To date, there are insufficient data on the concept of exploring rehabilitation potential in older patients with frailty syndrome, while developing strategies to improve outcomes after cardiac surgery and reducing the number of postoperative complications remains a relevant topic. Aim. To assess safety and feasibility of early physical rehabilitation in frail patients undergoing coronary artery bypass grafting (CABG). Material and methods. The study included 49 patients with stable coronary artery disease (CAD) admitted for elective CABG with cardiopulmonary bypass (CPB). Patients were randomized into two groups according to the approach to physical rehabilitation: in the early rehabilitation group (n=22), treadmill workouts were conducted starting from the 7th postoperative day and continued at the second stage of inpatient rehabilitation. Patients in the control group (n=27) had no treadmill training. In the inpatient rehabilitationsetting, the incidence and the type of complications were assessed; on the 6th day and 21-23 days after CABG, the results of the cardiopulmonary exercise testing (CPET) were analyzed. Results and discussion. The groups were similar in baseline intraoperative characteristics. Postoperative complications occurred in 18% of patients in the early rehabilitation group and in 48% of patients in the control group (p=0.037). In the group of patients with early rehabilitation, the rate of postoperative complications decreased by 4 times compared to the control group (OR – 0.24; 95% CI – 0.06- 0.896). Peak oxygen consumption (p=0.03) and exercise tolerance (p=0.03) were significantly higher in the group of patients with the early rehabilitation according to CPET conducted three weeks after the surgery. At the present stage, it seems optimal to shift the start of physical rehabilitation in postoperative period to the earlier dates. Minimizing the patient’s immobilization period helps to optimize the course of the postoperative period. Conclusion. Early rehabilitation in the postoperative period of CABG in patients with frailty is associated with lower incidence of postoperative complications and improvements in physical capacity of patients by the end of the hospital stay.
coronary artery bypass grafting, rehabilitation, physical training, initial asthenia syndrome
1. Vigorito C., Abreu A., Ambrosetti M., Belardinelli R., Corrà U., Cupples M., Davos C.H., Hoefer S., Iliou M.C., Schmid J.P., Voeller H., Doherty P. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. European Journal of Preventive Cardiology. 2017; 24(6): 577-590. https://doi.org/10.1177/2047487316682579
2. Sujino Y., Tanno J., Nakano S., Funada S., Hosoi Y., Senbonmatsu T., Nishimura S. Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction. Journal of Cardiology. 2015; 66(3): 263-268. https://doi.org/10.1016/j.jjcc.2014.12.001
3. McNallan S.M., Singh M., Chamberlain A.M., Kane R.L., Dunlay S.M., Redfield M.M., Weston S.A., Roger V.L. Frailty and healthcare utilization among patients with heart failure in the community. JACC Heart Failure. 2013; 1(2): 135-141. https://doi.org/10.1016/j.jchf.2013.01.002
4. Testa G., Liguori I., Curcio F., Russo G., Bulli G., Galizia G., Della-Morte D., Gargiulo G., Basile C., Cacciatore F., Bonaduce D., Abete P. Multidimensional frailty evaluation in elderly outpatients with chronic heart failure: A prospective study. European Journal of Preventive Cardiology. 2019; 26(10): 1115-1117. https://doi.org/10.1177/2047487319827460
5. Kehler D.S., Giacomantonio N., Firth W., Blanchard C.M., Rockwood K., Theou O. Association Between Cardiac Rehabilitation and Frailty. The Canadian Journal of Cardiology. 2020; 36(4): 482-489. https://doi.org/10.1016/j.cjca.2019.08.032
