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Exercise training following myocardial infarction improves myocardial perfusion assessed by thallium-201 scintigraphy
Gunning MG, Walker J, Eastick S, Bomanji JB, Ell PJ, Walker JM
International Journal of Cardiology 2002 Aug;84(2-3):233-239
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIM: We assessed the effects of a 6-week exercise programme on the thallium-201 myocardial perfusion characteristics of patients following myocardial infarction. METHODS: Twenty-five patients presenting with a first acute myocardial infarction were randomised into two groups: (i) those undergoing a supervised exercise training programme over 6 weeks (n = 15) and (ii) a control group who did not attend the exercise programme (n = 10). All underwent three sequential stress thallium myocardial perfusion scans at 10 days, 6 weeks and 3 months after infarction. The stress conditions were identical on each occasion. The images were analysed using a polar plot with a computer assisted algorithm comparing stress and redistribution data. Values for extent, severity and percentage redistribution of the thallium images were generated. RESULTS: A total of 29 perfusion defects were identified, 18 in the exercise group and 11 in the control group. Over 3 months in the exercise group the mean extent of the stress image defect fell from 109 +/- 64 to 95 +/- 51 pixels (p < 0.05) while in the control group there was an increase from 133 +/- 57 to 144 +/- 57 pixels (p = NS). Stress defect severity fell in the exercise group from 581 +/- 417 to 494 +/- 346 SD (p < 0.05) but increased in the control group from 765 +/- 494 to 877 +/- 543 SD (p = NS). On redistribution imaging in the exercise group a significant decrease was observed in both extent (94 +/- 56 to 76 +/- 43 pixels (p < 0.05)) and severity (541 +/- 387 to 438 +/- 291 SD (p < 0.05)) of the defects. However in the control group no significant change was observed for extent (125 +/- 54 to 125 +/- 52 pixels) or severity (745 +/- 485 to 820 +/- 503 SD) of the redistribution defects (p = NS). Reversibility of the defects increased slightly in both the exercise group (from 14.6 +/- 17 to 17.5 +/- 20%) and the control group (5.2 +/- 5 to 9.6 +/- 10%) (p = NS). CONCLUSION: Following myocardial infarction a 6-week exercise programme improves myocardial perfusion characteristics. An exercise programme should be integrated into cardiac rehabilitation protocols for patients after infarction.

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