Indoor cycling training in rehabilitation of patients after myocardial infarction

Indoor cycling training in rehabilitation of patients after myocardial infarction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Indoor cycling training in rehabilitation of patients after myocardial infarction Dagmara Gloc, Zbigniew Nowak, Agata Nowak- Lis, Tomasz Gabryś, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-505811/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Nov, 2021 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted 10 You are reading this latest preprint version Abstract Background Standard endurance training used from the second stage of cardiac rehabilitation has many common features with indoor cycling training which is used in fitness clubs. In the study, an attempt was made to evaluate the usefulness of this form of training in a 24-day rehabilitation program for patients after myocardial infarction. The study examined a group of 64 patients (51.34 ± 8.02 years) who were divided into two groups: the IC group (32 patients aged 53.40 ± 4.31 years) with indoor cycling training instead of standard endurance training; and the ST group (32 patients aged 55.31 ± 6.45 years) performing standard training. The level of exercise tolerance (cardiopulmonary exercise testing on a treadmill – Bruce's protocol), hemodynamic indicators of the left ventricle (echocardiography) and blood lipid profile (laboratory test) were assessed. Results In the IC group there was a significant increase in the test duration (9.21 ± 2.02 vs 11.24 ± 1.26 min; p < 0.001), the MET value (9.16 ± 1.30 vs 10.73 ± 1.23; p = 0.006) and VO 2 max (37.27 ± 3.23 vs 39.10 ± 3.17 ml/kg/min; p < 0.001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (9.41 ± 0.39 vs 10.91 ± 2.22; p < 0.001), MET value (8.65 ± 0.25 vs 9.86 ± 1.12; p = 0.002) and VO 2 max (36.89 ± 6.22 vs 38.76 ± 3.44; p < 0.001). No statistically significant changes were found in the hemodynamic indices of the left ventricle and the lipid profile. Also, the intergroup analysis did not show any statistical significance. Conclusion Based on the research results, it was found that indoor cycling training in the second phase of cardiac rehabilitation is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of early cardiac rehabilitation. Sports Medicine and Kinesiology Myocardial infarction cardiac rehabilitation indoor cycling 1. Introduction. Traditional physical training, in line with the existing standards of management, which begins in the second stage of cardiac rehabilitation, is well known and described [ 1 , 2 , 3 ]. Few publications deal with the issue of the effectiveness of innovative forms of training in patients with diseases of the cardiovascular system [ 4 , 5 , 6 ]. The ever younger age of cardiac patients, the progress of diagnostics and the development of interventional and surgical treatment methods require the gradual introduction of various forms of physical training. Adapting the rehabilitation programs to the possessed skills based on previous experience in the field of activity is becoming a key solution in the selection of training programs in modern cardiac rehabilitation. One such form is indoor cycling. [ 7 , 8 , 9 ]. It is a form of aerobic interval training similar to the traditional training recommended in the second stage of rehabilitation, but with a slightly different course. Participants are not divided into beginners and advanced, because each person during the course of classes can modify loads or positions according to their own abilities [ 10 , 11 ]. The training imitates cycling in two basic types of terrain – flat and hilly. Riding can take place with and without contact of the arms with the steering wheel, in a sitting and standing position. It is already possible to change the position of the hands (1. Close, 2. Open, 3.Standing), allowing a variety of rehabilitation activities. The techniques used in indoor cycling reflect road cycling or in professional cycling sports and are divided into: seated flat (SF) cadence 80–120 rpm, seated climb (SC) cadence 60–80 rpm, standing flat (StF) cadence 80–120 rpm, standing climbing (StC) cadence 60–80 rpm), combo (Co) cadence 60-80-120 rpm, sprint flat (SpF) and sprint climb (SpC) cadence, maximum 100–110 rpm. The presented diversity of solutions used during exercise on a bicycle creates the possibility of conducting frequently changing classes in terms of exercise technique. An additional attraction of such training is the use of music, which makes it possible to determine the intensity of the traveled section, as well as its profile. The most frequently used music genres for classes are pop, techno, hip-hop, disco, and reggae. The purpose of the class determines the profile, which can be: "active regeneration"/pro-health training (50–65% HRmax), "endurance low/fat burning" (65–75% HRmax) "endurance" (75–90% HRmax) "climbing" (75–85% HRmax), "interval" (65–85% HRmax) "challenge" (85% -100% HRmax) "first time/express" (65–75% HRmax) [7.8]. Scientific reports confirm the effective impact of indoor cycling training on cardiovascular and respiratory efficiency, reduction of adipose tissue and the risk of developing cardiovascular diseases in people without cardiovascular diseases [ 12 , 13 , 14 , 15 , 16 , 17 ]. The research conducted so far indicates the validity of undertaking research aimed at assessing the use of indoor cycling training as an alternative form to traditional endurance training in the primary and secondary prevention of cardiovascular diseases. Due to the lack of reports on the possibilities of using indoor cycling training in cardiac rehabilitation programs, an experiment was conducted to determine the effect of such training on the level of exercise tolerance and hemodynamic indices of the left ventricle in patients after a heart attack. The following research questions were formulated: 1. Can indoor cycling training, like standard endurance training, improve exercise tolerance (assessed by an exercise test) and change hemodynamic indicators of the left ventricle (assessed by echocardiography) and lipid profile (assessed using a laboratory method) in patients after myocardial infarction? 2. Can indoor cycling training be an alternative to standard endurance training commonly used in stage II rehabilitation? Hypotheses 1. Indoor cycling training may improve exercise tolerance, left ventricular hemodynamic indices and the lipid profile of patients after a heart attack. 2. Indoor cycling training can be an alternative to standard endurance training used during the second stage of cardiac rehabilitation. 2. Material And Methods 2.1. Participants The study included 64 men (51.34 ± 8.02 years), after myocardial infarction, who underwent percutaneous coronary angioplasty. The tests were performed during the second stage of rehabilitation. All participants of the experiment were qualified for model A (exercise test result ≥ 7 MET or 100 W). Reducing the number of confounding factors, such as age, sex, disease entity, treatment method, and level of exercise tolerance, patients included in the study were randomized to two rehabilitation procedures: standard rehabilitation (group ST) – 32 people indoor cycling training (group IC) – 32 people The characteristics of the subjects are presented in Tables 1 – 4 . Inclusion criteria: consent to participate in the study, documented stable ischemic heart disease or an uncomplicated course of myocardial infarction, time from the last cardiovascular event < 2 months, stress test result ≥ 7 MET/100 W, left ventricular ejection fraction (LVEF) ≥ 50%. Exclusion criteria: refusal to participate in the study, recent myocardial infarction, LVEF < 50%, coronary artery bypass surgery, unregulated hypertension, unstable coronary artery disease, arrhythmias and conduction disturbances, established cancer, diseases of the central or peripheral nervous system, varicose veins of the lower limbs, osteoarthritis of the peripheral joints and the spine, unhealed injuries of the lower limbs, advanced peripheral arteriosclerosis, age ≥ 75 and incomplete medical documentation Table 1 Characteristics of both groups Variable Group IC (N = 32) Group ST (N = 32) Age [years] 53.40 ± 4.31 (38–74) 55.31 ± 6.45 (41–72) Height [cm] 177 ± 4.66 (169–189) 178.20 ± 7.55 (163–188) Weight [kg] 85.65 ± 7.55 (72–101) 86.09 ± 13.22 (66.90-111.24) BMI [kg/m 2 ] 26.48 ± 1.61 (22.28–33.42) 27.82 ± 6.63 (22.80-31.23) LVEF [%] 55.22 ± 5.95 (51–59) 54.50 ± 8.44 (52–58) BMI –body mass index, N – number, LVEF – left ventricular ejection fraction Table 2 Disease entities occurring in patients of both groups Type Group IC N(%) Group ST N(%) Ischemic heart disease 27(84.3%) 28(87.5%) Type 2 diabetes 6(18.75%) 8(25%) Hyperlipidemia 9(28.12%) 11(34.37%) Hypertension 14(43.75%) 18(56.25%) Myocardial infarction 32(100%) 32(100%) Ischemic disease and myocardial infarction were dominant in both groups Table 3 Type of myocardial infarction Type Group IC N(%) Group ST N(%) NSTEMI 26(81.25%) 28(87.5%) STEMI 6(18.75%) 4(12.5%) Total 32(100%) 32(100%) NSTEMI – non-ST elevation myocardial infarction, STEMI – ST elevation myocardial infarction Table 4 Number of implanted stents Number Group IC N(%) Group ST N(%) 1 27(84.37%) 28(87.5%) 2 4(12.51%) 4(12.5%) ≥ 3 1(3.12%) 0(0%) Implantation of 1 stent was predominant in all groups. 2.2. Experimental Procedure Both the standard group and the IC group were subjected to a 24-day improvement program, which included 22 training units (2 days for initial and final tests) performed 5 times a week following ESC standards (a detailed training program is presented in Table 5 . Throughout the entire research procedure, the patients were supervised by medical personnel consisting of a physiotherapist and a cardiologist. Table 5 Training following ESC recommendations Type of training Methodology Workload Endurance training Training on a bicycle ergometer, 5 times a week 30 minutes Workload applied on the basis of calculation of heart rate training, starting from 60% of heart rate reserve increased by 10% after 5 units of training, to 80 % of heart rate reserve, 14 degrees of subjective scale effort assessment by the Borg scale Resistance training Exercises in the form of training station, 5 times a week 30 minutes General exercises Exercises in the gym – elements of aerobic and anaerobic training, stretching, breathing exercises, 5 times a week 30 minutes The intensity of the exercise varied on the basis of the calculated training heart rate, starting from 60% of the heart rate reserve, increasing by 10% after 5 training units, up to 80% of the heart rate reserve, up to a maximum of 15 according to the Borg scale. Endurance training on a bicycle ergometer (Kettler Ergometer X1) began with a 3-minute ride without load (0 W), followed by 5 cycles – a 3-minute load phase and a 2-minute rest phase, a total of 25 minutes of riding. The training session ended with 2 minutes of cycling without load. The training on a bicycle ergometer lasted a total of 30 minutes. After each training unit, stretching of the muscle groups involved during the ride was performed (5 minutes). People from the IC group performed indoor cycling training (Tomahawk I.C.E. Indoor Cycling) instead of the traditional interval training. The training ride lasted 30 minutes in total and started with a 5-minute warm-up with no load, in the rhythm of 100–110 RPM. The main part included cycling to the rhythm of changing music, including sitting and standing positions, and lasted 22.5 minutes (60–110 RPM). The main part was followed by a 2.5-minute cool down with a gradually decreasing load. The cycling cadence (RPM) was determined by the rhythm beats (BPM) present in each piece, being an important motivating instrument; moreover, the cadence of the rotation was signaled by the instructor. The unit ended with 5 minutes of stretching of the muscle groups – the muscles of the chest, back, quadriceps and biceps muscles of the thigh, as well as the buttocks, forearms and arms. The stretching was performed on mats placed on the dance floor. Details of the training protocol are presented in Table 6 . Patients from the experimental group also participated in the other two forms of training (resistance and general improvement), as did the control group (Table 5 ). Table 6 Protocol of the indoor cycling training unit Part of the training session Time (min) Borg scale RPM Position/ technique Warm-up 1–5 9–10 100–110 Position 2 (2½min) Position 1 – SF (2½min) Appropriate training 5–10 10-17.5 17.5–22.5 22.5–27.5 12–13 12–14 13–14 11–12 110 110 80 80 100–110 100 60–80 100 60–80 100 80 80 60–80 100–110 Position ja 1 (2 min) Position a 2 (2 min) Position a 2 – SC (1min) Position a 3 – StC (½min) Position a 1 (2½min) Position a 2 (2½min) Position a 3 StC (½min) Position 1 (1½min) Position ja 2 – SC (1min) Position 2 (3½min) Position 3 – StC (½min) Position 2 (2min) Position a 2 – SC (2min) Position a 2 (1min) Cool down 27.5–30 9–10 100 Position a 1 – SF Stretching 30–35 9 - - min – minute, position1 – close, position 2 – open, position 3 – standing, RPM – revolutions per minute, SC – seated climb, SF – seated flat, StC – standing climb, StF – standing flat The following was carried out before commencing the training program and immediately after its completion: - Electrocardiographic exercise test on a treadmill (six-stage Bruce protocol: stage 1 = 2.7 km/h, 10%, stage 2 = 4.0 km/h, 12%, stage 3 = 5.5 km/h, 14%, stage 4 = 6.8 km/h, 16%, stage 5 = 8.0 km/h, 18%, stage 6 = 8.8 km/h, 20%) Exercise test using the Excalibur Sport cycle ergometer (Lode, Groningen, The Netherlands) [ 18 ]. The following were measured: test duration (min), distance covered (m), energy cost (MET), heart rate at rest