A cardiac rehabilitation programme based on neuromuscular training improves the functional capacity of patients with acute coronary syndrome: a preliminary randomised controlled trial

OBJECTIVES: To evaluate the effects of a cardiac rehabilitation programme based on neuromuscular training (NMT) compared with classic rehabilitation strength training (CRST) in patients diagnosed with acute coronary syndrome (ACS). DESIGN: Preliminary randomised, double-blinded, parallel clinical trial. SETTING: University health clinic in Valencia, Spain. PARTICIPANTS: Thirty patients with ACS. INTERVENTIONS: Patients were assigned to one of two groups at random: the NMT group (n = 15) and the CRST group (n = 15). All patients attended the 20 sessions of the exercise programme. MAIN OUTCOME MEASURES: The primary outcome was the Incremental Shuttle Walk Test (ISWT). The secondary outcomes were the Chester Step Test (CST), the 30-Second Chair Stand Test (30CST), and hip flexor dynamometry. Assessments were made at baseline, immediately post-treatment, and at 6-month follow-up. RESULTS: The NMT group showed a greater improvement in the ISWT than the CRST group, both at post-treatment {mean 648 [standard deviation (SD) 197] vs 493 (SD 219), mean difference 155, 95% confidence interval (CI) -1 to 310} and at follow-up [732 (SD 183) vs 518 (SD 222), mean difference 214, 95% CI 61 to 367]. The secondary outcomes showed significant between-group differences in favour of the NMT group at 6-month follow-up, except for the 30CST. CONCLUSIONS: These preliminary findings indicate that a cardiac rehabilitation programme based on NMT may improve functional capacity in terms of patient performance, cardiorespiratory fitness and muscle strength. Moreover, the improvements were maintained at medium-term follow-up. This could help improve the design of rehabilitation sessions, considering factors associated with performing everyday activities in patients affected by ACS. CLINICAL TRIAL REGISTRATION NUMBER: NCT04246008. CONTRIBUTION OF THE PAPER.