Egzersiz Temelli Kardiyak Rehabilitasyon Programının Koroner Arter Hastalarında Fonksiyonel Kapasite, Kinezyofobi Düzeyi ve Yaşam Kalitesi Üzerine Etkisi

Öz

Amaç: Bu çalışma, egzersiz temelli kardiyak rehabilitasyon (ETKR) programının koroner arter hastalarının fonksiyonel kapasite, kinezyofobi düzeyi ve yaşam kaliteleri üzerine etkisini incelemek üzere planlanmıştır.

Materyal-Metod: Çalışmaya 22 koroner arter hastası (yaş ortalamaları 60,72±5,28 yıl) dahil edildi. Katılımcılar 5 hafta ve 5 seans/hafta bisiklet ergometrisi ile egzersiz eğitim programına tabi tutuldu. Katılımcıların fonksiyonel kapasiteleri 6 dakika yürüme testi (6DYT), kinezyofobi düzeyleri Tampa Kinezyofobi Ölçeği- Kalp versiyonu (TKÖ-K) ve yaşam kaliteleri ise Kısa Form-36 (KF-36) ve Macnew Kalp Hastalığı Sağlıkla İlgili Yaşam Kalitesi Ölçeği (MYKÖ) kullanılarak değerlendirildi. Tüm değerlendirmeler ETKR öncesi ve sonrasında gerçekleştirildi.

Bulgular: Katılımcıların 6DYT mesafeleri tedavi öncesi ve sonrası sırasıyla 524,55±67,78 m ve 561,68±68,39 m olarak ölçüldü ve aradaki fark istatistiksel olarak anlamlıydı (p<0,001). TKÖ-K skorundaki tedavi sonrası ve tedavi öncesi arasındaki değişim istatistiksel olarak anlamlı değildi (p=0,191). Ancak kinezyofobi düzeyi yüksek olan katılımcı sayısının istatistiksel olarak anlamlı azaldığı tespit edildi (p=0,035). Yaşam kalitesi verilerinde KF-36’nın fiziksel fonksiyon ve ağrı alt başlıklarında, MYKÖ’nün ise tüm alt başlıklarında istatistiksel olarak anlamlı iyileşme olduğu bulundu (p<0,05).

Sonuç: Bu çalışma sonuçları ETKR programının koroner arter hastalarında fonksiyonel kapasite, kinezyofobi düzeyi ve yaşam kalitesini iyileştirmede etkili olduğunu göstermektedir. Bu çalışma ETKR programının kinezyofobi düzeyi üzerine etkisini inceleyen bilgimiz dahilindeki ilk çalışmadır. Kinezyofobi düzeyinin belirlenmesinin ve tedavi programlarını bu doğrultuda şekillendirilmesinin rehabilitasyon çıktıları üzerine olumlu etki edeceğini düşünmekteyiz.

Anahtar Kelimeler

• Kardiyak rehabilitasyon
• egzersiz testi
• yaşam kalitesi
• koroner arter hastalığı
• kinezyofobi

Effect of Exercise-Based Cardiac Rehabilitation Program on Functional Capacity, Kinesiophobia Level and Quality of Life in Patients with Coronary Artery Disease

Öz

Objective: This study was planned to examine the effect of exercise-based cardiac rehabilitation (EBCR) program on functional capacity, kinesiophobia level and quality of life on patients with coronary artery disease.

Material and Method: A total of 22 patients with coronary artery disease (the mean age 60.72±5.28 years) were included in the study. Participants were recruited to exercise training programme with cycle ergometer for 5 weeks and 5 sessions/week. Functional capacities of participants were evaluated with the 6-minute walk test (6MWT), kinesiophobia levels with the Tampa Kinesiophobia Scale- Heart version (TKS-H), and quality of life with the Short Form-36 (SF-36) and the Macnew Heart Disease Health-Related Quality of Life Scale (Macnew). All evaluations were performed before and after the EBCR.