and maximum (BPM), systemic blood pressure at rest and maximum (mmHg), criteria for ending the test (physiological: submaximum heart rate, i.e., 85% of HRmax determined on the basis of the following formula: 208-0.7x age or fatigue; pathological: stenocardial pain, ST segment, and T-wave changes, rhythm and/or conduction disorders, blood pressure increase above 250/120 mmHg), maximum oxygen uptake (VO 2 max). - Two-dimensional ultrasound heart test, measured hemodynamic parameters (GE Vivid Q): left ventricular end-diastolic dimension (LVEDD; mm), left ventricular end-systolic dimension (LVESD; mm), left ventricular end-systolic volume (LVESV; mL) as per the following formula: LVESV = 7/(2.4 + LVESD) - (LVESD), left ventricular end-diastolic volume (LVEDV; mL) as per the following formula: LVEDV = 7/(2.4 + LVEDD) - (LVEDD), left ventricular ejection fraction (LVEF; %), left ventricular mass (LVM; g), left ventricular mass index (LVMI; g/m 2 ) based on the Devereux formula: LVMI = LVM/BSA (left ventricular mass/body surface area) - Blood lipid profile test. Measured parameters: Total cholesterol – TC (mg/dL), high-density lipoproteins - HDL (mg/dL), low-density lipoproteins – LDL (mg/dL), triglycerides – TG (mg/dL) Before, during and immediately after each training session, heart rate (Polar, FT1) and blood pressure (SOHO, 110 HS-50A) measurements were made, as well as the degree of perception of effort according to the 20-point Borg scale. The intensity of the exercise varied on the basis of the calculated training heart rate, starting from 60% of the heart rate reserve, increasing by 10% after 5 training units, up to 80% of the heart rate reserve, up to a maximum of 15 according to the Borg scale. The following was carried out before commencing the training program and immediately after its completion: - Electrocardiographic exercise test on a treadmill (six-stage Bruce protocol: stage 1 = 2.7 km/h, 10%, stage 2 = 4.0 km/h, 12%, stage 3 = 5.5 km/h, 14%, stage 4 = 6.8 km/h, 16%, stage 5 = 8.0 km/h, 18%, stage 6 = 8.8 km/h, 20%) Exercise test using the Excalibur Sport cycle ergometer (Lode, Groningen, The Netherlands)[ 18 ]. The following were measured: test duration (min), distance covered (m), energy cost (MET), heart rate at rest and maximum (BPM), systemic blood pressure at rest and maximum (mmHg), criteria for ending the test (physiological: submaximum heart rate, i.e., 85% of HRmax determined on the basis of the following formula 208-0.7x age or fatigue; pathological: stenocardial pain, ST segment, and T-wave changes, rhythm and/or conduction disorders, blood pressure increase above 250/120 mmHg), VO 2 max. - Two-dimensional ultrasound heart test, measured hemodynamic parameters (GE Vivid Q): LVEDD (mm), LVESD (mm), LVESV (mL) as per the following formula: LVESV = 7/(2.4 + LVESD) - (LVESD), LVEDV (mL) as per the following formula: LVEDV = 7/(2.4 + LVEDD) - (LVEDD), LVEF (%), left ventricular mass (LVM; g), left ventricular mass index (LVMI; g/m 2 ) based on the Devereux formula: LVMI = LVM/BSA (left ventricular mass/body surface area) - Blood lipid test profile. Measured parameters: total cholesterol – TC (mg/dL), high-density lipoproteins – HDL (mg/dL), low-density lipoproteins – LDL (mg/dL), triglycerides – TG (mg/dL) [ 18 ] 2.3. Data Analysis The Shapiro–Wilk normality test and the Brown–Forsythe variance homogeneity test were used to verify the assumptions of parametric tests. The parametric Student’s t-test was also performed for dependent variables whose distribution conformed to a normal distribution, and a nonparametric Wilcoxon paired order test was performed for dependent variables whose distribution did not conform to a normal distribution. Student’s t-test was also performed for independent variables whose distribution conformed to a normal distribution, and its nonparametric equivalent. The Mann–Whitney U-test was performed for independent variables whose distribution did not conform to a normal distribution. Statistica 12 (StatSoft, Kraków, Poland) software was used in the study. The assumed level of significance was p _ 0.05. 3. Results Table 7 shows the results for the two test groups of the treadmill exercise test as per the classical Bruce protocol. In both analyzed groups, after the completion of the rehabilitation programs, a statistically significant increase in test duration, energy cost (MET) and VO 2 max was demonstrated in relation to the baseline test. Table 7 Results of the treadmill exercise test in three groups of patients before (I) and at the end (II) of cardiac rehabilitation Variable IC group X ± SD p ST group X ± SD p Δ IC vs Δ ST p-Value Time I Time II Δ [min] 9.21 ± 2.02 11.24 ± 1.26 2.03 < 0.001 9.41 ± 0.39 10.91 ± 2.22 1.50 < 0.001 0.772 MET I MET II Δ MET 9.16 ± 1.30 10.73 ± 1.23 1.57 0.006 8.65 ± 0.25 9.86 ± 1.12 1.21 0.002 0.873 HRrest I HRrest II Δ[beats/minute] 66.32 ± 9.16 65.30 ± 10.31 -1.02 0.862 70.11 ± 8.15 68.40 ± 7.71 -1.71 0.790 0.899 HRmax I HRmax II Δ [beats/minute] 128.25 ± 14.79 133.65 ± 16.37 5.4 0.169 128.55 ± 14.69 133.75 ± 11.10 5.2 0.264 0.992 SBPrest I SBPrest II Δ [mmHg] 124.60 ± 11.59 125.45 ± 18.11 0.85 0.999 124.40 ± 13.96 123.88 ± 2.38 -0.52 0.936 0.914 DBPrest I DBPrest II Δ [mmHg] 82.10 ± 6.52 81.05 ± 7.26 -1.05 0.984 79.25 ± 4.16 79.34 ± 6.27 0.09 0.918 0.918 SBPmax I SBPmax II Δ [mmHg] 169.25 ± 11.30 174.09 ± 12.25 4.84 0.663 158.50 ± 10.15 162.33 ± 13.53 3.83 0.730 0.114 DBPmax I DBPmax II Δ [mmHg] 84.21 ± 6.48 82.20 ± 9.33 -2.01 0.954 83.85 ± 6.50 82.09 ± 6.18 -1.76 0.916 0.922 VO 2 max I VO 2 max II Δ [ml/kg/min] 37.27 ± 3.23 39.10 ± 3.17 1.83 < 0.001 36.89 ± 6.22 38.76 ± 3.44 1.87 < 0.001 0.167 All data are presented as means ± standard deviation and the difference (Δ – delta) MET – metabolic equivalent, HRrest – resting heart rate, HRmax – maximum heart rate, DBPmax – maximum diastolic blood pressure, DBPrest – resting diastolic blood pressure, SBPmax – maximum systolic blood pressure, SBPrest – resting systolic blood pressure, VO 2 max – maximal oxygen uptake The results of the echocardiographic examination are presented in Table 8 . In both studied groups, improvement in the analyzed hemodynamic parameters of the left ventricle, however, were not statistically significant. There was also no significant difference in intergroup comparisons. Table 8 Results of echocardiographic tests carried out before (I) and after (II) the 24-day rehabilitation cycle Variable IC group X ± SD p ST group X ± SD p Δ IC vs Δ ST p-Value LVEDD I LVEDD II Δ [mm] 49.98 ± 3.60 50.21 ± 3.34 0.23 0.918 50.33 ± 4.12 50.95 ± 3.23 0.62 0.843 0.825 LVESD I LVESD II Δ [mm] 32.71 ± 4.64 32.89 ± 7.83 0.18 0.933 33.22 ± 3.11 33.75 ± 3.28 0.53 0.773 0.818 LVESV I LVESV II Δ [ml] 44.33 ± 21.34 45.11 ± 16.97 0.78 0.932 47.22 ± 11.21 48.01 ± 10.01 0.79 0.892 0.899 LVEDV I LVEDV II Δ [ml] 116.32 ± 22.52 117.44 ± 14.66 1.12 0.911 121.12 ± 23.22 122.43 ± 14.38 1.31 0.902 0.948 LVSV I LVSV II Δ [ml] 84.12 ± 27.60 84.01 ± 21.11 -0.11 0.991 94.92 ± 31.43 94.12 ± 13.34 -0.8 0.981 0.932 LVEF I LVEF II Δ [%] 55.22 ± 5.95 56.45 ± 2.68 1.23 0.117 54.50 ± 8.44 55.75 ± 9.44 1.25 0.197 0.911 LVM I LVM II Δ [g] 180.56 ± 81.11 181.34 ± 22.46 0.78 0.998 191.43 ± 19.33 192.19 ± 23.91 0.76 0.935 0.989 LVMI I LVMI II Δ [g/m 2 ] 89.64 ± 22.45 90.33 ± 14.36 0.69 0.917 95.47 ± 16.75 96.09 ± 54.64 0.62 0.933 0.886 LVEDD – left ventricular end-diastolic diameter, LVESD – left ventricular end-systolic diameter, LVESV – left ventricular end-systolic volume, LVEDV – left ventricular end-diastolic volume, LVSV – left ventricular stroke volume, LVEF – left ventricular ejection fraction, LVM – left ventricular mass, LVMI – left ventricular mass index The analysis of changes in the lipid profile (Table 9 ) showed a favorable direction of changes in the values of all assessed indicators. However, these changes did not show statistically significant features. Table 9 Results of blood lipid profile tests carried out before (I) and after (II) the 24-day rehabilitation cycle. Variable IC group X ± SD p ST group X ± SD p Δ IC vs Δ ST p-Value TC I TC II Δ [mg/dl] 182.24 ± 26.41 171.67 ± 10.39 -10.57 0.249 172.27 ± 45.34 166.23 ± 66.29 − 6.04 0.113 0.601 HDL I HDL II Δ [mg/dl] 44.21 ± 19.07 48.34 ± 19.27 4.13 0.142 43.23 ± 24.56 47.88 ± 17.66 4.65 0.158 0.893 LDL I LDL II Δ [mg/dl] 111.23 ± 19.44 99.62 ± 26.12 -11.61 0.223 104.39 ± 24.34 91.47 ± 13.04 -12.92 0.223 0.367 TG I TG II Δ [mg/dl] 121.35 ± 71.37 115.15 ± 45.32 -6.2 0.815 126.22 ± 21.56 119.48 ± 14.59 -6.74 0.793 0.829 TC – total cholesterol, HDL – high-density lipoproteins, LDL – low-density lipoproteins, TG – triglycerides. 4. Discussion There are a small number of publications on the impact of alternative forms of endurance training used in the second stage of rehabilitation on the level of exercise tolerance, hemodynamic parameters of the left ventricle, or the lipid profile of patients after a myocardial infarction [ 4 , 6 ]. Never before has such an assessment been made of indoor cycling training. Until now, this form was available and associated only with the population of healthy people who attended classes in fitness clubs. It has many features in common with traditional endurance training that has been used for years in a cardiac rehabilitation program. These include: the interval training form, HR-controlled work intensity, the ability to control and dose external resistance, individual or group training form, constant monitoring of vital signs (HR, SpO 2 , blood pressure, Bf), low risk of injury. What makes it stand out is primarily the way it is run. It is possible to ride sitting and standing, as well as to adjust the height of the saddle and handlebars and the distance between the saddle and the handlebars, which makes it an ideal training device for people regardless of their constitutional body build [ 7 , 8 , 9 ]. The results obtained after the end of the cardiac rehabilitation program, in which indoor cycling was used, showed that it is a safe, effective and well-tolerated form of endurance exercise, which can be recommended in the process of comprehensive rehabilitation of patients after a heart attack. 4.1 Electrocardiographic exercise test The results obtained after 24 days of implementation of the rehabilitation program showed a significant improvement in physical capacity compared to the results obtained before its commencement. In both analyzed groups, i.e. the IC group and the ST group, a significant increase in test duration was obtained (respectively: 9.21 ± 2.02 vs 11.24 ± 1.26 min; p < 0.001 and 9.41 ± 0.39 vs 10.91 ± 2.22 min; p < 0.001). The extension of its duration is an effect that confirms the high effectiveness of the applied rehabilitation models and proves the expected increase in exercise tolerance. Another indicator showing the improvement of the physical capacity of patients, which significantly improved in both studied groups, is metabolic equivalents (MET) (IC group – 9.16 ± 1.30 vs 10.73 ± 1.23, p = 0.006; ST group – 8.65 ± 0.25 vs 9.86 ± 1.12; p = 0.002). The myocardial oxygen demand depends on the heart rate, the tension of the left ventricular wall and the contractility of the heart muscle. According to Myers et al. [ 19 ] peak exercise capacity measured in MET is the strongest prognostic factor for the risk of death both among healthy people and those with cardiovascular diseases, including those after myocardial infarction. A favorable increase in the value of MET after the completion of the second stage cardiac rehabilitation program was also observed in the retrospective analysis of the results of 10,671 patients, regardless of their initial level of exercise tolerance. [20,] A similar effect associated with the increase in MET was observed in the evaluation of the effects of hybrid rehabilitation of 125 patients with heart failure [21,]. The increase in MET energy expenditure at a similar level was also demonstrated in the studies by Nowak et al. [ 4 ] and Grabara et al. [ 6 ], who also assessed the effectiveness of alternative training methods in cardiac rehabilitation of patients after myocardial infarction. Maximum oxygen uptake (VO 2 max), also referred to as the body's aerobic capacity, is a real measure of exercise tolerance and, at the same time, an indicator of the cardiovascular system efficiency [ 4 ]. It provides objective information about the clinical condition and factors limiting the possibilities of a cardiac patient [22,]. A maximum oxygen intake of 10 mL/kg/min represents severe heart failure. The minimum level of physical activity assessed via VO 2 max is 40 mL/kg/min. For a person with a sedentary lifestyle, VO 2 max is approximately 30 ml/kg/min. The results of our research showed an increase (about 8%) in the VO 2 max value in both groups (IC group 37.27 ± 3.23 vs 39.10 ± 3.17 ml/kg/min; p < 0.001, ST group: 36.89 ± 6.22 vs 38.76 ± 3.44 ml/kg/min; p < 0.001). Endurance training increases oxygen uptake. It is the result of an increased capillary arteriovenous difference and an increase in cardiac output [23,]. In the group of healthy people, the increase in VO 2 max by 8–15% is the result of properly planned training. The similar increase achieved in our research proves that a properly planned rehabilitation program carried out in a continuous and systematic manner significantly improved the level of physical fitness of patients. This is also confirmed in the research by other authors [24,25,26,27 ]. The intergroup analysis did not show any statistically significant differences in the results of the research in terms of individual indicators. 