Effects Of Ba Duan Jin On Cardiac Function And Exercise Tolerance In Patients With Acute Myocardial Infarction Undergoing PPCI With Low LVE

Objective:Patients with acute myocardial infarction（AMI）still have significant residual risks after primary percutaneous coronary intervention（PPCI）,including decreased exercise tolerance and psychosocial functioning.Especially,patients with reduced left ventricular ejection fraction（LVEF）are usually accompanied by more pronounced reduction in exercise tolerance,which seriously affects the quality of life and clinical prognosis of patients.How to improve the cardiopulmonary function and exercise tolerance of patients with reduced LVEF has become one of the urgent problems to be solved in cardiovascular research.In recent years,traditional Chinese medicine（TCM）exercise have shown important advantages and values in the field of cardiac rehabilitation.Baduanjin,as a representative of TCM,characterized by the soft and stretching movements,dynamic and static fusimotor activity,and freedom from site condition restrictions,has been reported to play crucial roles in dredging the meridians and collaterals,harmonizing Qi and blood,which is helpful for the prevention and treatment of cardiovascular disorders.However,up to date,there are relatively few clinical studies regarding the role of Baduanjin in patients with AMI,especially for those with reduced LVEF.Therefore,based on the Meta-analysis of the effect of Baduanjin on cardiopulmonary function of patients with AMI,we carried out a prospective,randomized,controlled clinical research to explore the effect of Baduanjin on cardiac function and exercise tolerance in patients with reduced LVEFs after PPCI for AMI.Our research aimed to help in the scientific and reasonable clinical transformation of Baduanjin exercise rehabilitation,which may provide reference for the development of TCM and traditional elements in the field of cardiac rehabilitation.Materials and Methods:Part 1.Meta-analysis of the intervention effect of Baduanjin on LVEF and exercise tolerance in patients with AMI:Pub Med,Web of Science,Cochrane Library,Chinese National Knowledge Infrastructure（CNKI）,Sino Med,Wanfang Database,and China Science and Technology Journal Database were searched for clinical researches regarding the effects of Baduanjin in patients with AMI.The selected articles were all randomized controlled trials（RCTs）and published as a full-text article in the past 5 years,and 9 RCTs were finally included in the Meta-analysis（7 articles in Chinese,2 articles in English）,with a total of 832 patients（420 cases in the Baduanjin group,412 cases in the control group）.Baduanjin group were reported to receive Baduanjin exercise rehabilitation on the basis of conventional drug treatment,while the control group received conventional drug treatment or western medicine rehabilitation.The main outcome measures included LVEF,left ventricular end-diastolic diameter（LVEDd）,left ventricular end-systolic diameter（LVESd）,6-minute walking test（6MWT）,N-terminal pro-B type natriuretic peptide（NT-pro BNP）,36-item Short Form Health Survey（SF-36）and metabolic equivalent（MET）.Meta-analysis was performed using R software.Part 2.Effect of Baduanjin on cardiac function in the acute phase of patients with reduced LVEF after AMI undergoing PPCI:This study included patients with AMI who were treated in the Coronary Heart Disease Care Unit of the General Hospital of the Northern Theater Command from November 2021 to October 2022.A total of 140 patients with reduced LVEF（35%～50%）after AMI undergoing PPCI were enrolled.The study was set-up using dynamic randomized block design.The control group（70 cases）performed standardized western medicine rehabilitation exercise,and the experimental group（70 cases）implemented standardized Baduanjin rehabilitation exercise,including sitting Baduanjin in in-hospital stage I rehabilitation（48 hours after PPCI）and standing Baduanjin in out-of-hospital stage II rehabilitation for 3 months.The primary endpoint was LVEF,and the secondary endpoints included left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,SF-36 scale,Seattle angina questionnaire（SAQ）,Minnesota