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Coronary arteria disease is a status in which plaque builds up inside the coronary arterias which supply blood to the bosom muscles.

This disease is characterized by several symptoms like angina, reduced functional capacity etc. Approximately 1 in 20 topics suffer from coronary arteria disease harmonizing to the American Heart Association. Out of this, work forces are more prone to acquire this disease when compared to females.

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The incidence of this disease is chiefly found among persons of age between 30 to 65. Out of this male to female ratio is 4:1 in India. Among this every 13 patients travel for Coronary Artery Bypass Grafting for every 4 females.

By 2020, harmonizing to the WHO, the figure of Indian citizens deceasing each twelvemonth from bosom disease will transcend 2.4 million, more than twice the figure in 1990. One of every four cardiac patients in the universe will be an Indian.

A high resting bosom rate has been associated with increased cardiovascular disease mortality and increased hazard of sudden decease from unsophisticated myocardial infarction. It is projected that coronary arteria disease mortality rates will duplicate since 1990 -2020, with about 82 % of the addition attributable to the underdeveloped universe.

Regular physical exercising has both indirect and direct effects on the cardiovascular system, both of which can heighten functional capacity and cut down the resting bosom rate in patients with unsophisticated myocardial infarction. Indirect benefits are decrease in cardiovascular hazard factors, beef uping of the skeletal musculuss, and life manner alterations. This in bend gives the direct benefits such as deceleration of resting bosom rate, a decrease of blood force per unit area, and increase in peripheral vascular tone, an enlargement of plasma volume, an addition of myocardial contractility, coronary blood flow, an addition in coronary vass denseness and the threshold for myocardial fibrillation are obtained.

The hazard factors for this disease include Tobacco Smoke, High blood force per unit area, Physical Inactivity, High blood cholesterin, Obesity and Overweight. The normal LDL degree is considered to be in between 70 – 130 mg/dl of blood.

Patients with Coronary Artery Disease have comparatively low degrees of HDL and increased degree of LDL. The addition of incidence to Coronary Artery Disease is found to be increasing with addition in Body Mass Index and besides associate to Body fat distribution.

Several intervention processs are available for handling Coronary Artery Disease such as Transdermal Transluminal Coronary Angioplasty, medicines, stent interpolation etc. But Coronary Artery Bypass Grafting is the most followed process for multiple blocks. This is the beltway of blood by making an Aortic-coronary beltway, thereby reconstructing the normal blood supply to the myocardium.

Fleshiness has a important inauspicious consequence on assorted Coronary Artery Disease. Cardiac rehabilitation is the Procedure of reconstructing psychological, societal and physical maps in people with manifestations of a Heart disease. Cardiac Rehabilitation plan includes the traditional Myocardial Infraction, Coronary Artery Bypass Grafting, Congestive Heart Failure, Heart Transplantation, Exercise induced Ischemia, Peripheral vascular disease, coronary angioplasty, valvular fixs and aged patients.

Phase II cardiac rehabilitation is an out-patient stage of rehabilitation which consists of assorted rehabilitation protocols. Phase II Cardiac Rehabilitation is a medically monitored exercising plan designed for those who have had a recent bosom unwellness or surgery / process. This plan mixes regular physical exercising with hazard factor alteration in order to assist with recovery and beef up the organic structure. Phase II Cardiac Rehabilitation will normally get down anyplace between 1 and 4 hebdomads after being discharged from the infirmary.

Those who have had bosom onslaughts, angina, angioplasty, and stenting normally begin rehabilitation within 1 hebdomad. Those who have had unfastened bosom surgeries by and large start anyplace between 1 and 4 hebdomads after discharge from the infirmary. Normally, the manner is bicycle, treadmill, a rowing machine, a sitting motorcycle ( Nu-Step ) or an upper appendage bike ( Monarch ) . Mode is besides determined by the degree of supervising the Phase II plan utilizations.