4.2. Echocardiographic Test The result of myocardial infarction is impairment of the mechanical function of the myocardium and progressive structural changes in the myocardium (called remodeling), which affect all parts of the cardiovascular system equally [ 28 ]. Altered hemodynamic conditions (for instance reduction of left ventricular stroke volume – LVSV, enhancement of LVEDV) and increased activity of the renin-angiotensin-aldosterone and catecholamines consistently contribute to impaired diastolic function of the heart, thus affecting the systolic function with a reduction in LVEF in total. First of all, the activity of aldosterone leads to the replacement of contractile muscle tissue with an excess of connective tissue with a predominance of collagen, which initially is an adaptive response, and later may take the form of pathological heart failure. [29,] In addition to stimulating the renin-angiotensin-aldosterone system, diabetes mellitus, anterior infarction and its extensive early spread, and persistent occlusion of the intra-infarct artery exacerbate adverse myocardial remodeling. Reconstruction, and, more specifically, enlargement of the left ventricle silhouette may be a significant prognostic factor; therefore the assessment of its dimensions and functions should be routinely performed in most cardiological diseases. The study assessed the indicators of the left ventricle of the heart muscle. There were statistically insignificant increases in mean values of LVEDD, LVESD, LVESV, LVEDV, LVEF, LVMI, LVMI and a slight decrease in LVSV in both rehabilitated groups, which indicates a positive rehabilitation effect. It should be emphasized, however, that it is still ambiguous to determine the impact of physical activity (primarily of the endurance type) on the post-infarction structure and functions of the left ventricle [30, ]. The causes of this problem may include differences in the methodology of research carried out by different authors. The differences in the obtained results may be influenced by factors such as selection of the population, the extent of myocardial infarction, the age of the respondents, the period covered by the observation, measurement techniques and a combination of any of the above-mentioned factors. Similar conclusions were reached by Gates et al. [31,], Belardinelli et al. [32,] and Nowak et al. [33,]. With the exception of the ejection fraction of the left ventricle, they did not observe any significant changes in the diastolic function of the left ventricle under the influence of training, even in relation to physically more or less active patients. In conclusion, the influence of physical training on the heart has not been clearly explained. Most studies, including ours, failed to demonstrate a significant effect of physical training on the morphological and functional parameters of the left ventricle, or it was found that physical activity only slightly improved them. As in the case of the exercise test, the intergroup analysis showed no statistically significant differences. 4.3 Examination of the lipid profile Increased levels of total cholesterol and triglycerides are factors in the formation of atherosclerotic lesions in the coronary, cerebral and peripheral vessels. Their concentrations in blood serum are determined heredity, but a significant role in lowering the levels is attributed to lifestyle elements (environmental factors), such as a proper diet and systematic physical activity [34,35,]. Scientific reports confirm the beneficial effect of physical activity on the lipid profile, although it concerns longer observations, e.g. 6 months [32,33 ]. In the case of observations that cover a short period of time, the changes are not statistically significant, which was also the case in our own research. It is also difficult to say whether the reason for the changes observed is the rehabilitation program or the effect of statins. Comparing the results of the tests before and after the start of rehabilitation, the level of the analyzed lipids in both cases was within the normal range, which may be even more indicative of the earlier undertaking of pharmacological treatment. Limitation A limitation of the study was the inclusion of only a single group of patients with a high level of physical capacity ≥ 7 MET or ≥ 100 W. However, the results, which confirmed the effectiveness of indoor cycling training included in the cardiac rehabilitation program of patients after myocardial infarction, certainly warrant additional studies in this field, which will assess patient groups with lower physical capacity than those included in our study. A second limitation is the inclusion of the male study participants only. This was a select group of patients (see exclusion criteria) and may not be representative of a general cardiac rehabilitation population. Studies involving a large group of participants of both sexes with various levels of physical capacity and clinical status are needed. In the future, research should also be undertaken to determine which of the indoor cycling techniques and profile is the most appropriate for cardiac patients. Practical recommendation Indoor cycling training is a form of training that has many features in common with traditional endurance training used in cardiac rehabilitation. The obtained results also showed similarity in terms of changes in exercise tolerance, left ventricular hemodynamics and lipid profile. Therefore, it may be a more interesting and attractive alternative to traditional endurance training in patients after a heart attack. Conclusions Both indoor cycling training and standard training have a similar effect on the improvement of exercise tolerance, change of hemodynamic indicators of the left ventricle and the lipid profile in patients after a heart attack. Indoor cycling training can be an alternative to standard endurance training in cardiac rehabilitation. Declarations Ethics approval and consent to participate Permission of the University Bioethics Commission for scientific research at J.Kukuczka Academy of Physical Education in Katowice (Poland) No. 7/2017 at 18/05/2017 was granted for conducting the study. The study was approved by the local Bioethics Committee and conformed to the standards set by the Declaration of Helsinki. All patients were informed about the type and aim of the study. Written consent to the study was pasted into the appendix. Subjects were told that they may withdraw from the study at any time. The patients did not change their leisure physical activity, and medicaments were not modified during the study. The authors declare no conflict of interest. Consent for publication Not applicable Availability of data and materials The data presented in this study are available on request from the corresponding author. Competing interests Not applicable Funding This research received no external funding. Author Contributions Conceptualization, D.G. and Z.N.; methodology, T.G., P.V; software, A.N-L. and D.G; validation, T.G., and U.S.-G.; formal analysis, D.G. and A.P.; investigation, U.S.-G.; Z.N.; resources, D.G. and A.P.; data curation, T.G. and A.N-L. writing—original draft preparation, A.N.-L.; writing—review and editing, A.N.-L.; visualization, T.G. and A.P; supervision, T.G. and Z.N., P.V; project administration: U.S.-G.; funding acquisition, D.G. and Z.N. All authors have read and agreed to the published version of the manuscript. Acknowledgements Not applicable Authors' information Not applicable References El Missiri, A, Amin, SA, Tawfik, I.R, Shabana, A.M. Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery. Egypt Heart J. 2020; 14;72(1):69. doi: 10.1186/s43044-020-00107-8. Price, K.J., Gordon, B.A., Bird, S.R., Benson, A.C. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? Eur. J. Prev. Cardiol. 2016;23(16):1715-1733. doi: 10.1177/2047487316657669. Baumgärtner, R. Cardiovascular rehabilitation - a current overview. Ther. Umsch. 2019;76(8):415-423. doi: 10.1024/0040-5930/a001114. Nowak, A., Morawiec, M., Gabrys, T., Nowak, Z., Szmatlan-Gabry´s, U., Salcman, V. Effectiveness of Resistance Training with the Use of a Suspension System in Patients after Myocardial Infarction. Int. J. Environ. Res. Public Health 2020;17: 5419; doi:10.3390/ijerph17155419 Nowak-Lis, A., Gabrys, T., Nowak, Z., Jastrzebski, P., Szmatlan-Gabry´s , U., Konarska, A., Grzybowska-Ganszczyk, D., Pilis, A. The Use of Artificial Hypoxia in Endurance Training in Patients after Myocardial Infarction. Int. J. Environ. Res. Public Health 2021;18:1633. doi.org/10.3390/ijerph18041633 . Grabara, M., Nowak, Z., Nowak, A. 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Revista Brasileira de Ciência e Movimento 2005;13(2) :27-32 Bianco, A., Bellafiore, M., Battaglia, G., Paoli, A., Caramazza, G., Farina, F., Palma, A. The effects of indoor cycling training in sedentary overweight women. J. Sport Med. Phys.Fitness 2010;50(2):159-165. López-Miñarro, P.A., Muyor, J.M. Heart rate and overall ratings of perceived exertion during Spinning cycle indoor session in novice adults. Sci. Sports. 2010; 25(5):238-244 Valle, V.S., Mello, D.B., Fortes, S., Dantas, E.H.M., Mattos, M.A. Effect of diet and Indoor cycling on body composition and serum lipid. Arquivos Brasileiros de Cardiologia. 2010; 95(2):173-178. doi: 10.1590/s0066-782x201005000080. Valle, V.S., Mello, D.B., Fortes, M., Dantas, E.H.M. Effects of Indoor cycling associated with diet on body composition and serum lipids. Biomed. Hum. Kinet. 2009;1:11-15. Vilarinho, R., Souza,W.Y.G., Rodrigues, T.C., Ahlin J.V., Junior, D.P.G.; Barbosa, F.M. Effects of indoor cycling in body composition, muscular endurance, flexibility, balance and daily activities in physically active elders. Fitness & Performance Journal 2009; 8(6): 446-451 Foster, C., Andrew, J., Battista, R.A., Porcari, J.P. Metabolic and perceptual responses to indoor cycling. J. Cardiopulm. Rehabil. 2006; 26: 270 Nowak-Lis. A 1, Gabry´s T. Nowak Z, Jastrzebski P, Szmatlan-Gabry´s U., Konarska A., Grzybowska-Ganszczyk D., Pilis A. The Use of Artificial Hypoxia in Endurance Training in Patients after Myocardial Infarction. J. Environ. Res. Public Health 2021, 18, 1633. https://doi.org/10.3390/ijerph18041633 Myers, J., Prakash, M., Froelicher, V., Do, D., Partington, S., Atwood, J.E. Exercise capacity and mortality among men referred for exercise testing. New Engl . J. Med. 2002;346(11): 793-801 doi:10.1056/NEJMoa011858 Abu-Haniyeh, A., Shah, N.P., Wu, Y., Cho, L., Ahmed, H.M. Predictors of cardiorespiratory fitness improvement in phase II cardiac rehabilitation. Clin. Cardiol. 2018; 41:1563–1569 doi: 10.1002/clc.23101. Szalewska, D., Zielinski, P., Tomaszewski, J., Kusiak-Kaczmarek, M., Łepska, L., Gierat-Haponiuk, K., Niedoszytko, P. Effects of outpatient followed by home-based telemonitored cardiac rehabilitation in patients with coronary artery disease. Kardiol. Pol. 2015;73:1101–1107 doi: 5603/KP.a2015.0095 Working Group Report. Recommendations for exercise testing in chronic heart failure patients. Eur. Heart J. 2001; 22:37–45. doi: 1053/euhj.2000.2388. Poole, D.C., Barstow, T.J., Gaesser, G.A., Willis, W.T., Whipp, B.J. VO 2 slow component: physiological and functional significance. Med. Sci. Sport Exerc. 1994;26: 1354-1358 Yang, X., Li, Y., Ren, X.; Xiong, X., Wu, L., Li, J., Wang, J., Gao, Y., Shang, H., Xing, Y. Effects of exercise-based cardiac rehabilitation in patients after percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Sci. Rep. 2017; 7:1–9 doi: 1038/srep44789. Guazzi, M., Adams, V., Conraads, V., Halle, M., Mezzani, A., Vanhees, L., Arena, R., Fletcher, G.F., Forman, D.E., Kitzman, D.W., Lavie, C.J., Myers, J. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012;126: 2261–2274 doi: 1161/CIR.0b013e31826fb946. Adams, J., Cline, M., Reed, M., Masters, A., Ehlke, K., Hartman, J. Importance of resistance training for patients after a cardiac event. Bayl. Univ. Med. Cent. Proc. 2006; 19:, 246–248 doi: 1080/08998280.2006.11928172. Balady, G., Arena, R., Sietsema, K., Myers, J., Coke, L., Fletcher, G.F., Forman, D., Franklin, B., Guazzi, M., Gulati, M., Keteyian S.J., Lavie C.J., Macko, R., Mancini, D., Milani, R.V. American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease;Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician’s Guide to cardiopulmonary exercise testing in adults: A scientific statement from the American Heart Association. Circulation. 2010;122:191–225 doi: 1161/CIR.0b013e3181e52e69. Florea, V.G., Mareyev, V.Y., Samko, A.N., Orlova, I.A., Coats, A.J.S., Belenkov, Y.N. Left ventricular remodeling: common process in patients with different primary myocardial disorders. Int. J. Cardiol. 1999; 68(3): 281-287 Huang, B.S., White, R.A., Ahmad, M., Tan, J., Jeng, A.Y., Leenen, F.H.H. Central infusion of aldosterone synthase inhibitor attenuates left ventricular dysfunction and remodelling in rats after myocardial infarction. Cardiovasc. Res. 2009;81(3): 574-581 Sadeghi, M., Garakyaraghi, M., Khosravi, M.,Taghavi, M., Sarrafzadegan, N., Roohafza, H. The impacts of cardiac rehabilitation program on echocardiographic parameters in coronary artery disease patients with left ventricular dysfunction. Cardiol. Res. Pract.2013; 2013:201713.doi: 10.1155/2013/201713. Gates, P.E., Tanaka, H., Graves, J., Seals, D.R. Left ventricular structure and diastolic function with human ageing. Relation to habitual exercise and arterial stiffness. Eur. Heart J. 2003; 24(24): 2213-2220. doi: 10.1016/j.ehj.2003.09.026. Belardinelli, R., Paolini, I., Cianci, G., Piva, R., Georgiou, D., Purcaro, A. Exercise training intervention after coronary angioplasty: The ETICA Trial. J. Am. Coll. Cardiol. 2001; 37(7):1891-1900 doi: 10.1016/s0735-1097(01)01236-0. Nowak, Z., Plewa, M., Skowron, M., Osiadlo, G., Markiewicz, A., Kucio, C. Minnesota Leisure Time Physical Activity Questionnaire as an additional tool in clinical assessment of patients undergoing Percutaneous Coronary Interventions. Hum. Kinet. 