SYNCHRONISED CARDIORESPIRATORY CORONARY REHABILITATION

Background. Exercise remains core component in the process of cardiac rehabilitation, either in a (sub)acute phase after an acute event, or as part of the life‐long treatment. However, its intensity must be adapted to the individual patient’s characteristics, whose co-morbidities can also pose limitations to the commonly used modes of continuous aerobic / interval exercise (CAIE) in the conventional cardiac rehabilitation (CCR). Members of the project team have recently pioneered an innovative approach based on the coordinated use of slower movements with synchronised patterns of breathing. The approach referred to as synchronised cardiorespiratory rehabilitation (SCR) turns to reduce the physical stress while at the same time increases the efficiency of rehabilitation for the cardiorespiratory system. There are two main objectives of the proposed research project: (A) to assess quantitatively the effectiveness of SCR itself, as well as its comparison to CCR (CAIE), and (B) to refine rehabilitation protocols, by relying on calculated indexes during the therapeutic cycle. The first objective will be addressed in part using standard measurements such as blood pressure, heart rate variability and the assessment of the cardiorespiratory capacity. The core idea of the project refers to performing additional measurements on the patients before and after each treatment, including high resolution ECG, respiratory movement, microvascular blood flow using LDF (laser doppler flow), superficial and deep tissue oxygenation using white light spectroscopy and near‐infrared spectroscopy (NIRS), and skin temperature, measured on the skin over both wrists. The main scientific contribution refers to the analysis of the recorded time series in order to reveal index of coupling between particular physiological subsystems. For that purpose most recent non‐linear signal processing methodologies for the analysis of synchronisation will be applied. The result will be a vector of characteristic indices that reflect the condition of the physiological processes in a patient, in particular interactions between the cardiovascular and respiratory systems, as well as hierarchically higher centres. Methodology. Patients in stable phase of the cardiovascular disease (mainly with coronary artery disease), undergoing life‐long cardiac rehabilitation, will be included. The principal group (GROUP A) will encompass patients solely participating in SCR as their only rehabilitation method, while the control group (GROUP C) will involve patients that are only undertaking CCR (CAIE). In addition, a further cohort of patients (GROUP B), that according to their rehabilitation protocol participate in both forms of rehabilitation (on a 50‐50% basis) will be studied, in order to assess the comparative effectiveness of a hybrid approach to either type of rehabilitation evaluated. Patients who are newly embarking into the lifelong rehabilitation process are of particular interest, and, based on the current rate of uptake, it is expected that it will be possible to include at least 20 patients in each of the groups A, B and C. Each patient participating in the project will be monitored for a period of 12 weeks. Relevance of the results expected is mainly twofold: (1) the clarification of the effectiveness of SCR as a novel approach to cardiac (coronary) rehabilitation, and (2) better understanding of the cross‐system interactions going beyond the effect on individual organs. Due to the expected overall significantly better adherence of patients within the SCR mode of rehabilitation (in comparison with CCR (CAIE)) we can expect its significant contribution to better survival, prolongation of the disability‐free interval, as well as better quality of life of cardiac patients in general.