Effectiveness of the second stage program of medical rehabilitation of patients with ischemic heart disease

Medical rehabilitation for patients with circulatory system diseases is a set of measures that provide secondary prevention of acute coronary events and improve patients’ functional activity. However, some aspects of medical rehabilitation remain poorly known. Aim. To study the impact of the standard medical rehabilitation program for patients with coronary heart disease on the main indicators of the effectiveness of the measures taken, as well as the role of various dosed walking regimens along the Terrainkur routes. Material and methods. In 2023, a clinical comparative interventional study of 36 patients with coronary heart disease aged 45 to 70 years was conducted at «Yudino» Treatment and Rehabilitation Clinical Centre (a branch of «National Medical Research Center for Rehabilitation and Balneology» of the Ministry of Health of the Russian Federation). The patients were divided into two groups. Patients of comparison group 1 (n=18) walked the Terrainkur route in a sparing mode, and patients of comparison group 2 (n=18) walked the Terrainkur route in a training mode. The patients walked Terrainkur during the basic rehabilitation complex for 14 days. Before and after the rehabilitation course, heart rate variability was measured (hardware and software complex Health-Express, MKS LLC, Russia), hemodynamic characteristics of blood flow were assessed (Omron2 Basic tonometer, Omron Healthcare Co., Ltd., Japan), a stress test (a 6-minute walk test) was performed, the lipid spectrum and fasting blood glucose level were measured, anthropometry was performed, an EQ-5D quality of life test was administered (EuroQol Group, 1990, Russia). Results. Over time, patients of both groups showed a decrease in the values of the stress index and the indicator of the activity of regulatory systems, the level of systolic blood pressure, an increase in the distance covered in the 6-minute walk test, as well as a decrease in the lipid profile and body weight (p<0.05 according to the Wilcoxon test). In patients who walked Terrainkur in the sparing mode, there was a significant decrease in the diastolic and systolic blood pressure levels compared to patients who walked Terrainkur in the training mode (p<0.05 according to the Mann—Whitney test). No differences between the groups in the quality of life and no changes over time were observed (p>0.05 according to the Mann—Whitney test). Conclusion. The standard cardiac rehabilitation program can effectively improve the body’s adaptive potential, hemodynamics, and cardiovascular risk factors in patients with coronary heart disease. Sparing mode of dosed walking along the Terrainkur routes as part of a comprehensive rehabilitation program for patients with such conditions is highly effective.