2010; 23:79-87 Kinnear, F.J., Lithander, F.E., Searle, A., Bayly, G., Wei, C., Stensel, D.J., Thackray, A.E., Hunt, L., Shield, J.P.H. Reducing cardiovascular disease risk among families with familial hypercholesterolaemia by improving diet and physical activity: a randomised controlled feasibility trial. BMJ Open . 2020 ; 28,10(12):e044200. doi: 10.1136/bmjopen-2020-044200 Bouillon, K., Singh-Manoux, A., Jokela, M., Shipley, M.J.; Batty, G.D., Brunner, E.J., Sabia, S., Tabák, A.G., Akbaraly, T., Ferrie, J.E., Kivimäki, M. Decline in low-density lipoprotein cholesterol concentration: lipid-lowering drugs, diet, or physical activity? Evidence from the Whitehall II study 2011;97(11): 923-30. doi: 10.1136/hrt.2010.216309 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Nov, 2021 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted Editorial decision: Major revision 15 Jul, 2021 Reviews received at journal 08 Jul, 2021 Reviewers agreed at journal 05 Jul, 2021 Reviews received at journal 30 Jun, 2021 Reviewers agreed at journal 21 Jun, 2021 Reviewers invited by journal 08 Jun, 2021 Editor assigned by journal 07 Jun, 2021 Editor invited by journal 07 Jun, 2021 Submission checks completed at journal 07 Jun, 2021 First submitted to journal 07 May, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-505811","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":31557403,"identity":"b5b33042-ca3d-4a80-b1a9-585a2434f836","order_by":0,"name":"Dagmara Gloc","email":"","orcid":"","institution":"Silesian Center for Rehabilitation and Prevention","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dagmara","middleName":"","lastName":"Gloc","suffix":""},{"id":31557404,"identity":"03993017-1709-483a-90d5-767acfb734c3","order_by":1,"name":"Zbigniew Nowak","email":"","orcid":"","institution":"Jerzy Kukuczka Academy of Physical Education","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zbigniew","middleName":"","lastName":"Nowak","suffix":""},{"id":31557405,"identity":"26675b91-33ab-4fb5-b2b6-a330b23718c7","order_by":2,"name":"Agata Nowak- Lis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABKUlEQVRIie2RsWrDMBBAzxg8KXiVUar8goT29FdiDO7Sodmy1SHgLilZAx37A508OxjsJeBVhQ4JBmfJ4q0Ft1Rx0paATNdC/QYhcffudBJAR8ffxjI2ABRwc2CHxQxaUo1TwDJVnlCK+aUYvyoW/lHOIufYi8fd5hVeKMtSf/IWMnDu8lWBboYUyFSrYFny6RxKwdZ++nyvFII8UyDmCeiv9BeTMQ8QJG4UX4WyF9XqATyLXLPYDbCrVQYyq6b1Qcl34fg9YkDtolFu2xSWz/ms6SL91OwpheBjlxG0KFyi8UOfJeJSlh65+GDIWRZC1MzjYcssNM+eqv0koc7C59V+zSjO3e12WQ8HNpnF2vHxCE4fdwR97yysFdTH6Cs11VojHR0dHf+LT8qMY11M6r1rAAAAAElFTkSuQmCC","orcid":"","institution":"Jerzy Kukuczka Academy of Physical Education","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Agata","middleName":"Nowak-","lastName":"Lis","suffix":""},{"id":31557406,"identity":"eb5c752f-69aa-4da7-aa2d-fd2b1e109cec","order_by":3,"name":"Tomasz Gabryś","email":"","orcid":"","institution":"University of West Bohemia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tomasz","middleName":"","lastName":"Gabryś","suffix":""},{"id":31557407,"identity":"adcc9913-2e03-4729-8a9f-da686376536e","order_by":4,"name":"Urszula Szmatlan-Gabrys","email":"","orcid":"","institution":"University of Physical Education","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Urszula","middleName":"","lastName":"Szmatlan-Gabrys","suffix":""},{"id":31557408,"identity":"55280023-1a93-4ee5-b9a8-c610025ddc77","order_by":5,"name":"Peter Valach","email":"","orcid":"","institution":"University of West Bohemia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Valach","suffix":""},{"id":31557409,"identity":"f54feec8-68b6-4624-8e19-fc7e170d7a34","order_by":6,"name":"Anna Pilis","email":"","orcid":"","institution":"Jan Dlugosz University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Pilis","suffix":""}],"badges":[],"createdAt":"2021-05-07 16:29:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-505811/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-505811/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13102-021-00379-w","type":"published","date":"2021-11-29T10:55:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":15962102,"identity":"09ac4cfc-ce64-4bd7-b133-dec7cfbd03a3","added_by":"auto","created_at":"2021-11-29 10:55:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":592186,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-505811/v1/0aea149a-408f-477c-81d6-63228b229351.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Indoor cycling training in rehabilitation of patients after myocardial infarction","fulltext":[{"header":"1. Introduction.","content":"\u003cp\u003eTraditional physical training, in line with the existing standards of management, which begins in the second stage of cardiac rehabilitation, is well known and described [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Few publications deal with the issue of the effectiveness of innovative forms of training in patients with diseases of the cardiovascular system [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. The ever younger age of cardiac patients, the progress of diagnostics and the development of interventional and surgical treatment methods require the gradual introduction of various forms of physical training. Adapting the rehabilitation programs to the possessed skills based on previous experience in the field of activity is becoming a key solution in the selection of training programs in modern cardiac rehabilitation. One such form is indoor cycling. [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is a form of aerobic interval training similar to the traditional training recommended in the second stage of rehabilitation, but with a slightly different course. Participants are not divided into beginners and advanced, because each person during the course of classes can modify loads or positions according to their own abilities [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. The training imitates cycling in two basic types of terrain \u0026ndash; flat and hilly. Riding can take place with and without contact of the arms with the steering wheel, in a sitting and standing position. It is already possible to change the position of the hands (1. Close, 2. Open, 3.Standing), allowing a variety of rehabilitation activities. The techniques used in indoor cycling reflect road cycling or in professional cycling sports and are divided into: seated flat (SF) cadence 80\u0026ndash;120 rpm, seated climb (SC) cadence 60\u0026ndash;80 rpm, standing flat (StF) cadence 80\u0026ndash;120 rpm, standing climbing (StC) cadence 60\u0026ndash;80 rpm), combo (Co) cadence 60-80-120 rpm, sprint flat (SpF) and sprint climb (SpC) cadence, maximum 100\u0026ndash;110 rpm. The presented diversity of solutions used during exercise on a bicycle creates the possibility of conducting frequently changing classes in terms of exercise technique. An additional attraction of such training is the use of music, which makes it possible to determine the intensity of the traveled section, as well as its profile. The most frequently used music genres for classes are pop, techno, hip-hop, disco, and reggae.\u003c/p\u003e\n\u003cp\u003eThe purpose of the class determines the profile, which can be:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\"active regeneration\"/pro-health training (50\u0026ndash;65% HRmax),\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\"endurance low/fat burning\" (65\u0026ndash;75% HRmax)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\"endurance\" (75\u0026ndash;90% HRmax)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\"climbing\" (75\u0026ndash;85% HRmax),\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\"interval\" (65\u0026ndash;85% HRmax)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\"challenge\" (85% -100% HRmax)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\"first time/express\" (65\u0026ndash;75% HRmax) [7.8].\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eScientific reports confirm the effective impact of indoor cycling training on cardiovascular and respiratory efficiency, reduction of adipose tissue and the risk of developing cardiovascular diseases in people without cardiovascular diseases [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. The research conducted so far indicates the validity of undertaking research aimed at assessing the use of indoor cycling training as an alternative form to traditional endurance training in the primary and secondary prevention of cardiovascular diseases.\u003c/p\u003e\n\u003cp\u003eDue to the lack of reports on the possibilities of using indoor cycling training\u003c/p\u003e\n\u003cp\u003ein cardiac rehabilitation programs, an experiment was conducted to determine the effect of such training on the level of exercise tolerance and hemodynamic indices of the left ventricle in patients after a heart attack.\u003c/p\u003e\n\u003cp\u003eThe following research questions were formulated:\u003c/p\u003e\n\u003cp\u003e1. Can indoor cycling training, like standard endurance training, improve exercise tolerance (assessed by an exercise test) and change hemodynamic indicators of the left ventricle (assessed by echocardiography) and lipid profile (assessed using a laboratory method) in patients after myocardial infarction?\u003c/p\u003e\n\u003cp\u003e2. Can indoor cycling training be an alternative to standard endurance training commonly used in stage II rehabilitation?\u003c/p\u003e\n\u003cp\u003eHypotheses\u003c/p\u003e\n\u003cp\u003e1. Indoor cycling training may improve exercise tolerance, left ventricular hemodynamic indices and the lipid profile of patients\u003c/p\u003e\n\u003cp\u003eafter a heart attack.\u003c/p\u003e\n\u003cp\u003e2. Indoor cycling training can be an alternative to standard endurance training used during the second stage of cardiac rehabilitation.\u003c/p\u003e"},{"header":"2. Material And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 64 men (51.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.02 years), after myocardial infarction, who underwent percutaneous coronary angioplasty. The tests were performed during the second stage of rehabilitation. All participants of the experiment were qualified for model A (exercise test result\u0026thinsp;\u0026ge;\u0026thinsp;7 MET or 100 W). Reducing the number of confounding factors, such as age, sex, disease entity, treatment method, and level of exercise tolerance, patients included in the study were randomized to two rehabilitation procedures:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003estandard rehabilitation (group ST) \u0026ndash; 32 people\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eindoor cycling training (group IC) \u0026ndash; 32 people\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe characteristics of the subjects are presented in Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eInclusion criteria: consent to participate in the study, documented stable ischemic heart disease or an uncomplicated course of myocardial infarction, time from the last cardiovascular event\u0026thinsp;\u0026lt;\u0026thinsp;2 months, stress test result\u0026thinsp;\u0026ge;\u0026thinsp;7 MET/100 W, left ventricular ejection fraction (LVEF)\u0026thinsp;\u0026ge;\u0026thinsp;50%. Exclusion criteria: refusal to participate in the study, recent myocardial infarction, LVEF\u0026thinsp;\u0026lt;\u0026thinsp;50%, coronary artery bypass surgery, unregulated hypertension, unstable coronary artery disease, arrhythmias and conduction disturbances, established cancer, diseases of the central or peripheral nervous system, varicose veins of the lower limbs, osteoarthritis of the peripheral joints and the spine, unhealed injuries of the lower limbs, advanced peripheral arteriosclerosis, age\u0026thinsp;\u0026ge;\u0026thinsp;75 and incomplete medical documentation\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of both groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup IC\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup ST\u003c/p\u003e\n\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge [years]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e\n\u003cp\u003e(38\u0026ndash;74)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45\u003c/p\u003e\n\u003cp\u003e(41\u0026ndash;72)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHeight [cm]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e177\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e\n\u003cp\u003e(169\u0026ndash;189)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e178.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e\n\u003cp\u003e(163\u0026ndash;188)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWeight [kg]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85.65\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e\n\u003cp\u003e(72\u0026ndash;101)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e86.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.22\u003c/p\u003e\n\u003cp\u003e(66.90-111.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBMI [kg/m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\n\u003cp\u003e(22.28\u0026ndash;33.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e\n\u003cp\u003e(22.80-31.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVEF [%]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e\n\u003cp\u003e(51\u0026ndash;59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\n\u003cp\u003e(52\u0026ndash;58)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eBMI \u0026ndash;body mass index, N \u0026ndash; number, LVEF \u0026ndash; left ventricular ejection fraction\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDisease entities occurring in patients of both groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup IC\u003c/p\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup ST\u003c/p\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIschemic heart disease\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(84.