Efficacy Of Exercise-based Rehabilitation After Coronary Artery Bypass Graft And Stroke

Background:Exercise-based rehabilitation(ER)has been proven beneficial for cardiovascular and cerebrovascular disease recovery.A disease-specific or individualized rehabilitation program is the key to boosting recovery and reducing patient suffering.ER after coronary artery bypass graft(CABG)and stroke sufficiently improve functional capacity,but post-stroke changes in hemodynamic parameters-a profound premise of cardiac health-are still uncertain.Moreover,overall patient quality of life(QoL)and cardiac health need to be reexplored regarding implications and modification of ER for CABG and Stroke patients.Objectives:This study aimed to identify the efficacy of exercise therapy for CABG and Stroke patients’functional capacity,exercise capacity,cardiac health,and QoL through systematic review and meta-analysis methods and recommend further guidelines.Methods:We conducted two systematic reviews.In the first study for CABG,we searched data from four online databases,EBSCOhost,Scopus,PubMed,and Web of Science,from 1 January 2000 and 15 September 2022 to identify the current rehabilitation protocol and followed the guidelines of synthesis without meta-analysis(SWiM).The second study is for stroke;data for this study were retrieved from three reputed search engines(Web of Science,PubMed,and Scopus)for papers reporting current post-stroke rehabilitation techniques or procedures published between January 2012 and January 2022;and conducted a meta-analysis.The data search was conducted for both studies utilizing PICOS(population,intervention,comparison,outcome,and study design)methods.Data are presented for both studies according to preferred reporting items for systematic reviews and meta-analyses(PRISMA)2020 statement.The systematic review protocol of both studies is registered and published online.Results:In study one,we identified nine randomized control trials(RCTs)and 599 CABG patients participated in ER.At discharge and follow-up,in-patient cardiac rehabilitation(CR),which combines inspiratory muscle training,mobilization,active upper and lower limb exercise,and aerobic exercise as multiple exercise therapy,found a significant improvement in 6-minute walking distance(6MWD)over single exercise(breathing exercise)(moderate quality evidence).The peak volume of oxygen(VO2)at discharge was not higher in the multipleexercise group compared to the single-exercise group.Despite this,considerable progress was observed during the follow-up(moderate quality of evidence).The out-patient CR,which included high-intensity inspiratory muscle training,strength training for the upper and lower limbs,and aerobic exercise as multiple exercise therapy,substantially increased 6MWD and peak VO2 at discharge(High-quality evidence).QoL improvement was insignificant among multiple exercise group patients assessed with different health-related QoL questionnaires.In the second study,eleven RCTs satisfied all inclusion criteria.Rehabilitation programs included aerobic exercise,balance,flexibility,strength training,upper and lower limb stretching,exergaming activities,and counselling on managing cardiovascular risk factors.Postrehabilitation results from four RCTs revealed that the six-minute walking test(6MWT)and peak volume of oxygen(VO2peak)significantly improved in mean difference[MD]-57.61m;(95%Confidence interval[CI]-72.34m,-42.89m;P<0.00)and(MD-2.30 mL/kg/min;95%CI-3.51,-1.09;P=0.00),respectively.However,an insignificant improvement in hemodynamics:blood pressure(MD 0.84 mmHg;95%CI-1.01,2.69;P=0.54),heart rate(MD 1.64;95%CI2.36,5.64;P=0.42),and cardiac output(MD 0.19,95%CI-0.25,0.37;P=0.37).Conclusion:Our study reveals that exercise-based rehabilitation,which includes multiple exercises(a combination of limb exercises,inspiratory muscle training,and aerobic and resistance exercise)under proper supervision in in-patient and out-patient rehabilitation centers,improves functional and exercise capacity more than single exercise therapy.In contrast,the effects of multiple exercise therapy on CABG patients’ health-related QoL are insignificant.Post-rehabilitation,hemodynamic(heart rate,blood pressure,and cardiac output)improvements among stroke survivors,were insignificant,but functional and exercise capacity,notably 6MWT and VO2peak,increased considerably.To enhance hemodynamic measurements and post-stroke recovery,rehabilitation practitioners should prioritize cardiovascular exercise training,sufficient exercise intensity,and patient education about cardiac health within a post-stroke rehabilitation program.