Fysisk träning som hjärtrehabilitering efter en myokardieinfarkt
en litteraturstudie
Background: Myocardial infarction is the most common individual disease among people in the west world. In Sweden there are over 50 000 women and men who get myocardial infarction every year and about 40 % of them dies. Exercise training is one part of cardiac rehabilitation and since 1980 Sweden use the guidelines from that time. Aim: The aim was to review exercise-training modalities in cardiac rehabilitation after myocardial infarction and the physiologic- and psychological effects. Method: Facts were obtained by searching through the database PubMed for articles published from 1994 and ten years forward. The study was based on 53 randomized and controlled trials that met the criteria for inclusion. The study includes patients in all ages with normal and reduced ventricular function. Result: Many treatment modalities with several multidisciplinary cardiac rehabilitation program and several studies include low and high intensity exercise training. Five of the studies were about strength training. There were also studies about hospital-based rehabilitation and one study contained home based rehabilitation. Physiologic effects were increased oxygen uptake, exercise capacity and many studies showed higher lactate level in anaerobe threshold. We had eleven studies about patients with reduced ventricular function and they got the same favourable physiologic effects like patients with normal heart function. Six studies examine vasodilitation, the earlier studies in the ten years period show no effect after training when later studiers had another opinion. Two articles examined and found greater glucose uptake and insulin sensitivity after training. Three studies examine and observed improvements in exercise habits and another three studies show reduction in mortality. One of the studies prove that increased work capacity with 1 % provided joint survival benefit up to 10 %.There were nineteen articles examine about the several different hemodynamic measurements. Few studies were about recovery of autonomic nervesystem and one of the studies found improvements through exercise training. Heart rate variability gave different results of the effects in three studies. The same various effects in the results were three studies about blood lipids. Psychological effects observed in thirteen studies. Many of the articles showed improved wellbeing, less anxiety and depression in all ages, but one study found out that very old patients seem to need more active interventions to get same effects. Conclusion: The results were that training alone could improve the physiological work capacity. Physical training needs to be completed with several multifactorial interventions to get greater potential influence in both physical and psychological variables.