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(87.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType 2 diabetes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(18.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHyperlipidemia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(28.12%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(34.37%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(43.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(56.25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMyocardial infarction\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eIschemic disease and myocardial infarction were dominant in both groups\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eType of myocardial infarction\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup IC\u003c/p\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup ST\u003c/p\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNSTEMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26(81.25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(87.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSTEMI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(18.75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(12.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eNSTEMI \u0026ndash; non-ST elevation myocardial infarction, STEMI \u0026ndash; ST elevation myocardial infarction\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNumber of implanted stents\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup IC\u003c/p\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup ST\u003c/p\u003e\n\u003cp\u003eN(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27(84.37%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(87.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4(12.51%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(12.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026ge;\u0026thinsp;3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(3.12%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eImplantation of 1 stent was predominant in all groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Experimental Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003cp\u003eBoth the standard group and the IC group were subjected to a 24-day improvement program, which included 22 training units (2 days for initial and final tests) performed 5 times a week following ESC standards (a detailed training program is presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e. Throughout the entire research procedure, the patients were supervised by medical personnel consisting of a physiotherapist and a cardiologist.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eTraining following ESC recommendations\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType of training\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMethodology\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWorkload\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEndurance training\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTraining on a bicycle ergometer,\u003c/p\u003e\n\u003cp\u003e5 times a week\u003c/p\u003e\n\u003cp\u003e30 minutes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eWorkload applied on the basis of calculation of heart rate training, starting from 60% of heart rate reserve increased by 10% after\u003c/p\u003e\n\u003cp\u003e5 units of training,\u003c/p\u003e\n\u003cp\u003eto 80 % of heart rate reserve,\u003c/p\u003e\n\u003cp\u003e14 degrees of subjective scale\u003c/p\u003e\n\u003cp\u003eeffort assessment by the Borg scale\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eResistance training\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExercises in the form of\u003c/p\u003e\n\u003cp\u003etraining station,\u003c/p\u003e\n\u003cp\u003e5 times a week\u003c/p\u003e\n\u003cp\u003e30 minutes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral exercises\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExercises in the gym \u0026ndash;\u003c/p\u003e\n\u003cp\u003eelements of aerobic and anaerobic training, stretching, breathing exercises,\u003c/p\u003e\n\u003cp\u003e5 times a week\u003c/p\u003e\n\u003cp\u003e30 minutes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe intensity of the exercise varied on the basis of the calculated training heart rate, starting from 60% of the heart rate reserve, increasing by 10% after 5 training units, up to 80% of the heart rate reserve, up to a maximum of 15 according to the Borg scale.\u003c/p\u003e\n\u003cp\u003eEndurance training on a bicycle ergometer (Kettler Ergometer X1) began with a 3-minute ride without load (0 W), followed by 5 cycles \u0026ndash; a 3-minute load phase and a 2-minute rest phase, a total of 25 minutes of riding. The training session ended with 2 minutes of cycling without load. The training on a bicycle ergometer lasted a total of 30 minutes. After each training unit, stretching of the muscle groups involved during the ride was performed (5 minutes). People from the IC group performed indoor cycling training (Tomahawk I.C.E. Indoor Cycling) instead of the traditional interval training. The training ride lasted 30 minutes in total and started with a 5-minute warm-up with no load, in the rhythm of 100\u0026ndash;110 RPM. The main part included cycling to the rhythm of changing music, including sitting and standing positions, and lasted 22.5 minutes (60\u0026ndash;110 RPM). The main part was followed by a 2.5-minute cool down with a gradually decreasing load. The cycling cadence (RPM) was determined by the rhythm beats (BPM) present in each piece, being an important motivating instrument; moreover, the cadence of the rotation was signaled by the instructor. The unit ended with 5 minutes of stretching of the muscle groups \u0026ndash; the muscles of the chest, back, quadriceps and biceps muscles of the thigh, as well as the buttocks, forearms and arms. The stretching was performed on mats placed on the dance floor. Details of the training protocol are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e. Patients from the experimental group also participated in the other two forms of training (resistance and general improvement), as did the control group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eProtocol of the indoor cycling training unit\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePart of the training session\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTime (min)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBorg scale\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRPM\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePosition/ technique\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWarm-up\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u0026ndash;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u0026ndash;110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition 2 (2\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition 1 \u0026ndash; SF (2\u0026frac12;min)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAppropriate training\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\n\u003cp\u003e10-17.5\u003c/p\u003e\n\u003cp\u003e17.5\u0026ndash;22.5\u003c/p\u003e\n\u003cp\u003e22.5\u0026ndash;27.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u0026ndash;13\u003c/p\u003e\n\u003cp\u003e12\u0026ndash;14\u003c/p\u003e\n\u003cp\u003e13\u0026ndash;14\u003c/p\u003e\n\u003cp\u003e11\u0026ndash;12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003cp\u003e100\u0026ndash;110\u003c/p\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003cp\u003e60\u0026ndash;80\u003c/p\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003cp\u003e60\u0026ndash;80\u003c/p\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003cp\u003e60\u0026ndash;80\u003c/p\u003e\n\u003cp\u003e100\u0026ndash;110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition ja 1 (2 min)\u003c/p\u003e\n\u003cp\u003ePosition a 2 (2 min)\u003c/p\u003e\n\u003cp\u003ePosition a 2 \u0026ndash; SC (1min)\u003c/p\u003e\n\u003cp\u003ePosition a 3 \u0026ndash; StC (\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition a 1 (2\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition a 2 (2\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition a 3 StC (\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition 1 (1\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition ja 2 \u0026ndash; SC (1min)\u003c/p\u003e\n\u003cp\u003ePosition 2 (3\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition 3 \u0026ndash; StC (\u0026frac12;min)\u003c/p\u003e\n\u003cp\u003ePosition 2 (2min)\u003c/p\u003e\n\u003cp\u003ePosition a 2 \u0026ndash; SC (2min)\u003c/p\u003e\n\u003cp\u003ePosition a 2 (1min)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCool down\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.5\u0026ndash;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u0026ndash;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition a 1 \u0026ndash; SF\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eStretching\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003emin \u0026ndash; minute, position1 \u0026ndash; close, position 2 \u0026ndash; open, position 3 \u0026ndash; standing,\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eRPM \u0026ndash; revolutions per minute, SC \u0026ndash; seated climb, SF \u0026ndash; seated flat, StC \u0026ndash; standing climb, StF \u0026ndash; standing flat\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe following was carried out before commencing the training program and immediately after its completion:\u003c/p\u003e\n\u003cp\u003e- Electrocardiographic exercise test on a treadmill (six-stage Bruce protocol: stage 1\u0026thinsp;=\u0026thinsp;2.7 km/h, 10%, stage 2\u0026thinsp;=\u0026thinsp;4.0 km/h, 12%, stage 3\u0026thinsp;=\u0026thinsp;5.5 km/h, 14%, stage 4\u0026thinsp;=\u0026thinsp;6.8 km/h, 16%, stage 5\u0026thinsp;=\u0026thinsp;8.0 km/h, 18%, stage 6\u0026thinsp;=\u0026thinsp;8.8 km/h, 20%) Exercise test using the Excalibur Sport cycle\u0026nbsp;ergometer (Lode, Groningen, The Netherlands) [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. The following were measured: test duration (min), distance covered (m), energy cost (MET), heart rate at rest and maximum (BPM), systemic blood pressure at rest and maximum (mmHg), criteria for ending the test (physiological: submaximum heart rate, i.e., 85% of HRmax determined on the basis of the following formula: 208-0.7x age or fatigue; pathological: stenocardial pain, ST segment, and T-wave changes, rhythm and/or conduction disorders, blood pressure increase above 250/120 mmHg), maximum oxygen uptake (VO\u003csub\u003e2\u003c/sub\u003emax).\u003c/p\u003e\n\u003cp\u003e- Two-dimensional ultrasound heart test, measured hemodynamic parameters (GE Vivid Q): left ventricular end-diastolic dimension (LVEDD; mm), left ventricular end-systolic dimension (LVESD; mm), left ventricular end-systolic volume (LVESV; mL) as per the following formula:\u003c/p\u003e\n\u003cp\u003eLVESV\u0026thinsp;=\u0026thinsp;7/(2.4\u0026thinsp;+\u0026thinsp;LVESD) - (LVESD), left ventricular end-diastolic volume (LVEDV; mL) as per the following formula: LVEDV\u0026thinsp;=\u0026thinsp;7/(2.4\u0026thinsp;+\u0026thinsp;LVEDD) - (LVEDD), left ventricular ejection fraction (LVEF; %), left ventricular mass (LVM; g), left ventricular mass index (LVMI; g/m\u003csup\u003e2\u003c/sup\u003e) based on the Devereux formula: LVMI\u0026thinsp;=\u0026thinsp;LVM/BSA (left ventricular mass/body surface area)\u003c/p\u003e\n\u003cp\u003e- Blood lipid profile test. Measured parameters: Total cholesterol \u0026ndash; TC (mg/dL), high-density lipoproteins - HDL (mg/dL), low-density lipoproteins \u0026ndash; LDL (mg/dL), triglycerides \u0026ndash; TG (mg/dL)\u003c/p\u003e\n\u003cp\u003eBefore, during and immediately after each training session, heart rate (Polar, FT1) and blood pressure (SOHO, 110 HS-50A) measurements were made, as well as the degree of perception of effort according to the 20-point Borg scale. The intensity of the exercise varied on the basis of the calculated training heart rate, starting from 60% of the heart rate reserve, increasing by 10% after 5 training units, up to 80% of the heart rate reserve, up to a maximum of 15 according to the Borg scale.\u003c/p\u003e\n\u003cp\u003eThe following was carried out before commencing the training program and immediately after its completion:\u003c/p\u003e\n\u003cp\u003e- Electrocardiographic exercise test on a treadmill (six-stage Bruce protocol: stage 1\u0026thinsp;=\u0026thinsp;2.7 km/h, 10%, stage 2\u0026thinsp;=\u0026thinsp;4.0 km/h, 12%, stage 3\u0026thinsp;=\u0026thinsp;5.5 km/h, 14%, stage 4\u0026thinsp;=\u0026thinsp;6.8 km/h, 16%, stage 5\u0026thinsp;=\u0026thinsp;8.0 km/h, 18%, stage 6\u0026thinsp;=\u0026thinsp;8.8 km/h, 20%) Exercise test using the Excalibur Sport cycle ergometer (Lode, Groningen, The Netherlands)[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. The following were measured: test duration (min), distance covered (m), energy cost (MET), heart rate at rest and maximum (BPM), systemic blood pressure at rest and maximum (mmHg), criteria for ending the test (physiological: submaximum heart rate, i.e., 85% of HRmax determined on the basis of the following formula 208-0.7x age or fatigue; pathological: stenocardial pain, ST segment, and T-wave changes, rhythm and/or conduction disorders, blood pressure increase above 250/120 mmHg), VO\u003csub\u003e2\u003c/sub\u003emax.