The Effects of Beta-blocker and Aerobic Exercise on Heart Rate Recovery and Exercise Capacity after Maximal Exercise in Acute Coronary Syndrome Patients

  • Cha, Kyung-Hwa (Department of Health and Exercise Science, Korea National Sport University) ;
  • Oh, Jae-Keun (Department of Health and Exercise Science, Korea National Sport University) ;
  • Kim, Young-Joo (Department of Rehabilitation Medicine, Sanggye-Paik Hospital)
  • Received : 2012.12.31
  • Accepted : 2013.03.21
  • Published : 2013.03.31

Abstract

This study was conducted to identify the effects of intake of beta-blocker and aerobic exercise on heart rate recovery (HRR) and exercise capacity after maximal exercise in acute coronary syndrome patients (ACS). Subjects were divided into 4 groups; Beta-blocker-Exercise group (n=10), Beta-blocker group (n=10), Exercise group (n=10), Control group (n=10). Symptom-limited grade exercise test were conducted on subjects pre- and post- 6 week study, to measure maximal heart rate, heart rate at 1 minute and 2 minutes at the recovery stage, maximal oxygen uptake and maximal exercise time. Study resulted in significant improvements in heart rate recovery for BB-Ex group ($17.40{\pm}5.58$ bpm to $26.10{\pm}6.66$ bpm), maximal oxygen uptake for BB-Ex group ($30.46{\pm}8.63$ to $36.33{\pm}8.10$) and Ex group ($29.04{\pm}4.93$ to $34.31{\pm}5.19$), and total exercise time for BB-Ex group ($906.30{\pm}158.57$ to $1018.50{\pm}151.21$), BB group ($805.70{\pm}182.94$ to $897.50{\pm}160.16$) and Ex group ($870.00{\pm}145.63$ to $961.90{\pm}107.29$). Therefore it showed the biggest improvement for heart rate recovery and exercise capacity in acute coronary syndrome patients when both Beta-blocker and aerobic exercise were in effect.