living with heart failure questionnaire（MLHFQ）,GAD-7 anxiety scale,PHQ-9 depression scale Table,Traditional Chinese Medicine Symptom Scale,and biochemical indexes,together with the safety evaluation of the rehabilitation exercise.Part 3.Effect of Baduanjin on exercise tolerance in the recovery period of patients with reduced LVEF after AMI undergoing PPCI:This study included patients who were treated in the ward or outpatient clinic of the General Hospital of the Northern Theater Command from November 2021 to October 2022.Patients after AMI undergoing PPCI（1～2 months）with reduced LVEF value（35%～50%）were enrolled.A total of 90 cases were included and divided into two groups by using the dynamic randomized block design.The control group（45 cases）implemented the standardized western medicine rehabilitation exercise,and the experimental group（45 cases）implemented the standardized standing Baduanjin rehabilitation exercise for3 months.The primary endpoint index was the peak oxygen consumption in kilograms（VO₂/kg-peak）,and the secondary endpoint indexes included anaerobic threshold oxygen consumption（VO₂-at）,peak oxygen consumption（VO₂-peak）,anaerobic threshold oxygen consumption in kilograms（VO₂/kg-at）,MET,oxygen pulse（VO₂ pulse）,measured and predicted value of maximum vital capacity（VC-max）,measured and predicted value of forced vital capacity（FVC）,measured and predicted value of forced expiratory volume in one second（FEV1）,measured and predicted value of maximum ventilatory volume（MVV）,LVEF,LVEDV,LVESV,SF-36 scale,SAQ scale,MLHFQ scale,GAD-7 anxiety scale,PHQ-9 depression scale,TCM symptom score scale,and biochemical indexes.The safety evaluation of the rehabilitation exercise was also performed.Result:Part 1.Meta-analysis of the intervention effect of Baduanjin on LVEF and exercise tolerance in patients with AMI:9 RCTs were included in the Meta-analysis.Compared with the control group,the Baduanjin group was observed with significantly improved LVEF value of AMI patients[SMD=0.76,95%CI（0.41,1.11）,P<0.05],reduced LVEDd value[SMD=-0.99,95%CI（-1.81,-0.17）,P<0.05]and LVESd value[SMD=-1.77,95%CI（-2.51,-1.02）,P<0.05].In addition,the 6MWT value[SMD=4.79,95%CI（0.51,9.07）,P<0.05]and the MET value[SMD=1.20,95%CI（0.84,1.55）,P<0.05]of patients in the Baduanjin group were significantly increased.Furthermore,the SF-36 scale results revealed that the quality of life of patients in the Baduanjin group was significantly improved（P<0.05）,and the difference between the two groups in scores of each dimension were all statistically significant.Part 2.Effect of Baduanjin on cardiac function in the acute phase of patients with reduced LVEF after AMI undergoing PPCI:Our study confirmed that early Baduanjin exercise in in-hospital stage I rehabilitation（48 hours after PPCI）has a positive effect on patients with reduced LVEF after AMI,including the improvement of heart function,quality of life,anxiety and depression,TCM symptoms and biochemical indicators.1.Regarding the primary endpoint of LVEF,the Baduanjin group was observed with improvement of LVEF at 3 months compared with the control group（0.52±0.06 vs.0.51±0.06）,and the LCI of the absolute difference between the two groups was-0.0086,which was within the prespecified margin of-0.0385 for non-inferiority,thereby providing evidence for non-inferiority（P<0.001）.The results showed that the effect of Baduanjin exercise on LVEF in the acute phase of patients with reduced LVEF after AMI undergoing PPCI can be considered as non-inferior to the control group.2.Baduanjin exercise could further significantly improve the indicators for quality of life in the SF-36 scale,including physiological function,general health,energy,social function,emotional function,mental health,and health change（all for P<0.05）.In addition,scores for negative emotions such as anxiety and depression could be reduced in the Baduanjin group（P<0.05）.3.The scores of the SAQ scale were significantly increased in the Baduanjin group,including physical activity limitation,treatment satisfaction,and disease cognition of patients（all for P<0.05）.The MLHFQ scale score was reduced in the Baduanjin group,but the reduction was