\u003c/p\u003e\n\u003cp\u003e- Two-dimensional ultrasound heart test, measured hemodynamic parameters (GE Vivid Q): LVEDD (mm), LVESD (mm), LVESV (mL) as per the following formula:\u003c/p\u003e\n\u003cp\u003eLVESV\u0026thinsp;=\u0026thinsp;7/(2.4\u0026thinsp;+\u0026thinsp;LVESD) - (LVESD), LVEDV (mL) as per the following formula: LVEDV\u0026thinsp;=\u0026thinsp;7/(2.4\u0026thinsp;+\u0026thinsp;LVEDD) - (LVEDD), LVEF (%), left ventricular mass (LVM; g), left ventricular mass index (LVMI; g/m\u003csup\u003e2\u003c/sup\u003e) based on the Devereux formula: LVMI\u0026thinsp;=\u0026thinsp;LVM/BSA (left ventricular mass/body surface area)\u003c/p\u003e\n\u003cp\u003e- Blood lipid test profile. Measured parameters:\u003c/p\u003e\n\u003cp\u003etotal cholesterol \u0026ndash; TC (mg/dL), high-density lipoproteins \u0026ndash; HDL (mg/dL), low-density lipoproteins \u0026ndash; LDL (mg/dL), triglycerides \u0026ndash; TG (mg/dL) [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003cp\u003eThe Shapiro\u0026ndash;Wilk normality test and the Brown\u0026ndash;Forsythe variance homogeneity test were used to verify the assumptions of parametric tests. The parametric Student\u0026rsquo;s t-test was also performed for dependent variables whose distribution conformed to a normal distribution, and a nonparametric Wilcoxon paired order test was performed for dependent variables whose distribution did not conform to a normal distribution. Student\u0026rsquo;s t-test was also performed for independent variables whose distribution conformed to a normal distribution, and its nonparametric equivalent. The Mann\u0026ndash;Whitney U-test was performed for independent variables whose distribution did not conform to a normal distribution. Statistica 12 (StatSoft, Krak\u0026oacute;w, Poland) software was used in the study. The assumed level of significance was p _ 0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e shows the results for the two test groups of the treadmill exercise test as per the classical Bruce protocol. In both analyzed groups, after the completion of the rehabilitation programs, a statistically significant increase in test duration, energy cost (MET) and VO\u003csub\u003e2\u003c/sub\u003emax was demonstrated in relation to the baseline test.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eResults of the treadmill exercise test in three groups of patients before (I) and at the end (II) of cardiac rehabilitation\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIC group\u003c/p\u003e\n\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eST group\u003c/p\u003e\n\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026Delta; IC vs \u0026Delta; ST\u003c/p\u003e\n\u003cp\u003ep-Value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTime I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTime II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [min]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\n\u003cp\u003e11.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\n\u003cp\u003e2.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\n\u003cp\u003e10.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e\n\u003cp\u003e1.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.772\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMET I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMET II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; MET\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e\n\u003cp\u003e10.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n\u003cp\u003e1.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\n\u003cp\u003e9.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\n\u003cp\u003e1.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.873\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHRrest I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHRrest II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta;[beats/minute]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16\u003c/p\u003e\n\u003cp\u003e65.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.31\u003c/p\u003e\n\u003cp\u003e-1.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.862\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70.11\u0026thinsp;\u0026plusmn;\u0026thinsp;8.15\u003c/p\u003e\n\u003cp\u003e68.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.71\u003c/p\u003e\n\u003cp\u003e-1.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.790\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.899\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHRmax I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHRmax II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [beats/minute]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e128.25\u0026thinsp;\u0026plusmn;\u0026thinsp;14.79\u003c/p\u003e\n\u003cp\u003e133.65\u0026thinsp;\u0026plusmn;\u0026thinsp;16.37\u003c/p\u003e\n\u003cp\u003e5.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.169\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e128.55\u0026thinsp;\u0026plusmn;\u0026thinsp;14.69\u003c/p\u003e\n\u003cp\u003e133.75\u0026thinsp;\u0026plusmn;\u0026thinsp;11.10\u003c/p\u003e\n\u003cp\u003e5.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.264\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.992\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSBPrest I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSBPrest II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mmHg]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124.60\u0026thinsp;\u0026plusmn;\u0026thinsp;11.59\u003c/p\u003e\n\u003cp\u003e125.45\u0026thinsp;\u0026plusmn;\u0026thinsp;18.11\u003c/p\u003e\n\u003cp\u003e0.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.999\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124.40\u0026thinsp;\u0026plusmn;\u0026thinsp;13.96\u003c/p\u003e\n\u003cp\u003e123.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e\n\u003cp\u003e-0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.936\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.914\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDBPrest I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDBPrest II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mmHg]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52\u003c/p\u003e\n\u003cp\u003e81.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26\u003c/p\u003e\n\u003cp\u003e-1.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.984\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16\u003c/p\u003e\n\u003cp\u003e79.34\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.918\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.918\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSBPmax I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSBPmax II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mmHg]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e169.25\u0026thinsp;\u0026plusmn;\u0026thinsp;11.30\u003c/p\u003e\n\u003cp\u003e174.09\u0026thinsp;\u0026plusmn;\u0026thinsp;12.25\u003c/p\u003e\n\u003cp\u003e4.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.663\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e158.50\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\u003c/p\u003e\n\u003cp\u003e162.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.53\u003c/p\u003e\n\u003cp\u003e3.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.730\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.114\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDBPmax I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDBPmax II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mmHg]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e\n\u003cp\u003e82.20\u0026thinsp;\u0026plusmn;\u0026thinsp;9.33\u003c/p\u003e\n\u003cp\u003e-2.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.954\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e\n\u003cp\u003e82.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e\n\u003cp\u003e-1.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.916\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.922\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eVO\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sub\u003e\u003cstrong\u003emax I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVO\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sub\u003e\u003cstrong\u003emax II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [ml/kg/min]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\n\u003cp\u003e39.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e\n\u003cp\u003e1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e\n\u003cp\u003e38.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e\n\u003cp\u003e1.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.167\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eAll data are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and the difference (\u0026Delta; \u0026ndash; delta)\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eMET \u0026ndash; metabolic equivalent, HRrest \u0026ndash; resting heart rate, HRmax \u0026ndash; maximum heart rate, DBPmax \u0026ndash; maximum diastolic blood pressure, DBPrest \u0026ndash; resting diastolic blood pressure, SBPmax \u0026ndash; maximum systolic blood pressure, SBPrest \u0026ndash; resting systolic blood pressure, VO\u003csub\u003e2\u003c/sub\u003emax \u0026ndash; maximal oxygen uptake\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of the echocardiographic examination are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e. In both studied groups, improvement in the analyzed hemodynamic parameters of the left ventricle, however, were not statistically significant. There was also no significant difference in intergroup comparisons.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab8\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eResults of echocardiographic tests carried out before (I) and after (II) the 24-day rehabilitation cycle\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIC group\u003c/p\u003e\n\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eST group\u003c/p\u003e\n\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026Delta; IC vs \u0026Delta; ST\u003c/p\u003e\n\u003cp\u003ep-Value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVEDD I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVEDD II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mm]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e\n\u003cp\u003e50.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.918\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e\n\u003cp\u003e50.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\n\u003cp\u003e0.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.843\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.825\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVESD I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVESD II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mm]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64\u003c/p\u003e\n\u003cp\u003e32.89\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.933\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e\n\u003cp\u003e33.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e\n\u003cp\u003e0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.773\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.818\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVESV I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVESV II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [ml]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.33\u0026thinsp;\u0026plusmn;\u0026thinsp;21.34\u003c/p\u003e\n\u003cp\u003e45.11\u0026thinsp;\u0026plusmn;\u0026thinsp;16.97\u003c/p\u003e\n\u003cp\u003e0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.932\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47.22\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21\u003c/p\u003e\n\u003cp\u003e48.01\u0026thinsp;\u0026plusmn;\u0026thinsp;10.01\u003c/p\u003e\n\u003cp\u003e0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.892\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.899\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVEDV I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVEDV II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [ml]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e116.32\u0026thinsp;\u0026plusmn;\u0026thinsp;22.52\u003c/p\u003e\n\u003cp\u003e117.44\u0026thinsp;\u0026plusmn;\u0026thinsp;14.66\u003c/p\u003e\n\u003cp\u003e1.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.911\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121.12\u0026thinsp;\u0026plusmn;\u0026thinsp;23.22\u003c/p\u003e\n\u003cp\u003e122.43\u0026thinsp;\u0026plusmn;\u0026thinsp;14.38\u003c/p\u003e\n\u003cp\u003e1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.902\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.948\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVSV I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVSV II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [ml]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84.12\u0026thinsp;\u0026plusmn;\u0026thinsp;27.60\u003c/p\u003e\n\u003cp\u003e84.01\u0026thinsp;\u0026plusmn;\u0026thinsp;21.11\u003c/p\u003e\n\u003cp\u003e-0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.991\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e94.92\u0026thinsp;\u0026plusmn;\u0026thinsp;31.43\u003c/p\u003e\n\u003cp\u003e94.12\u0026thinsp;\u0026plusmn;\u0026thinsp;13.34\u003c/p\u003e\n\u003cp\u003e-0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.981\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.932\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVEF I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVEF II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [%]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e\n\u003cp\u003e56.