Results: The 6MWT distances of the participants pre- and post-treatment were measured as 524.55±67.78 m and 561.68±68.39 m, respectively, and the difference was statistically significant(p<0.001). The post- and pre-treatment difference in the TKS-H score was not statistically significant(p=0.191), however it was determined that there was a statistically significant decrease in the participants with high kinesiophobia levels(p=0.035). It was found that SF-36 had a statistically significant improvement in physical function and pain, and in all subtitles of Macnew(p<0.05).

Conclusions: The results of this study showed that EBCR is effective in improving functional capacity, kinesiophobia level and quality of life in patients with coronary artery disease. To our knowledge, this study is the first study examines the effect of EBCR program on kinesiophobia level. We thought that determining the level of kinesiophobia and planning the treatment programs accordingly, will have a positive effect on rehabilitation outcomes.

Anahtar Kelimeler

• Kardiac rehabilitation
• exercise test
• quality of life
• coronary artery disease
• kinesiophobia

Kaynakça

1. [1] Naghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151-1210.
2. [2] Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nicholas M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37:3232-3245.
3. [3] Onat A, Can G, Yüksel H, Ademoğlu E, et al. TEKHARF 2017 Tıp dünyasının kronik hastalıklara yaklaşımına öncülük. Istanbul:2017;20-28. Available at: https://file.tkd.org.tr/PDFs/TEKHARF-2017.pdf. Accessed April 2, 2021
4. [4] Ferreira González I. The epidemiology of coronary heart disease. Rev Esp Cardiol (Engl Ed) 2014;67:139-144.
5. [5] Quindry JC, Franklin BA, Chapman M, Humphrey R, Mathis S. Benefits and risks of high-intensity interval training in patients with coronary artery disease. Am J Cardiol 2019;123:1370-1377.
6. [6] Bäck M, Cider A, Herlitz J, Lundberg M, Jansson B. The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease. Int J Cardiol 2013;167:391-397.
7. [7] Bosworth HB, Siegler IC, Olsen MK, et al. Social support and quality of life in patients with coronary artery disease. Qual Life Res 2000;9:829-839.
8. [8] Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002;346:793-801.

