Modi¢ed programme of in-patient (phase I) cardiac rehabilitation after acute myocardial infarction ANNA BRZEK 1 , ZBIGNIEW NOWAK 2, * and MICHAL PLEWA 2 1 First Clinic Hospital, Silesian Medical Academy, Katowice, Poland 2 Rehabilitation Department, Academyof Physical Education, Katowice, Poland A group of 61 men who suffered from myocardial infarction (MI) were divided into two groups: group A (31 patients post MI, one day at intensive care unit (ICU), no b-blockers, physical therapy according to a seven-day programme) and group B (30 patients post MI, two days at ICU, with b-blockers, physical therapy according to a seven-day programme). Results from both groups were compared with a control group (C) (38 patients post MI, three days at ICU, physical therapy according to a longer ten-day graded programme). The objective of this study was to assess the efficacy of a proposed modified rehabilitation programme in patients after acute MI on the basis of a submaximal stress test performed on a cycle ergometer and to find out which stress test parameters might be used for the selection of an appropriate phase 2 rehabilitation programme. The performed analysis of correlation between exercise and resting parameters showed statistical relevancy with regard to systolic blood pressure in group A. Maximal load (WATs), metabolic cost (METs), maximal heart rate (beats/min), stress-test time (T-test) and time of normalization for the exercise parameters (t n ) are the parameters of the stress test that should be taken into consideration for appropriate selection of an out-patient (phase 2) rehabilitation programme. Keywords: acute myocardial infarction; cycle ergometer stress test; modified programme of cardiac rehabilitation Introduction Recent developments in cardiac rehabilitation in the treatment of patients after acute myocardial infarction (MI) have resulted in various programmes and models being used. At the same time, constant increasing of training loads during the rehabilitation process is based on various diagnostic criteria that are supposed to reflect patients’ tolerance to physical effort during consecutive rehabilitation sessions (Peel, 1962; Norris and Gaughey, 1970). The utilization of physical exercise in cardiac patients creates a risk of over- loading because there is no possibility for everyday evaluation of patients’ exercise tolerance. Such evalu- ation would allow for appropriate selection of training loads during consecutive rehabilitation sessions. Individual differences and genetically determined exercise tolerance cause additional difficulties as far as the selection of an appropriate rehabilitation programme is concerned. The severity of MI influences the selection of the appropriate model for rehabilitation. Nowadays there is a tendency to reduce the time of immobilization due to general deconditioning that results from prolonged bed rest. Patients after both non-complicated and complicated MI may be subjected to early supine-to- stand transfer training, although it should be taken into consideration that patients after complicated MI usually receive b-blockers and that differences in rehabilitation between patients after non-complicated and complicated MI are related only to the length of time spent at the intensive care unit (ICU). Therefore it seems to be necessary to establish rehabilitation programmes that would be suitable for patients’ current exercise tolerance (Fletcher et al., 1990; Willenheimer et al., 1998; Belardinelli et al., 1999; Keteyian et al., 2000). Results of such rehabilitation programmes would be evaluated with the use of a stress test and together with patients’ actual clinical status would probably allow for accurate prediction of a further course of treatment. The objective of this study was to present a modified programme of phase I rehabilitation for patients after acute MI and to assess its efficacy with the use of a submaximal cycle ergometer stress test. The study authors also attempted to analyse a * Address for correspondence: ul. Sowin´skiego 9-30, 40-272 Katowice, Poland. Tel: þ48 32 2553654; e-mail: zbigniew@awf.katowice.pl 0342-5282 r 2002 Lippincott Williams & Wilkins International Journal of Rehabilitation Research 25, 225–229 (2002)