Keywords

References

  1. ACSM's guidelines for exercise testing and prescription-seven edition. 2006. seven edition. American College of Sports Medicine. USA.
  2. Arai Y, Saul JP, Albrecht P, Hartley LH, Lilly LS, Cohen RJ, Colucci WS. Modulation of cardiac autonomic activity during and immediately after exercise. Am J Physiol. 1989. 256: 132-141.
  3. Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992. 85: 164-171. https://doi.org/10.1161/01.CIR.85.1.164
  4. Billman G. Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention. J Apple Physiol. 2002. 92: 446-454. https://doi.org/10.1152/japplphysiol.00874.2001
  5. Black & Matassarin-Jacobs, E. Medical-Surgical Nursing. 1997. (5th ed.). Philadelphia, Saunders Co.
  6. Blair SN, Kohl HW 3rd., Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989. 3; 262: 2395-2401.
  7. Bonnemeier H, Hartmann F, Wiegand UK, Irmer C, Kurz T, Tolq R, Katus HA, Richardt G. Heart rate variability in patients with acute myocardial infarction undergoing primary coronary angioplasty. Am Cardiol J. 2000. 85: 815-820. https://doi.org/10.1016/S0002-9149(99)00873-5
  8. Casolo GC, Stroder P, Signorini C, Calzolari F, Zucchini M, Balli E, Sulla A, Lazzerini S. Heart rate variability during the acute phase of myocardial infarction. Circulation. 1992. 85: 2073-2079. https://doi.org/10.1161/01.CIR.85.6.2073
  9. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart rate recovery immediately after exercise as a predictor of mortality. N Eng J Med. 1999. 341: 1351-1357. https://doi.org/10.1056/NEJM199910283411804
  10. Fink LI, Wilson JR, Ferraro N. Exercise ventilation and pulmonary artery wedge pressure in chronic stable congestive geart failure. Am J Cardiol. 1986. 57: 249-253. https://doi.org/10.1016/0002-9149(86)90900-8
  11. Fletcher GF. Exercise training during chronic beta blockade in cardiovascular disease. Am Cardiol J. 1985. 55: 110-113 https://doi.org/10.1016/0002-9149(85)91064-1
  12. Giannuzzi P, Tavazzi L, Temporelli PL, Corrà U, Imparato A, Gattone M, Giordano A, Sala L, Schweiger C, Malinverni C. Long-term physical training and left ventricular remodeling after anterior myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) trial. EAMI Study Group. J Am Coll Cardiol. 1993. 22: 1821-1829. https://doi.org/10.1016/0735-1097(93)90764-R
  13. Goldsmith RL, Bigger JT, Bloomfield DM. Physical fitness as a determinant of vagal modulation. Med Sci Sports Exerc. 1997. 29: 812-817. https://doi.org/10.1097/00005768-199706000-00012
  14. Kim C, Bang IG, Kim YJ. Effect of beta blocker on heart rate variability at rest and heart rate recovery after maximum exercise for coronary artery disease. KJSS. 2006. 17: 23-32.
  15. Kim HS, Lee JH, Kwon YS, Lee HS, Yang DH, Park HS, Jo YK, Chae SC, Jun JE, Park WH. Changes in Heart Rate during and after Exercise Treadmill Test as Prognostic Factor in Cardiovascular Disease. KCJ. 2004. 34: 170-177.
  16. Kim YJ, Shin YO, Kim SH, Oh JK. Effect of beta blocker and ACE inhibitor treatment after percutaneous coronary intervention on blood pressure during exercise stress test. JKSR. 2007. 18: 61-72.
  17. Iellamo F, Legramante JM, Massaro M, Raimondi G, Galante A. Effects of a residential exercise training on baroreflex sensitivity and heart rate variability in patients with coronary artery disease: a randomized, controlled study. Circulation. 2000. 102: 2588-2592. https://doi.org/10.1161/01.CIR.102.21.2588
  18. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994. 24: 1529-1535. https://doi.org/10.1016/0735-1097(94)90150-3
  19. Jette M, Heller R, Landry F, Blumchen G. Randomized 4-week exercise program in patients with impaired left ventricular function. Circulation. 1991. 84: 1561-1567. https://doi.org/10.1161/01.CIR.84.4.1561
  20. Ju DU, Kang HJ, Kim SW, No TM, Son HS, Kang BJ, Kim SR, Lee BR, Jung BC, Lee JJ. The difference of heart rate recovery in ischemic heart dissease comparing to normal. Korean J Intern Med. 2004. 66: 586-593.
  21. Keteyian SJ, Levine AB, Brawner CA, Kataoka T, Rogers FJ, Schairer JR, Stein PD, Levine TB, Goldstein S. Exercise training in patients with heart failure. A randomized, controlled trial. Ann Intern Med. 1996. 124: 1051-1057. https://doi.org/10.7326/0003-4819-124-12-199606150-00004
  22. Klaus KA, Witte Simon Thackray, Nikolay P, Nikitin John GF, Cleland Andrew L, Clark. The effects of long-term b-blockade on the ventilatory responses to exercise in chronic heart failure. The European Journal of Heart Failure 2005. 7: 612-617. https://doi.org/10.1016/j.ejheart.2004.05.006
  23. Kiilavuori K, Toivonen L, Naveri H, Leinonen H. Beversal of autonomic derangements by physical training in chronic geart failure assessed by geart rate variability. Eur Geart J. 1995. 16: 490-495.
