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[Physical exercise in combined outpatient rehabilitation of patients with ischemic heart disease associated with biliary dysfunction].

AIM
To study prevalence of gastrointestinal symptoms (GIS) including gall-bladder dysfunction (GBD) in coronary patients after acute coronary event (ACE) and effects of early physical exercise (PE) of moderate intensity in coronary patients with GBD on efficacy of outpatient rehabilitation.


MATERIAL AND METHODS
A two-stage trial was conducted. Stage 1: 237 coronary patients responded to questionnaire detecting incidence of GIS including GBD 8 weeks after ACE. Stage 2: 85 coronary patients with verified GBD were examined for efficacy of rehabilitation. Of them, 43 patients entered PE group while 42 patients entered a control group. The latter received standard therapy without PE. The efficacy of the treatment was evaluated by clinical, device and biochemical findings at baseline and 12 months later.


RESULTS
Of 237 coronary patients 217 (91.7%) patients 2 months after ACE had symptoms of coronary insufficiency, 192 (81.3%) had GIS, 78.9% had GBD. Patients from PE group significantly improved exercise tolerance (bicycle exercise test reached 79.3 +/- 15 and 121.3 +/- 14.5 bt (p < 0.05), respectively. These patients demonstrated improvement of gall-bladder contraction, a decrease in the level of total cholesterol from 6.12 +/- 0.4 to 4.7 +/- 0.2 mmol/l (p < 0.05), of LDLP cholesterol from 3.85 +/- 0.21 to 2.86 +/- 0.32 mmol/l (p < 0.05), thioldisulphide coefficient from 13 +/- 0.3 to 2.7 +/- 0.4 (p < 0.01). The intergroup analysis 12 months after the study revealed significant differences in favor of the PE group. A weekly number of anginal attacks reduced from 5.1 +/- 1.5 to 1.3 +/- 1.4 (p < 0.01).


CONCLUSION
The exercise program is rather effective and can be practiced outpatiently in coronary patients after ACE associated with GBD. It can be also used for secondary prophylaxis of cholestasis in coronary patients with biliary problems.