Features of Application of the Optimized Physical Rehabilitation Program in Patients with Coronary Heart Disease

Keywords: physical rehabilitation, endothelial dysfunction, ergometry, cardiopulmonary exercise, citrulline malate, exercise tolerance, physical performance


Multisymptomatic coronary heart disease (CHD) remains a leading problem in cardiology. A person’s ability to perform physical work determines their quality of life, especially in patients with existing symptoms of damage to the cardiovascular system. The most advanced approach in the physical rehabilitation of patients with CHD is the use of ergometric testing indicators.

The aim. To study the influence of the developed method of cycling training on the indicators of cardiopulmonary exercise (CPX) in patients with CHD.

Materials and methods. We examined 65 men with CHD, I-II functional class stable angina pectoris, mean age 44.6 ± 1.39 years (from 32 to 60 years). The diagnosis was made on the basis of clinical findings, electrocardiography and laboratory examination according to the generally accepted criteria of the European Society of Cardiology.

Results. The treatment results were evaluated two weeks after the completion of the physical rehabilitation program. Qualitative assessment was performed by using the CPX test with the recording of cardiac bioelectric potentials from 12 leads. The criteria for discontinuation of the test were generally accepted provisions based on WHO recommendations.

While developing a physical rehabilitation program and predicting the timing of a functional recovery, several factors have to be taken into account that significantly affect the patient’s motor activity and determine the pace and outcome of the rehabilitation process as a whole. Long-term, regular physical activity in patients with CHD with limited coronary reserve have an impact on the mechanisms of cardiac function regulation, synchronization and optimization of the activity of the muscular, cardiovascular and respiratory systems. Systematic training sessions reduce the volume of drug therapy and can improve the patients’ quality of life.

Conclusions. The use of the proposed individualized uniform interval cycling training combined with the intake of citrulline malate leads to a significant improvement in the achieved load capacity, heart rate, duration of work, total volume of completed work, inotropic reserve index, optimization of coronary blood circulation and improvement of bioenergy metabolism in the myocardium.


  1. Aktaa S, Gencer B, Arbelo E, Davos CH, Désormais I, Hollander M, et al. European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology. Eur J Prev Cardiol. 2022;29(7):1060-1071. https://doi.org/10.1093/eurjpc/zwab160
  2. Abramov VV, Klapchuk VV, Nekhanevych OB, et al. [Physical rehabilitation, sports medicine]. Dnipropetrovsk; 2014. Ukrainian.
  3. Zharinov OY, Ivaniv YuA, Kuts VO, editors. [Functional diagnostics]. Kyiv; 2018. Ukrainian.
  4. Yepanchintseva OA, Borkhalenko YuA, Zharinov OJ, Todurov BM. [Evaluation of quality of life in patients with stable ischemic heart disease]. Ukrainskyi kardiolohichnyi zhurnal. 2016;(2):61-70. Ukrainian.
  5. Marcadet DM. Nouvelles recommandations concernant la pratique des tests d’effort en cardiologie [Exercise testing: New guidelines]. Presse Med. 2019;48(12):1387-1392. French. https://doi.org/10.1016/j.lpm.2019.09.011
  6. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al.; ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021;42(1):17-96. https://doi.org/10.1093/eurheartj/ehaa605
  7. Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, et al. Depression Is a Risk Factor for Mortality After Myocardial Infarction: Fact or Artifact? J Am Coll Cardiol. 2007;49(18):1834-1840. https://doi.org/10.1016/j.jacc.2007.01.075
  8. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. https://doi.org/10.1093/eurheartj/ehz425
  9. European Physical and Rehabilitation Medicine Bodies Alliance. White Book on Physical and Rehabilitation Medicine in Europe. Introductions, Executive Summary, and Methodology. Eur J Phys Rehabil Med. 2018 Apr;54(2):125-155. https://doi.org/10.23736/S1973-9087.18.05143-2
  10. Polianska OS, Kurtyan TV, inventors; Bukovinian State Medical University, assignee. Method for physical rehabilitation of patients with ischemic heart disease. UA patent No. 18353. 2006 Apr 3.
  11. Ronan G, Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Nucl Cardiol. 2014;21(1):192-220. https://doi.org/10.1007/s12350-013-9841-9
  12. Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol. 2022;29(1):205-215. https://doi.org/10.1093/eurjpc/zwaa141
  13. Bracewell NJ, Plasschaert J, Conti CR, Keeley EC, Conti JB. Cardiac rehabilitation: Effective yet underutilized in patients with cardiovascular disease. Clin Cardiol. 2022;45(11):1128-1134. https://doi.org/10.1002/clc.23911
  14. Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2022;29(1):230-245. https://doi.org/10.1093/eurjpc/zwab007
  15. Smarż K, Jaxa-Chamiec T, Bednarczyk T, Bednarz B, Eysymontt Z, Gałaszek M, et al. Electrocardiographic exercise testing in adults: performance and interpretation. An expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology. Kardiol Pol. 2019;77(3):399-408. https://doi.org/10.5603/KP.a2018.0241
  16. Smarż K, Jaxa-Chamiec T, Chwyczko T, Główczyńska R, Jegier A, Niedoszytko P, et al. Cardiopulmonary exercise testing in adult cardiology: expert opinion of the Working Group of Cardiac Rehabilitation and Exercise Physiology of the Polish Cardiac Society. Kardiol Pol. 2019;77(7-8):730-756. https://doi.org/10.33963/KP.14889
  17. Corrado D, Drezner JA, D’Ascenzi F, Zorzi A. How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm. Br J Sports Med. 2020 Oct;54(19):1142-1148. https://doi.org/10.1136/bjsports-2018-100529
How to Cite
Vladymyrov, O. A., Kurtian, T. V., Vladymyrova, N. I., Verych, N. M., & Polyanska, O. S. (2023). Features of Application of the Optimized Physical Rehabilitation Program in Patients with Coronary Heart Disease. Ukrainian Journal of Cardiovascular Surgery, 31(3), 105-110. https://doi.org/10.30702/ujcvs/23.31(03)/VV032-105110

Most read articles by the same author(s)