Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β‐blocker therapy or both

• Published in: Clinical physiology and functional imaging Vol. 38; no. 3; pp. 351 - 359
• Main Authors: Medeiros, Wladimir M., Luca, Fabio A., Figueredo Júnior, Alcides R., Mendes, Felipe A. R., Gun, Carlos
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2018
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Aerobic capacity; autonomic function; Beta blockers; beta‐blocker; cardiac rehabilitation; Cardiac Rehabilitation - adverse effects; Cardiac Rehabilitation - methods; Cardiovascular disease; Exercise; exercise testing; Exercise Therapy - adverse effects; Exercise Tolerance - drug effects; exercise training; Fitness training programs; Heart attacks; heart disease; Heart diseases; Heart rate; Heart Rate - drug effects; heart rate recovery; Humans; Intervention; Male; Middle Aged; Myocardial infarction; Patients; Physical fitness; Physical training; Recovery; Recovery of Function; Rehabilitation; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - physiopathology; ST Elevation Myocardial Infarction - rehabilitation; Therapy; Time Factors; Training; Treatment Outcome; exercise testing; beta-blocker; heart disease; autonomic function; exercise training; heart rate recovery; cardiac rehabilitation
• ISSN: 1475-0961; 1475-097X
• DOI: 10.1111/cpf.12420

Summary Heart rate recovery (HRR) is a strong mortality predictor. Exercise training (ET) and β‐blocker therapy have significant impact on the HRR of patients following myocardial infarction (MI). However, the combination of ET and β‐blocker therapy, as well as its effectiveness in patients with a more compromised HRR (≤12 bpm), has been under‐studied. Male patients (n = 64) post‐MI were divided: Training + β‐blocker (n = 19), Training (n = 15), β‐blocker (n = 11) and Control (n = 19). Participants performed an ergometric test before and after 3 months of intervention. HRR was obtained during 5 min of recovery and corrected by the cardiac reserve (HRRcorrCR). Compared to pre‐intervention, HRRcorrCR was significantly increased during the 1st and 2nd minutes of recovery in the Training + β‐blocker group (70·5% and 37·5%, respectively; P<0·05). A significant improvement, lasting from the 1st to the 4th minute of recovery, was also observed in the Training group (47%, 50%, 25% and 8·7%, respectively; P<0·05). In contrast, the β‐blocker group showed a reduction in HRRcorrCR during the 2nd and 3rd minutes of recovery (−21·2% and −16·3%, respectively; P<0·05). In addition, interventions involving ET (Training + βb, Training) were significantly more effective in patients with a pre‐intervention HRR ≤ 12 bpm than for patients with HRR > 12 bpm. Combination of β‐blocker therapy with ET does not compromise the effect of training and instead promotes HRR and aerobic capacity improvement. In addition, this combination is particularly beneficial for individuals presenting with a more compromised HRR. However, chronic administration of β‐blocker therapy alone did not promote improvement in HRR or aerobic capacity.