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\n\u003cp\u003e1.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\n\u003cp\u003e55.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e\n\u003cp\u003e1.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.197\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.911\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVM I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVM II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [g]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180.56\u0026thinsp;\u0026plusmn;\u0026thinsp;81.11\u003c/p\u003e\n\u003cp\u003e181.34\u0026thinsp;\u0026plusmn;\u0026thinsp;22.46\u003c/p\u003e\n\u003cp\u003e0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.998\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e191.43\u0026thinsp;\u0026plusmn;\u0026thinsp;19.33\u003c/p\u003e\n\u003cp\u003e192.19\u0026thinsp;\u0026plusmn;\u0026thinsp;23.91\u003c/p\u003e\n\u003cp\u003e0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.935\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.989\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLVMI I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLVMI II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [g/m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e89.64\u0026thinsp;\u0026plusmn;\u0026thinsp;22.45\u003c/p\u003e\n\u003cp\u003e90.33\u0026thinsp;\u0026plusmn;\u0026thinsp;14.36\u003c/p\u003e\n\u003cp\u003e0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.917\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e95.47\u0026thinsp;\u0026plusmn;\u0026thinsp;16.75\u003c/p\u003e\n\u003cp\u003e96.09\u0026thinsp;\u0026plusmn;\u0026thinsp;54.64\u003c/p\u003e\n\u003cp\u003e0.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.933\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.886\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eLVEDD \u0026ndash; left ventricular end-diastolic diameter, LVESD \u0026ndash; left ventricular end-systolic diameter, LVESV \u0026ndash; left\u0026nbsp;ventricular end-systolic volume, LVEDV \u0026ndash; left ventricular end-diastolic volume, LVSV \u0026ndash; left ventricular stroke\u0026nbsp;volume, LVEF \u0026ndash; left ventricular ejection fraction, LVM \u0026ndash; left ventricular mass, LVMI \u0026ndash; left ventricular mass index\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis of changes in the lipid profile (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e ) showed a favorable direction of changes in the values of all assessed indicators. However, these changes did not show statistically significant features.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab9\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eResults of blood lipid profile tests carried out before (I) and after (II) the 24-day rehabilitation cycle.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIC group\u003c/p\u003e\n\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eST group\u003c/p\u003e\n\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026Delta; IC vs \u0026Delta; ST\u003c/p\u003e\n\u003cp\u003ep-Value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTC I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTC II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mg/dl]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e182.24\u0026thinsp;\u0026plusmn;\u0026thinsp;26.41\u003c/p\u003e\n\u003cp\u003e171.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39\u003c/p\u003e\n\u003cp\u003e-10.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.249\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e172.27\u0026thinsp;\u0026plusmn;\u0026thinsp;45.34\u003c/p\u003e\n\u003cp\u003e166.23\u0026thinsp;\u0026plusmn;\u0026thinsp;66.29\u003c/p\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;6.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.113\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.601\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHDL I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHDL II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mg/dl]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.21\u0026thinsp;\u0026plusmn;\u0026thinsp;19.07\u003c/p\u003e\n\u003cp\u003e48.34\u0026thinsp;\u0026plusmn;\u0026thinsp;19.27\u003c/p\u003e\n\u003cp\u003e4.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43.23\u0026thinsp;\u0026plusmn;\u0026thinsp;24.56\u003c/p\u003e\n\u003cp\u003e47.88\u0026thinsp;\u0026plusmn;\u0026thinsp;17.66\u003c/p\u003e\n\u003cp\u003e4.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.893\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLDL I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLDL II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mg/dl]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e111.23\u0026thinsp;\u0026plusmn;\u0026thinsp;19.44\u003c/p\u003e\n\u003cp\u003e99.62\u0026thinsp;\u0026plusmn;\u0026thinsp;26.12\u003c/p\u003e\n\u003cp\u003e-11.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.223\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104.39\u0026thinsp;\u0026plusmn;\u0026thinsp;24.34\u003c/p\u003e\n\u003cp\u003e91.47\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04\u003c/p\u003e\n\u003cp\u003e-12.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.223\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.367\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTG I\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTG II\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Delta; [mg/dl]\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121.35\u0026thinsp;\u0026plusmn;\u0026thinsp;71.37\u003c/p\u003e\n\u003cp\u003e115.15\u0026thinsp;\u0026plusmn;\u0026thinsp;45.32\u003c/p\u003e\n\u003cp\u003e-6.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.815\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126.22\u0026thinsp;\u0026plusmn;\u0026thinsp;21.56\u003c/p\u003e\n\u003cp\u003e119.48\u0026thinsp;\u0026plusmn;\u0026thinsp;14.59\u003c/p\u003e\n\u003cp\u003e-6.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.793\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.829\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eTC \u0026ndash; total cholesterol, HDL \u0026ndash; high-density lipoproteins, LDL \u0026ndash; low-density lipoproteins, TG \u0026ndash; triglycerides.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThere are a small number of publications on the impact of alternative forms of endurance training used in the second stage of rehabilitation on the level of exercise tolerance, hemodynamic parameters of the left ventricle, or the lipid profile of patients after a myocardial infarction [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eNever before has such an assessment been made of indoor cycling training.\u003c/p\u003e\n\u003cp\u003eUntil now, this form was available and associated only with the population of healthy people who attended classes in fitness clubs. It has many features in common with traditional endurance training that has been used for years in a cardiac rehabilitation program. These include: the interval training form, HR-controlled work intensity, the ability to control and dose external resistance, individual or group training form,\u003c/p\u003e\n\u003cp\u003econstant monitoring of vital signs (HR, SpO\u003csub\u003e2\u003c/sub\u003e, blood pressure, Bf), low risk of injury. What makes it stand out is primarily the way it is run. It is possible to ride sitting and standing, as well as to adjust the height of the saddle and handlebars and the distance between the saddle and the handlebars, which makes it an ideal training device for people regardless of their constitutional body build [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. The results obtained after the end of the cardiac rehabilitation program, in which indoor cycling was used, showed that it is a safe, effective and well-tolerated form of endurance exercise, which can be recommended in the process of comprehensive rehabilitation of patients after a heart attack.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Electrocardiographic exercise test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results obtained after 24 days of implementation of the rehabilitation program showed a significant improvement in physical capacity compared to the results obtained before its commencement. In both analyzed groups, i.e. the IC group and the ST group, a significant increase in test duration was obtained (respectively: 9.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02 vs 11.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26 min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and 9.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 vs 10.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22 min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The extension of its duration is an effect that confirms the high effectiveness of the applied rehabilitation models and proves the expected increase in exercise tolerance. Another indicator showing the improvement of the physical capacity of patients, which significantly improved in both studied groups, is metabolic equivalents (MET) (IC group \u0026ndash; 9.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30 vs 10.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23, p\u0026thinsp;=\u0026thinsp;0.006; ST group \u0026ndash; 8.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25 vs 9.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12; p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\n\u003cp\u003eThe myocardial oxygen demand depends on the heart rate, the tension of the left ventricular wall and the contractility of the heart muscle. According to Myers et al. [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e] peak exercise capacity measured in MET is the strongest prognostic factor for the risk of death both among healthy people and those with cardiovascular diseases, including those after myocardial infarction. A favorable increase in the value of MET after the completion of the second stage cardiac rehabilitation program was also observed in the retrospective analysis of the results of 10,671 patients, regardless of their initial level of exercise tolerance. [20,] A similar effect associated with the increase in MET was observed in the evaluation of the effects of hybrid rehabilitation of 125 patients with heart failure [21,]. The increase in MET energy expenditure at a similar level was also demonstrated in the studies by Nowak et al. [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] and Grabara et al. [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e], who also assessed the effectiveness of alternative training methods in cardiac rehabilitation of patients after myocardial infarction. Maximum oxygen uptake (VO\u003csub\u003e2\u003c/sub\u003emax), also referred to as the body's aerobic capacity, is a real measure of exercise tolerance and, at the same time, an indicator of the cardiovascular system efficiency [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. It provides objective information about the clinical condition and factors limiting the possibilities of a cardiac patient [22,]. A maximum oxygen intake of 10 mL/kg/min represents severe heart failure. The minimum level of physical activity assessed via VO\u003csub\u003e2\u003c/sub\u003emax is 40 mL/kg/min. For a person with a sedentary lifestyle, VO\u003csub\u003e2\u003c/sub\u003emax is approximately 30 ml/kg/min. The results of our research showed an increase (about 8%) in the VO\u003csub\u003e2\u003c/sub\u003emax value in both groups (IC group 37.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23 vs 39.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17 ml/kg/min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, ST group: 36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22 vs 38.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44 ml/kg/min; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Endurance training increases oxygen uptake. It is the result of an increased capillary arteriovenous difference and an increase in cardiac output [23,]. In the group of healthy people, the increase in VO\u003csub\u003e2\u003c/sub\u003e max by 8\u0026ndash;15% is the result of properly planned training. The similar increase achieved in our research proves that a properly planned rehabilitation program carried out in a continuous and systematic manner significantly improved the level of physical fitness of patients. This is also confirmed in the research by other authors [24,25,26,27 ]. The intergroup analysis did not show any statistically significant differences in the results of the research in terms of individual indicators.