EFFECTS OF PHASE II CARDIAC REHABILITATION ON INSULIN RESISTANCE AND MYOCARDIAL REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objectives We have designed a new 2-week hospitalized phase II Cardiac Rehabilitation (CR) program in Japan. The purpose of the present study is to determine long-term effects on physical parameters; especially insulin resistance and myocardial remodeling in patients with acute myocardial infarction. Methodology Thirty-four patients (30 men, 4 women, mean age: 52±11years, peak CK 2378±1881 IU/l, mean EF 60±18%) with AMI enrolled in this program, we evaluated plasma propeptide of type I procollagen (PICP) and physical parameters. The physical status was assessed by the exercise tolerance (AT and peak VO2), exercise frequency, serum lipid profiles and BMI. In 25 CR patients with non-diabetics, we evaluated plasma pro-insulin, insulin, FBS, HbA1c, and HOMA-R. These were evaluated before, 1, 6 and 12 months after the participation in the program. Results Serum lipid profiles (HDL cholesterol, triglyceride, apolipoprotein-A-I), BMI, peak VO2 and AT were improved significantly, PICP was stable at the 1, 6 and 12 months follow-up. Eighty percent of patients had regular exercise activity (R-EX). There was no significant difference in PICP between R-EX and sedentary groups. From the result of HOMA-R, 72% of the patients had insulin resistance. However, HbA1c tended to improve at the 12 months, and Pro-insulin, insulin, FBS and HOMA-R were stable at the 1, 6 and 12 months follow-up. The change in HOMA-R was not related to exercise tolerance; it strongly correlated with the change in BMI (r=0.61).
Conclusion These results suggest that Phase II CR program do not accelerate myocardial remodeling and our 2-week hospitalized Phase II CR program contributes to not only maintain insulin sensitivity but also improve in the management of other cardiac risk factors.
Supported by the grant MSM 0021622402