Patients with coronary artery disease (CAD) attended by the Sistema Unico de Saude (SUS) in the city of Uberlandia and region are routinely referred to Hospital de Clinicas - Federal University of Uberlandia after acute myocardial infarction (AMI) for coronary angiography and other exams, receiving appropriate clinical or surgical follow-up. After the resolution of the clinical condition, the patient is released from the hospital with a medical referral to the Cardiorespiratory Rehabilitation Program offered by the institution.
These patients are contacted by telephone by the team of the rehabilitation sector, and invited to attend for a pre-entry evaluation for inclusion in treatment. In this telephone contact the secretary of the sector clarifies that the hospital does not have transportation services for the patients who accept to be part of the program, and afterwards the evaluation is scheduled. The initial anamnesis will be performed by a multidisciplinary team. In this screening are collected complaints, past and current history of possible diseases, personal and family history, life habits, medications in use, exams performed pre-hospital discharge and physical examination, collected from an individual anamnesis form. At the end of the evaluation the patient receives a card with the scheduling of training days that occur three times a week and dressing and feeding instructions prior to training.
All volunteers who fit the study criteria will be invited to participate in the study, being informed about the experimental procedures to which they would be submitted. They will also be clarified that all the information collected during the accomplishment of the work will be kept confidential, protecting their identities. Individuals who agree to participate in the study will sign an informed consent according to National Health Council (466/12) guidelines, and a next return will be scheduled to begin physical testing and blood collection. At that moment, the Research Participant Identification Card will be filled in, which will be kept in a confidential place separated from the other evaluations, with restricted access to the researcher, and a code will be given to the participant. In case of refusal to participate in the study, the participant will receive the same care offered to other patients routinely referred to the rehabilitation sector, being included into the conventional rehabilitation program that also lasts for 12 weeks.
Considering that the patients enrolled in the research will have to attend for evaluation and monitoring related to the study, all the displacements related to these additional activities will be refunded to the participants during the entire period of the study.
The evaluation procedures that will be performed in 2 days will consist of: Step 1 - ankle brachial index, heart rate variability at rest, respiratory pressures (maximal inspiratory and expiratory pressures), cardiopulmonary exercise test (incremental and constant load tests), spirometry and quality of life questionnaires (SF-36 and MacNew QLMI); Step 2 - blood collection (hematological and biochemical profile, erythrocytes membrane deformability and stability, inflammatory markers), plethysmography, carbon monoxide diffusion capacity and echocardiography.
After these exams the participant will be randomized to a training group: Group 1 - interval training (IT) or group 2 - IT + inspiratory muscle training (IMT), and will participate in the cardiorespiratory rehabilitation program for a period of 12 weeks, three times a week. Group 3 will consist of those participants who for any reason do not agree to participate in the rehabilitation program, such as those who do not live in the city, and will remain without intervention.
During the 6 months of discharge, participants will be monitored monthly, by telephone contact to verify possible changes in medications in use and general health status.
At the end of the 2nd, 4th and 6th month of discharge, in the last week of each period, the patient will be invited to return to the rehabilitation sector for placement of an accelerometer, a monitor that quantifies free activities and sedentary lifestyle. The selected equipment (activPAL3 ™ micro, PAL Technologies Ltd, Scotland, UK) makes use of algorithms properties to quantify periods of sitting, orthostatism and walking. This information will be used to estimate the daily energy expenditure in the period and will store information of seven consecutive days during the selected weeks.
The re-evaluations will consist of all the exams mentioned above (steps 1 and 2), and will be performed at the beginning and at the end of the training period and after 6 months of the program's discharge.