not statistically significant（P>0.05）.4.Patients in the Baduanjin group showed a clinical improvement of chest tightness or palpitation symptom scores（P<0.05）,and the exercise was well tolerated and safe.But the reduction of TCM symptom integral was not statistically significant（P>0.05）.5.The fasting blood glucose（FBG）index of patients in the Baduanjin group was obviously reduced（P<0.05）,while the change in blood lipid indexes was not statistically significant（P>0.05）.Part 3.Effect of Baduanjin on exercise tolerance in the recovery period of patients with reduced LVEF after AMI undergoing PPCI:Our study confirmed that Baduanjin exercise in the recovery period has a positive effect on patients with reduced LVEF after AMI and PPCI,including the improvement of exercise tolerance,pulmonary ventilation function,cardiac function,quality of life,anxiety and depression,TCM symptom integral,and biochemical indicators.1.Regarding the primary endpoint of VO₂/kg-peak,the Baduanjin group was observed with improvement of VO₂/kg-peak at 3 months compared with the control group（16.63±2.60ml/kg/min vs.15.80±2.61ml/kg/min）,and the LCI of the absolute difference between the two groups was-1.7727ml/kg/min,which was within the prespecified margin of-4.2ml/kg/min for non-inferiority,thereby providing evidence for non-inferiority（P<0.001）.The results showed that the effect of Baduanjin exercise on VO₂/kg-peak in the recovery period of patients with reduced LVEF after AMI undergoing PPCI can be considered as non-inferior to the control group.2.Baduanjin could further significantly improve the pulmonary function indicators of patients,including the percentage of VC-max reaching the predicted value and the percentage of FVC reaching the predicted value,all of which are statistically different（P<0.05）.3.Baduanjin exercise in the recovery period could further significantly improve the indicators for quality of life in the SF-36 scale,including physiological function,general health,energy,social function,emotional function,mental health,and health change（all for P<0.05）.In addition,scores for negative emotions such as anxiety and depression could be reduced in the Baduanjin group（P<0.05）.4.The scores of the SAQ scale were significantly increased in the Baduanjin group,including physical activity limitation,treatment satisfaction,and disease cognition of patients（all for P<0.05）.In addition,The MLHFQ scale score was obviously reduced in the Baduanjin group（P<0.05）.5.Patients in the Baduanjin group who performed Baduanjin exercise in the recovery period showed a clinical improvement of chest tightness,shortness of breath or palpitation symptom scores and TCM symptom integral（P<0.05）,and the exercise was well tolerated and safe.6.Baduanjin exercise in the recovery period could significantly reduce both the FBG index and low-density lipoprotein cholesterol（LDL-C）of patients with reduced LVEF after AMI undergoing PPCI（P<0.05）.Conclusion:Part 1.Meta-analysis of the intervention effect of Baduanjin on LVEF and exercise tolerance in patients with AMI:Meta-analysis results showed that Baduanjin exercise rehabilitation has a beneficial effect on the cardiopulmonary function and quality of life of AMI patients receiving PCI treatment.Part 2.Effect of Baduanjin on cardiac function in the acute phase of patients with reduced LVEF after AMI undergoing PPCI:Baduanjin exercise rehabilitation in the early stage（48hours after PPCI）in the hospital can improve cardiac systolic function（LVEF value）of patients with reduced LVEF（35%～50%）after AMI,and it is not inferior to western medicine exercise rehabilitation prescription.At the same time,it can significantly improve the quality of life of the included patients.Part 3.Effect of Baduanjin on exercise tolerance in the recovery period of patients with reduced LVEF after AMI undergoing PPCI:Baduanjin exercise in the recovery period can improve the VO₂/kg-peak index of patient with reduced LVEF value（35%～50%）after AMI undergoing PPCI（1～2months）,and it is non-inferior to the western medicine exercise rehabilitation prescription,indicating the equivalent role of improving the exercise tolerance of the included patients.