Improvement of physical performance and aerobic capacity mediated by a novel 4-week ambulatory cardiac rehabilitation program

During a 4-week ambulatory cardiac rehabilitation program, 262 patients wit h coronary artery disease (CAD), 235 men and 27 women, 53.6 +/- 10.2 years, performed 30.5 +/- 2.9 exercise units. Before and after the rehabilitation program exercise, capacity was assessed by bicycle ergometry. There was a significant (p < 0.001) increase in the maximum exercise capacity at the en d of the program (105.3 +/- 32.3 vs. 121.9 +/- 37.3 W). Physical work capac ity on the 2.0 mmol lactate level improved (p < 0.001) from 72.2 +/- 23.5 t o 86.4 +/- 25.8 W, on the 2.5 mmol/l level (p < 0.001) from 83.5 +/- 23.2 t o 97.4 +/- 26.3 W, and on the 3.0 mmol/l level (p < 0.001) from 93.1 +/- 23 .0 to 106.6 +/- 26.1 W. Despite enhanced performance, heart rate remained u naltered on the 2.0, 2.5, and 3.0 mmol/l lactate level. Furthermore, ergome tric performance on predefined heart pare levels was significantly (p < 0.0 01) increased: 85/min: from 56.0 +/- 24.1 to 65.8 +/- 24.5 W, 90/min: from 62.0 +/- 27.3 to 71.2 +/- 26 W; 95/min: from 67.2 +/- 26.4 to 77.5 +/- 27.6 TY; 100/min: from 71.1 +/- 29.6 to 80.6 +/- 28.1 W; 105/min: from 69.8 +/- 26.2 to 81.9 +/- 28.2 W and 110/min: from 73.6 +/- 28.9 to 90.4 +/- 29.4 W . The results demonstrate that physical performance in patients with CAD wa s improved by our novel ambulatory cardiac rehabilitation program. This imp rovement included an increase in maximum as well as endurance work capacity ; furthermore, this increase was accompanied by a decrease in resting and e xercise heart rates. The results demonstrate an absolute increase of physic al performance, more importantly an increase of physical performance at def ined lactate levels in the presence of unchanged heart rates mediated by th e rehabilitation program. Thus, this increase was independent of motivation al factors in the patients and/or the: investigators during the re-exercise test. On the contrary, our data demonstrate that it is based on an improve ment of aerobic endurance capacity associated with a therapeutically benefi cial significant decrease of heart rate for a defined workload. The effects were independent of pharmacological influences (e.g., beta-receptor antago nists). These findings are of clinical importance with respect to reduction of myocardial oxygen consumption in patients with CAD.