6. Taran I.N., Argunova Yu.A., Pomeshkina S.A., Barbarash O.L. Vliyanie ranney programmy reabilitacii s aerobnymi nagruzkami na techenie posleoperacionnogo perioda u pacientov s koronarnym shuntirovaniem. Profilakticheskaya medicina. 2021; 24(1): 86-92. https://doi.org/10.17116/profmed20212401186
7. Taran I.N., Pomeshkina S.A., Argunova Yu.A., Barbarash O.L. Bezopasnost' i effektivnost' aerobnyh nagruzok v ranney reabilitacii pacientov posle operacii na serdce. Kompleksnye problemy serdechno-sosudistyh zabolevaniy. 2020; 9(3): 30-39. https://doi.org/10.17802/2306-1278-2020-9-3-30-39
8. Doyle M.P., Indraratna P., Tardo D.T., Peeceeyen S.C., Peoples G.E. Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis. European Journal of Preventive Cardiology. 2019; 26(1): 36-45. https://doi.org/10.1177/2047487318798924
9. Tkacheva O.N., Kotovskaya Yu.V., Runihina N.K., Frolova E.V., Naumov A.V., Vorob'eva N.M., Ostapenko V.S., Mhitaryan E.A., Sharashkina N.V., Tyuhmenev E.A., Pereverzev A.P., Dudinskaya E.N. Klinicheskie rekomendacii «Starcheskaya asteniya». Rossiyskiy zhurnal geriatricheskoy mediciny. 2020; (1): 11-46. https://doi.org/10.37586/2686-8636-1-2020-11-46
10. Barbarash O.L., Pomeshkina S.A., Argunova Yu.A. Sposob posleoperacionnoy fizicheskoy reabilitacii pacientov s ishemicheskoy bolezn'yu serdca posle koronarnogo shuntirovaniya. Patent na izobretenie RU 2738571 C1, 14.12.2020. Zayavka № 2020116036 ot 27.04.2020.
11. Bokeriya L.A., Aronov D.M., Barbarash O.L., Bubnova M.G., Knyazeva T.A., Lyamina N.P. Rossiyskie klinicheskie rekomendacii. Koronarnoe shuntirovanie bol'nyh ishemicheskoy bolezn'yu serdca: reabilitaciya i vtorichnaya profilaktika. CardioSomatika. 2016; 7(3-4): 5-71.
12. Inozemceva A.A. Primenenie nagruzochnogo testirovaniya u pacientov posle koronarnogo shuntirovaniya dlya ocenki effektivnosti operacii, opredeleniya reabilitacionnyh vozmozhnostey i prognoza. Byulleten' sibirskoy mediciny. 2018; 17(4): 221-228. https://doi.org/10.20538/1682-0363-2018-4-221-228
13. Kumar K.R., Pina I.L. Cardiac rehabilitation in older adults: new options. Clinical Cardiology. 2020; 43(2): 163-170. https://doi.org/10.1002/clc.23296
14. Montgomery C., Stelfox H., Norris C., Rolfson D., Meyer S., Zibdawi M., Bagshaw S. Association between preoperative frailty and outcomes among adults undergoing cardiac surgery: a prospective cohort study. CMAJ Open. 2021; 9(3): E777-E787. https://doi.org/10.9778/cmajo.20200034
15. Tamuleviciute-Prasciene E., Drulyte K., Jurenaite G., Kubilius R., Bjarnason-Wehrens B. Frailty and exercise training: how to provide best care after cardiac surgery or intervention for elder patients with valvular heart disease. BioMed Research International. 2018; (2018): 36 p. https://doi.org/10.1155/2018/9849475
16. Rossi P.G., Carnavale B.F., Farche A.C.S., Ansai J.H., de Andrade L.P., Takahashi A.C.M. Effects of physical exercise on the cognition of older adults with frailty syndrome: A systematic review and meta-analysis of randomized trials. Archives of Gerontology and Geriatrics. 2021; (93): 104322. https://doi.org/10.1016/j.archger.2020.104322
17. Ushijima A., Morita N., Hama T., Yamamoto A., Yoshimachi F., Ikari Y., Kobayashi Y. Effects of cardiac rehabilitation on physical function and exercise capacity in elderly cardiovascular patients with frailty. Journal of Cardiology. 2021; 77(4): 424-431. https://doi.org/10.1016/j.jjcc.2020.11.012
18. Buttery A.K. Cardiac rehabilitation for frail older people. Advances in Experimental Medicine and Biology. 2020; (1216): 131-147. https://doi.org/10.1007/978-3-030-33330-0_13
19. Waite I., Deshpande R., Baghai M., Massey T., Wendler O., Greenwood S. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. Journal of Cardiothoracic Surgery. 2017; 12(1): 91 p. https://doi.org/10.1186/s13019-017-0655-8