9. [9] Bäck M. Exercise and physical activity in relation to kinesiophobia and cardiac risk markers in coronary artery disease. Gothenburg: Aidla Trading AB; 2012. Available at: https://www.sls.se/globalassets/vic/disputerade-medlemmar/mariaback.pdf. Accessed April 5, 2021
10. [10] Jette DU, Downing J. Health status of individuals entering a cardiac rehabilitation program as measured by the medical outcomes study 36-item short-form survey (SF-36). Phys Ther 1994;74:521-527.
11. [11] Perk J, Backer GD, Gohlke H, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012): the fifth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33:1635-1701.
12. [12] Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic reiew and meta-analysis. J Am Coll Cardiol 2016;67:1-12.
13. [13] Lavie CJ, Milani RV. Disparate effects of improving aerobic exercise capacity and quality of life after cardiac rehabilitation in young and elderly coronary patients. J Cardiopulm Rehabil 2000;20:235-240.
14. [14] Nilsson BB, Lunde P, Grogaard HK, Holm I. Long-term results of high-ıntensity exercise-based cardiac rehabilitation in revascularized patients for symptomatic coronary artery disease. Am J Cardiol 2018;121:21-26.
15. [15] Swank AM, Funk DC, Manire JT, Allard AL, Denny DM. Effect of resistance training and aerobic conditioning on muscular strength and submaximal fitness for ındividuals with chronic heart failure: influence of age and gender. J Strength Cond Res 2010;24:1298-1305.
16. [16] Albouaini, K., Egred, M., Alahmar, A., Wright, D. J. Cardiopulmonary exercise testing and its application. Postgrad Med J 2007; 83(985), 675-682.
17. [17] Hamilton DM, Haennel RG. Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. J Cardiopulm Rehabil 2000;20:156-164.
18. [18] Gremeaux V, Troisgros O, Benaim S, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil 2011;92:611-619.
19. [19] Acar S, Savci S, Keskinoğlu P, et al. Tampa scale of kinesiophobia for heart Turkish version study: cross-cultural adaptation, exploratory factor analysis, and reliability. J Pain Res 2016;9:445-451.
20. [20]Vlaeyen JW, Kole Snijders AM, Rotteveel AM, Ruesink R, Heuts PH. The role of fear of movement/(re) injury in pain disability. J Occup Rehabil 1995;5:235-252. [21] Najafi M, Sheikhvatan M, Montazeri A, Sheikhfathollahi M. Reliability of World Health Organization's Quality of Life-BREF versus Short Form 36 Health Survey questionnaires for assessment of quality of life in patients with coronary artery disease. J Cardiovasc Med (Hagerstown) 2009;10:316-321.
21. [22] Çelik D, Çoban Ö. Short Form Health Survey version-2.0 Turkish (SF-36v2) is an efficient outcome parameter in musculoskeletal research. Acta Orthop Traumatol Turc 2016;50:558-561.
22. [23]Daskapan A, Höfer S, Oldridge N, Alkan N, Muderrisoglu H, Tuzun EH. The validity and reliability of the Turkish version of the MacNew Heart Disease Questionnaire in patients with angina. J Eval Clin Pract 2008;14:209-213.
23. [24]Dixon T, Lim LLY, Oldridge NB. The MacNew heart disease health-related quality of life instrument: reference data for users. Qual Life Res 2002;11:173-183.
24. [25] Cohen, J.. Statistical Power Analysis for the Behavioral Sciences. 1988. New York, NY: Routledge Academic.
25. [26] Kavanagh T, Mertens DJ, Hamm LF, et al. Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation. Circulation 2002;106:666-671.
26. [27] Gomes Neto M, Duraes AR, Reis HFCD, Neves VR, Martinez BP, Carvalho VO. High-intensity interval training versus moderate-intensity continuous training on exercise capacity and quality of life in patients with coronary artery disease: a systematic review and meta-analysis. Eur J Prev Cardiol 2017;24:1696-1707.
27. [28] Suaya JA, Stason WB, Ades PA, Normand SLT, Shepard DS. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol 2009;54:25-33.
28. [29] Pack Quinn R, Goel K, Lahr Brian D, et al. Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery: a community-based study. Circulation 2013;128:590-597.
29. [30] Lavie CJ, Milani RV, O'Keefe JH, Lavie TJ. Impact of exercise training on psychological risk factors. Prog Cardiovasc Dis 2011;53:464-470.
30. [31] Tutun Yumin E, Ozel A, Saltan A, Sertel M, Ankaralı H, Tarsuslu Simsek T. Effects of pain, dyspnea, and kinesiophobia on life quality in patients with coronary artery disease. Anatol Klin J Med Sci 2017;22:75-84.
31. [32] Currie KD, Bailey KJ, Jung ME, McKelvie RS, MacDonald MJ. Effects of resistance training combined with moderate-intensity endurance or low-volume high-intensity interval exercise on cardiovascular risk factors in patients with coronary artery disease. J Sci Med Sport 2015;18:637-642.
32. [33] He CJ, Zhu CY, Zhu YJ, et al. Effect of exercise-based cardiac rehabilitation on clinical outcomes in patients with myocardial infarction in the absence of obstructive coronary artery disease (MINOCA). Int J Cardiol 2020;315:9-14.
33. [34] Saeidi M, Mostafavi S, Heidari H, Masoudi S. Effects of a comprehensive cardiac rehabilitation program on quality of life in patients with coronary artery disease. ARYA Atheroscler 2013;9:179-185.
34. [35] Schönfelder M, Oberreiter H, Egger A, Tschentscher M, Droese S, Niebauer J. Effect of different endurance training protocols during cardiac rehabilitation on quality of life. Am J Med 2021;134:805-811.