Impact of Structured Early Exercise Rehabilitation on Left Ventricular Ejection Fraction in Post-Coronary Event Patients: A Randomized Controlled Trial

Abstract

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality globally, with significant prevalence in Pakistan. Early exercise-based cardiac rehabilitation has been shown to improve cardiac function, but its effects on left ventricular ejection fraction (LVEF) in the early post-coronary event period require further investigation.

Objective: This study aimed to evaluate the effectiveness of a 12-week early exercise-based cardiac rehabilitation program on LVEF in post-coronary event patients.

Methods: Randomized controlled trial at Umer Hospital, Lahore, between July and December 2022 Among 26 patients, the age range was 35-75 years, and they were experiencing a recent coronary event, or had been treated surgically or conservatively. The patients were randomly divided into two groups: those with continued physical activity in an individually directed exercise scheme, and the control group—those who underwent only standard care. It is a combination of home-based and center-based exercise session as per the American College of Sports Medicine protocol. LVEF was measured at baseline and post-intervention by echocardiography. Other secondary outcomes were the exercise capacity through Bruce protocol graded exercise test and quality of life through SF-36 questionnaire. Data were analyzed using SPSS version 25. Values have been presented as mean with standard deviations for continuous variables. Independent t-tests were conducted for comparisons between groups; changes within groups were calculated by paired t-tests, and baseline differences were adjusted by ANCOVA.

Results: At baseline, the mean LVEF was 43.68 ± 1.89% in the control group and 44.85 ± 2.75% in the intervention group (p=0.218). Post-intervention, the mean LVEF in the control group was 44.62 ± 3.34%, showing no significant change (p=0.365). In contrast, the intervention group showed a significant increase in mean LVEF to 59.07 ± 2.73% (p=4.13e-09). The between-group difference in post-intervention LVEF was also significant (p=1.13e-11). ANCOVA confirmed the significant effect of the intervention on LVEF, independent of baseline values (F=129.84, p=6.16e-11).

Conclusion: Early exercise-based cardiac rehabilitation significantly improved LVEF in post-coronary event patients. These findings support the integration of structured exercise programs into standard post-coronary care to enhance cardiac function and improve patient outcomes.