilitation after cardiovascular diseases, with special emphasis on developing countries. Technical Report Series number 831. Geneva: World Health Organization; 1993.
7. [7] Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation 2007;116:1653-62.
8. [8] Balady GJ, Williams M, Ades PA, Bittner V, Commoss P, Foody JA, et al. Core components of cardiac rehabilitation/ secondary prevention programs: 2007 Update. A scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2007;115:2675-82.

9. [9] Corrà U, Piepoli MF, Carré F, Heuschmann P, Hoffman U, Verschuren M, et al. Secondary prevention through cardiac rehabilitation: physical activity counseling and exercise training. Key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2010;31:1967-74.
10. [10] Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol 2014;63:1345-54.
11. [11] Fryar CD, Carroll MD, Ogden CL. Prevalence of over- weight, obesity, and extreme obesity among adults: United States, trends 1960–1962 through 2009–2010. Hyattsville: National Center for Health Statistics; 2012.
12. [12] Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-32.
13. [13] Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-77.
14. [14] Lavie CJ, Milani RV. Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients. Am J Cardiol 1997;79:397-401.
15. [15] Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011;162:571-84.
16. [16] Jahangir E, De Schutter A, Lavie CJ. The relationship between obesity and coronary artery disease. Transl Res 2014;164:336-44.
17. [17] Gunstad J, Luyster F, Hughes J, Waechter D, Rosneck J, Josephson R. The effects of obesity on functional work capacity and quality of life in phase II cardiac rehabilitation. Prev Cardiol 2007;10:64-7.
18. [18] Lavie CJ, Milani RV. Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease. Chest 1996;109:52-6.
19. [19] Sattar A, Josephson R, Moore SM. Impact of obesity and other chronic conditions on lifestyle exercise during the year after completion of cardiac rehabilitation. J Cardiopulm Rehabil Prev 2017;37:262-7.
20. [20] Lim SK, Han JY, Choe YR. Comparison of the Effects of Cardiac Rehabilitation Between Obese and Non-obese Patients After Acute Myocardial Infarction. Ann Rehabil Med 2016;40:924-32.
21. [21] Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness –a systemic review. Phsiotherapy. 2012;98:277-86.
22. [22] Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memis A. Reliability and validity of the Turkish version of Short Form-36 (SF-36). İlac ve Tedavi Dergisi 1999;12:102-6.
23. [23] Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893-7.
24. [24] Ulusoy M, Şahin N, Erkman H. Turkish version of the beck anxiety inventory: psychometric properties. J Cognitive Psychotherapy:Int Quaterly 1998;12:28-35.
25. [25] Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253.
26. [26] Sierra-Johnson J, Wright SR, Lopez-Jimenez F, Allison TG. Relation of body mass index to fatal and nonfatal cardiovascular events after cardiac rehabilitation. Am J Cardiol 2005;96:211-4.
27. [27] Bader DS, Maguire TE, Spahn CM, O’Malley CJ, Balady GJ. Clinical profile and outcomes of obese patients in cardiac rehabilitation stratified according to National Heart, Lung, and Blood Institute criteria. J Cardiopulm Rehabil 2001;21:210-7.
28. [28] Seres L, Lopez-Ayerbe J, Coll R, Rodriguez O, Vila J, Formiguera X, et al. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obesity (Silver Spring) 2006;14:273-9.
29. [29] Sadeghi M, Garakyaraghi M, Taghavi M, Khosravi M, Sarrafzadegan N, Roohafza H. The Impacts of Cardiac Rehabilitation Program on Exercise Capacity, Quality of Life, and Functional Status of Coronary Artery Disease Patients with Left Ventricular Dysfunction. Rehabil Nurs 2015;40:305-9.
30. [30] Bellet RN, Francis RL, Jacob JS, Healy KM, Bartlett HJ, Adams L, et al. Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. Arch Phys Med Rehabil 2011;92:1388-94.
31. [31] Granbari-Firoozabadi M, Rahimianfar AA, Reza Vafaii Nasab M, Namayandeh SM, Emami M, Boostani F, et al. A study of the effect of cardiac rehabilitation on heart failure patients' life quality. J Med Life 2014;7:51-4.
32. [32] Weberg M, Hjermstad MJ, Hilmarsen CW, Oldervoll L. Inpatient cardiac rehabilitation and changes in self-reported health related quality of life--a pilot study. Ann Phys Rehabil Med 2013;56:342-55.
33. [33] Clark JM, Marszalek JM, Bennett KK, Harry KM, Howarter AD, Eways KR, et al. Comparison of factor structure models for the Beck Anxiety Inventory among cardiac rehabilitation patients. J Psychosom Res 2016;89:91-7.
34. [34] Korzeniowska-Kubacka I, Bilinska M, Piotrowska D, Stepnowska M, Piotrowicz R. The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction. Eur J Cardiovasc Nurs 2017;16:390-6.
35. [35] Solak Ö, Yaman F, Ulaşlı MA, Eroğlu S, Akçi Ö, Özkeçeci G, et al. Improvement in Quality of Life, Functional Capacity, and Depression Level after Cardiac Rehabilitation. Turk J Phys Med Rehab 2015;61:130-5.
36. [36] Van Camp SP, Peterson RA. Cardiovascular complications of out- patient cardiac rehabilitation programs. JAMA 1986;256:1160-3.
37. [37] Franklin BA, Bonzheim K, Gordon S, Timmis GC. Safety of medically supervised outpatient cardiac rehabilitation exercise therapy: a 16- year follow-up. Chest 1998;114:902-6.