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Echocardiographic Test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe result of myocardial infarction is impairment of the mechanical function of the myocardium and progressive structural changes in the myocardium (called remodeling), which affect all parts of the cardiovascular system equally [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Altered hemodynamic conditions (for instance reduction of left ventricular stroke volume \u0026ndash; LVSV, enhancement of LVEDV) and increased activity of the renin-angiotensin-aldosterone and catecholamines consistently contribute to impaired diastolic function of the heart, thus affecting the systolic function with a reduction in LVEF in total. First of all, the activity of aldosterone leads to the replacement of contractile muscle tissue with an excess of connective tissue with a predominance of collagen, which initially is an adaptive response, and later may take the form of pathological heart failure. [29,] In addition to stimulating the renin-angiotensin-aldosterone system, diabetes mellitus, anterior infarction and its extensive early spread, and persistent occlusion of the intra-infarct artery exacerbate adverse myocardial remodeling. Reconstruction, and, more specifically, enlargement of the left ventricle silhouette may be a significant prognostic factor; therefore the assessment of its dimensions and functions should be routinely performed in most cardiological diseases. The study assessed the indicators of the left ventricle of the heart muscle. There were statistically insignificant increases in mean values of LVEDD, LVESD, LVESV, LVEDV, LVEF, LVMI, LVMI and a slight decrease in LVSV in both rehabilitated groups, which indicates a positive rehabilitation effect. It should be emphasized, however, that it is still ambiguous to determine the impact of physical activity (primarily of the endurance type) on the post-infarction structure and functions of the left ventricle [30, ]. The causes of this problem may include differences in the methodology of research carried out by different authors. The differences in the obtained results may be influenced by factors such as selection of the population, the extent of myocardial infarction, the age of the respondents, the period covered by the observation, measurement techniques and a combination of any of the above-mentioned factors. Similar conclusions were reached by Gates et al. [31,], Belardinelli et al. [32,] and Nowak et al. [33,]. With the exception of the ejection fraction of the left ventricle, they did not observe any significant changes in the diastolic function of the left ventricle under the influence of training, even in relation to physically more or less active patients.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the influence of physical training on the heart has not been clearly explained. Most studies, including ours, failed to demonstrate a significant effect of physical training on the morphological and functional parameters of the left ventricle, or it was found that physical activity only slightly improved them. As in the case of the exercise test, the intergroup analysis showed no statistically significant differences.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Examination of the lipid profile\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncreased levels of total cholesterol and triglycerides are factors in the formation of atherosclerotic lesions in the coronary, cerebral and peripheral vessels. Their concentrations in blood serum are determined heredity, but a significant role in lowering the levels is attributed to lifestyle elements (environmental factors), such as a proper diet and systematic physical activity [34,35,]. Scientific reports confirm the beneficial effect of physical activity on the lipid profile, although it concerns longer observations, e.g. 6 months [32,33 ]. In the case of observations that cover a short period of time, the changes are not statistically significant, which was also the case in our own research. It is also difficult to say whether the reason for the changes observed is the rehabilitation program or the effect of statins. Comparing the results of the tests before and after the start of rehabilitation, the level of the analyzed lipids in both cases was within the normal range, which may be even more indicative of the earlier undertaking of pharmacological treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA limitation of the study was the inclusion of only a single group of patients with a high level of physical capacity\u0026thinsp;\u0026ge;\u0026thinsp;7 MET or \u0026ge;\u0026thinsp;100 W. However, the results, which confirmed the effectiveness of indoor cycling training included in the cardiac rehabilitation program of patients after myocardial infarction, certainly warrant additional studies in this field, which will assess patient groups with lower physical capacity than those included in our study. A second limitation is the inclusion of the male study participants only. This was a select group of patients (see exclusion criteria) and may not be representative of a general cardiac rehabilitation population. Studies involving a large group of participants of both sexes with various levels of physical capacity and clinical status are needed.\u003c/p\u003e\n\u003cp\u003eIn the future, research should also be undertaken to determine which of the indoor cycling techniques and profile is the most appropriate for cardiac patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical recommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndoor cycling training is a form of training that has many features in common with traditional endurance training used in cardiac rehabilitation. The obtained results also showed similarity in terms of changes in exercise tolerance, left ventricular hemodynamics and lipid profile. Therefore, it may be a more interesting and attractive alternative to traditional endurance training in patients after a heart attack.\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eBoth indoor cycling training and standard training have a similar effect on the improvement of exercise tolerance, change of hemodynamic indicators of the left ventricle and the lipid profile in patients after a heart attack.\u003c/li\u003e\n\u003cli\u003eIndoor cycling training can be an alternative to standard endurance training in cardiac rehabilitation.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission of the University Bioethics Commission for scientific research at J.Kukuczka Academy of Physical Education in Katowice (Poland) No. 7/2017 at 18/05/2017\u0026nbsp; was granted for conducting the study.\u003c/p\u003e\n\u003cp\u003eThe study was approved by the local Bioethics Committee and conformed to the standards set by the Declaration of Helsinki. All patients were informed about the type and aim of the study.\u0026nbsp; Written consent to the study was pasted into the appendix. Subjects were told that they may withdraw from the study at any time. The patients did not change their leisure physical activity, and medicaments were not modified during the study.\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Conceptualization, D.G. and Z.N.; methodology, T.G., P.V; software, A.N-L. and D.G; validation, T.G., and U.S.-G.; formal analysis, D.G. and A.P.; investigation, U.S.-G.; Z.N.; resources, D.G. and A.P.; data curation, T.G. and A.N-L. writing\u0026mdash;original draft preparation, A.N.-L.; writing\u0026mdash;review and editing, A.N.-L.; visualization, T.G. and A.P; supervision, T.G. and Z.N., P.V; project administration: U.S.-G.; funding acquisition, D.G. and Z.N. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEl Missiri, A, Amin, SA, Tawfik, I.R, Shabana, A.M. Effect of a 6-week and 12-week cardiac rehabilitation program on heart rate recovery. Egypt Heart J. 2020; 14;72(1):69. doi: 10.1186/s43044-020-00107-8.\u0026nbsp;\u0026nbsp;\u003c/li\u003e\n\u003cli\u003ePrice, K.J., Gordon, B.A., Bird, S.R., Benson, A.C. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? Eur. J. Prev. 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Effects of exercise-based cardiac rehabilitation in patients after percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Sci. Rep. 2017; 7:1\u0026ndash;9 doi: 1038/srep44789.\u003c/li\u003e\n\u003cli\u003eGuazzi, M., Adams, V., Conraads, V., Halle, M., Mezzani, A., Vanhees, L., Arena, R., Fletcher, G.F., Forman, D.E., Kitzman, D.W., Lavie, C.J., Myers, J. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012;126: 2261\u0026ndash;2274 doi: 1161/CIR.0b013e31826fb946.\u003c/li\u003e\n\u003cli\u003eAdams, J., Cline, M., Reed, M., Masters, A., Ehlke, K., Hartman, J. Importance of resistance training for patients after a cardiac event. Bayl. Univ. Med. Cent. 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Heart J. 2003; 24(24): 2213-2220. doi: 10.1016/j.ehj.2003.09.026.\u003c/li\u003e\n\u003cli\u003eBelardinelli, R., Paolini, I., Cianci, G., Piva, R., Georgiou, D., Purcaro, A. Exercise training intervention after coronary angioplasty: The ETICA Trial. J. Am. Coll. Cardiol. 2001; 37(7):1891-1900 doi: 10.1016/s0735-1097(01)01236-0.\u003c/li\u003e\n\u003cli\u003eNowak, Z., Plewa, M., Skowron, M., Osiadlo, G., Markiewicz, A., Kucio, C. Minnesota Leisure Time Physical Activity Questionnaire as an additional tool in clinical assessment of patients undergoing Percutaneous Coronary Interventions. Hum. Kinet. 2010; 23:79-87\u003c/li\u003e\n\u003cli\u003eKinnear, F.J., Lithander, F.E., Searle, A., Bayly, G., Wei, C., Stensel, D.J., Thackray, A.E., Hunt, L., Shield, J.P.H. Reducing cardiovascular disease risk among families with familial hypercholesterolaemia by improving diet and physical activity: a randomised controlled feasibility trial. BMJ Open\u003cstrong\u003e. \u003c/strong\u003e2020\u003cstrong\u003e;\u003c/strong\u003e28,10(12):e044200. doi: 10.1136/bmjopen-2020-044200\u003c/li\u003e\n\u003cli\u003eBouillon, K., Singh-Manoux, A., Jokela, M., Shipley, M.J.; Batty, G.D., Brunner, E.J., Sabia, S., Tab\u0026aacute;k, A.G., Akbaraly, T., Ferrie, J.E., Kivim\u0026auml;ki, M. Decline in low-density lipoprotein cholesterol concentration: lipid-lowering drugs, diet, or physical activity? Evidence from the Whitehall II study 2011;97(11): 923-30.\u0026nbsp;doi: 10.1136/hrt.2010.216309\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Myocardial infarction, cardiac rehabilitation, indoor cycling","lastPublishedDoi":"10.21203/rs.3.rs-505811/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-505811/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eStandard endurance training used from the second stage of cardiac rehabilitation has many common features with indoor cycling training which is used in fitness clubs. In the study, an attempt was made to evaluate the usefulness of this form of training in a 24-day rehabilitation program for patients after myocardial infarction. The study examined a group of 64 patients (51.34 ± 8.02 years) who were divided into two groups: the IC group (32 patients aged 53.40 ± 4.31 years) with indoor cycling training instead of standard endurance training; and the ST group (32 patients aged 55.31 ± 6.45 years) performing standard training. The level of exercise tolerance (cardiopulmonary exercise testing on a treadmill – Bruce's protocol), hemodynamic indicators of the left ventricle (echocardiography) and blood lipid profile (laboratory test) were assessed.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eIn the IC group there was a significant increase in the test duration (9.21 ± 2.02 vs 11.24 ± 1.26 min; p \u0026lt; 0.001), the MET value (9.16 ± 1.30 vs 10.73 ± 1.23; p = 0.006) and VO\u003csub\u003e2\u003c/sub\u003emax (37.27 ± 3.23 vs 39.10 ± 3.17 ml/kg/min; p \u0026lt; 0.001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (9.41 ± 0.39 vs 10.91 ± 2.22; p \u0026lt; 0.001), MET value (8.65 ± 0.25 vs 9.86 ± 1.12; p = 0.002) and VO\u003csub\u003e2\u003c/sub\u003emax (36.89 ± 6.22 vs 38.76 ± 3.44; p \u0026lt; 0.001). No statistically significant changes were found in the hemodynamic indices of the left ventricle and the lipid profile. Also, the intergroup analysis did not show any statistical significance.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eBased on the research results, it was found that indoor cycling training in the second phase of cardiac rehabilitation is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of early cardiac rehabilitation.\u003c/p\u003e","manuscriptTitle":"Indoor cycling training in rehabilitation of patients after myocardial infarction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-06-08 12:37:26","doi":"10.21203/rs.3.rs-505811/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-07-15T10:31:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-07-08T09:06:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"e26d1b76-de78-47fc-b0b3-dae2cf2cd18e","date":"2021-07-05T06:53:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-06-30T06:34:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1ce7e149-0a9c-4699-a0c8-20c99cda63a0","date":"2021-06-21T20:49:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-06-09T00:24:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-06-07T06:20:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-06-07T05:09:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-06-07T05:05:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2021-05-07T16:24:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3fcb87b-5d21-4f83-a1d1-c234dfe26354","owner":[],"postedDate":"June 8th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":4872795,"name":"Sports Medicine and Kinesiology"}],"tags":[],"updatedAt":"2021-11-29T10:55:46+00:00","versionOfRecord":{"articleIdentity":"rs-505811","link":"https://doi.org/10.1186/s13102-021-00379-w","journal":{"identity":"bmc-sports-science-medicine-and-rehabilitation","isVorOnly":false,"title":"BMC Sports Science, Medicine and Rehabilitation"},"publishedOn":"2021-11-29 10:55:46","publishedOnDateReadable":"November 29th, 2021"},"versionCreatedAt":"2021-06-08 12:37:26","video":"","vorDoi":"10.1186/s13102-021-00379-w","vorDoiUrl":"https://doi.org/10.1186/s13102-021-00379-w","workflowStages":[]},"version":"v1","identity":"rs-505811","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-505811","identity":"rs-505811","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}