  24. Larsen AI, Gjesdal K, Hall C, Aukrust P, Aarsland T, Dickstein K. Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability. Eur J Cardiovasc Prev Rehabi. 2004. 11: 162-167. https://doi.org/10.1097/01.hjr.0000124214.21584.bb
  25. Lauer MS. Heart rate response in stress testing: clinical implication. ACC Curr J Rec. 2001. 10: 16-19.
  26. Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol. 1993. 22: 678-683. https://doi.org/10.1016/0735-1097(93)90176-2
  27. Lipinski MJ, Vetrovec GW, Froelicher VF. Importance of the first two minutes of heart rate recovery after exercise treadmill testing in predicting mortality and the presence of coronary artery disease in men. Am J Cardiol. 2004. 15; 93: 445-449.
  28. Lund-Johansen P. Exercise and antihypertensive therapy. Am J Cardiol. 1987. 23; 59: 98-107.
  29. Malfatto G, Facchini M, Sala L, Branzi G, Bragato R, Leonetti G. Effects of cardiac rehabilitation and beta-blocker therapy on heart rate variability after first acute myocardial infarction. Am J Cardiol. 1998. 8: 834-840.
  30. Metra M, Nodari S, Dei Cas L. Beta-blockade in heart failure: selective versus nonselective agents. Am J Cardiovasc Drugs. 2001. 1: 3-14. https://doi.org/10.2165/00129784-200101010-00001
  31. O'Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS Jr, Hennekens CH. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989. 80: 234-244. https://doi.org/10.1161/01.CIR.80.2.234
  32. Provencher S, Herve P, Jais X, Lebrec D, Humbert M, Simonneau G, Sitbon O. Deleterious effects of beta-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension. Gastroenterology 2006. 130: 120-126. https://doi.org/10.1053/j.gastro.2005.10.013
  33. Pollock ML, Lowenthal DT, Foster C, Pels AE, Rod J, Stoiber J, Schmidt DH. Acute and chronic responses to exercise in patients treated with beta blockers. J Cardiopul Rehabil. 1991. 11: 132-144. https://doi.org/10.1097/00008483-199103000-00009
  34. Rainer Hambrecht, Claudia Walther, Sven Mobius-Winkler, Stephan Gielen, Axel Linke, Katrin Conrandi, Sandra Erbs, Regine Kluge, Kai Kendziorra, Osama Sabri, Peter Sick, Gerhard Schuler. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease. Circulation. 2004. 109: 1371-1378. https://doi.org/10.1161/01.CIR.0000121360.31954.1F
  35. Richter EA, Sonne B, Mikines KJ, Ploug T, Galbo H. Muscle and liver glycogen, protein, and triglyceride in the rat. Effect of exercise and of the sympatho-adrenal system. Eur J Appl Physiol Occup Physiol. 1984. 52: 346-350. https://doi.org/10.1007/BF01015225
  36. Rosenwinkel ET, Bloomfield DM, Arwady MA, Goldsmigh RL. Exercise and autonomic function in health and cardiovascular disease. Cardiol Clin. 2001. 19: 369-387. https://doi.org/10.1016/S0733-8651(05)70223-X
  37. Shah PK. New insighis in the pathogenesis and prevention of acute coronary dyndromes. The American Journal of Cardiology 1997. 79: 17-23.
  38. Talbert RL. Pharmacokinetics and pharmacodynamics of beta blockers in heart failure. Heart Fail Rev. 2004. 9: 131-137. https://doi.org/10.1023/B:HREV.0000046368.08825.20
  39. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Wenger N. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: A statement from the council on clinical cardiology (subcommittee on exercise, rehabilitation, and prevention) and the council on nutrition, physical activity, and metabolism. Circulation. 2003. 107: 3109-3116. https://doi.org/10.1161/01.CIR.0000075572.40158.77
  40. Tiukinhoy S, Beohar N, Hsie M. Improvement in Heart Rate Recovery After Cardiac Rehabilitation. Journal of Cardiopulmonary Rehabilitation 2003. 23: 84-87. https://doi.org/10.1097/00008483-200303000-00002
  41. Tuttle N, Horvath SM. Comparison of effect of static and dynamic work on blood pressure and heart rate. J Appl Physiol. 1957. 10: 294-296. https://doi.org/10.1152/jappl.1957.10.2.294
  42. Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003. 3; 42: 831-838.
  43. Wilmore JH, Wambsgans KC, Kunkel RC, Baron SB, Ewy GY, Goolsby JP, Morris DL, Robinson WA, Strauss M, Kalis JK. Effect of beta-adrenergic blockade on achievement of the trained state in post-MI patients: non-selective vs beta-selective blockers. J Cardiopul Rehabil. 1990. 10: 50-57. https://doi.org/10.1097/00008483-199002000-00003
  44. Witte KK, Thackray S, Nikitin NP, Cleland JG, Clark AL. The effects of long-term beta-blockade on the ventilatory responses to exercise in chronic heart failure. Eur J Heart Fail. 2005. 7: 612-627. https://doi.org/10.1016/j.ejheart.2004.05.006
  45. Yamamoto Y, Hughson RL, Peterson JC. Autonomic control of heart rate during exercise studied by heart rate variability spectral analysis. J Appl Physiol. 1991. 71: 1136-1142. https://doi.org/10.1152/jappl.1991.71.3.1136
  46. Yeo NH, Kim SS. The effect of aerobic exercise training on blood pressure and electrocardiogram (ECG) in chronic heart failure. Exercise Science. 2001. 10: 31-41.