Cardiac rehabilitation therapy: A few minutes on the treadmill can do wonders

Dr Basit Ansari uses cost-effective approaches for monitoring exercise intensity.

KARACHI:

For  women, the general reason for signing up for aerobics is to shed off the extra pounds and for men, joining the gym means building some extra muscles. Research, however, has proven that the most important muscle in the human body that needs exercise is the heart, especially once it has undergone a bypass surgery. All it takes is three to four weeks of an exercise therapy programme and a patient can reduce the likelihood of undergoing another surgery.

After establishing this thesis, Dr Basit Ansari - the head of department of health and physical education at the University of Karachi - become the first person in the Pakistani clinical set up to complete this research by taking simple and cost-effective approaches for measuring and monitoring exercise intensity.

While few hospitals - including Aga Khan University Hospital, Liaquat National Hospital and Medical College, Tabba Heart Institute and Ziauddin Medical College - have established modern rehabilitation units, most hospitals in the country cannot afford such units due to the high cost of imported digital equipments, said Dr Ansari.

“The application of cardiac healthcare in Pakistan is far less known and practiced than other countries,” explained Dr Ansari. “Even the newly established Karachi Institute of Heart Diseases does not have a phase II cardiac rehabilitation programme. Patients are referred to the Tabba Heart Institute instead.”



The first phase, according to Dr Ansari, only deals with achieving the post-surgical stability in patients after which they are allowed to go home and put on medicine. “Phase II, which is the rehabilitation, costs between Rs500 and Rs1,000 per day for a programme that ideally runs over for six to eight weeks.”

In the absence of any past research on the topic, it took him seven years to establish his thesis under the supervision of Prof. Dr Masood Anwar Qureshi, the head of physiology department at the Dow International Medical College, after which he was awarded a doctorate degree by KU.

Monitoring cardiac patients

Around 55 studies have been conducted on practicalities involving bypass surgery in Pakistan, but the important domain of the patient’s cardiac rehabilitation has been neglected, explained Dr Ansari. “Perhaps this is the reason why the mortality rate in patients who have undergone a bypass surgery is much higher in Pakistan as compared to developed countries. Around half of the post-bypass surgery patients fail to survive for more than two years.”

Considering that Pakistan is among the countries with the highest rate of cardiac diseases, it is imperative that the bypass surgery patients are studied in order to document the effectiveness of cardiac rehabilitation exercises with simple and cost-effective approaches. “Such a study on cardiac rehabilitation therapy in bypass surgery patients, to the best of my knowledge, is the first of its kind in Pakistan,” he said.

Research-based analysis 

Dr Ansari’s study was conducted on 100 cardiac patients of both sexes, between ages 57 and 65. After their coronary artery bypass grafting or the bypass surgery, these patients were referred to the department of physiotherapy and rehabilitation between 2008 and 2010 at the Liaquat National Hospital and Medical College, Dr Ansari told The Express Tribune.

He determined the effects of aerobic and strength exercise training, using a treadmill, recumbent bike, calf-muscle stretching and grading in post-bypass surgery patients over a period of three to four weeks. The effects of these exercises were compared with normal and subnormal ejection fraction in the patient - the medical term to determine how well the heart is pumping the blood with each contraction. He also observed and recorded the daily improvement in the heart rate and blood pressure during the period.

“The thesis presents a very well defined study to investigate the benefits of exercise therapy on cardiac rehabilitation in post-bypass surgery patients,” remarked Iqbal Khan, an assistant dean at the Georgia Regents University’s school of medicine, who examined Dr Ansari’s thesis and recommended it for the award of doctorate.

Published in The Express Tribune, March 25^th, 2013.