1.1 NEED FOR THE STUDY

The stage II cardiac rehabilitation has been proven good for both corpulent and non-obese patients in bettering Body Mass Index, Body fat per centum and quality of life. Circuit Training has been a modern-day attack to heighten and advance an person ‘s functional capacity, particularly in patients with cardiac upsets. This consequence of Circuit preparation incorporated in stage 2 cardiac rehabilitation and its benefits on Body Mass Index, Body fat per centum and Quality of life has been proven. But, there is no survey available to compare the consequence of stage II cardiac rehabilitation between corpulent and non-obese patients. Thus the demand for the survey.

1.2STATEMENT OF PROBLEM

To analyse the consequence of stage II cardiac rehabilitation on organic structure mass index, organic structure fat per centum and quality of life for corpulent and non-obese patients with coronary arteria beltway grafting.

1.3 KEYWORDS

Cardiac rehabilitation

Coronary arteria beltway grafting

Circuit preparation

Fleshiness

1.4OBJECTIVES

1. To happen the consequence of stage II cardiac rehabilitation on Body Mass Index, Body Fat Percentage and Quality of life for corpulent patients with Coronary Artery Bypass Grafting.

2. To happen the consequence of stage II cardiac rehabilitation on Body Mass Index, Body Fat Percentage and Quality of life for non-obese patients Coronary Artery Bypass Grafting.

3. To happen the consequence of stage II cardiac rehabilitation on Body Mass Index, Body Fat Percentage and Quality of life between corpulent and non-obese patients Coronary Artery Bypass Grafting.

1.5HYPOTHESIS

NULL HYPOTHESIS

There is no important difference in BMI, Body fat per centum and Quality Of Life between corpulent and non-obese patients with Coronary Artery Bypass Grafting after stage II cardiac rehabilitation.

ALTERNATE HYPOTHESIS

There is a important difference in Body Mass Index, Body fat per centum and Quality Of Life between corpulent and non-obese patients with Coronary Artery Bypass Grafting after stage II cardiac rehabilitation.

II. REVIEW OF LITERATURE

CARL J LAVIE, MD, FCCP, RICHARD V MILANI, MD ( 1996 )

Modest decreases in BMI, fleshiness and terrible fleshiness occur after cardiac rehabilitation.

ORNISH JOHN 1990, SCHULER ( 1992 )

Increasing grounds suggest that uniting a low fat diet and intense exercising preparation better myocardial perfusion by arrested development of coronary arterial sclerosis.

HARTUNG GH, SQUAIRES WG, GOTTO AM ( 1990 )

Greater effects of exercising preparation on plasma high- strength lipoprotein cholesterin is seen in coronary disease patients

ANDREW JS COAST et Al ( 2000 )

Home based exercising preparation consequences in bettering exercising capacity and in Quality of life.

FLETCHER GF et Al ( 2001 )

Aerobic exercising is clearly good on take downing mortality compared to a sedentary life manner in myocardial infarction patients.

WENGER NK et Al ( 1995 )

Aerobic exercisings after myocardial infarction improves exercising tolerance, coronary hazard factors, psychological well being and wellness related Quality of life

HAENNEL RG ( 1991 )

Suggested that good being structured, decently supervised circuit preparation plans can be safe and good for patients after coronary arteria beltway grafting.

JIM MERILL ( 1997 )

Phase 2, out- patient preparation with light dumbbells and elastic sets, has been successfully initiated every bit early as 3 to 8 hebdomads after a myocardial infarction or coronary arteria beltway grafting

DENDALE P et Al ( 1992 )

The incidence of major inauspicious cardiac events and rest enosis were significantly lowered when coronary arteria beltway grafting patients are included in the cardiac rehabilitation plan.

MICHEAL D KENNEDY ( 1983 )

Concluded that there is a important betterment in Quality of life after take parting in cardiac rehabilitation plan.

ELLRAALZ AD ( 1986 )

Concluded that there is an betterment of left ventricular contractile map in patients with coronary arteria beltway grafting after stage 2 cardiac rehabilitation.

MARTIN MORENO V et Al ( 2001 )

Concluded that OMRON HBF 306 proctor satisfies the preciseness standards and proof and is a valid option to cutaneal creases as a method of measuring the patient

G SUN, C FRENCH et Al ( 2005 )

Concluded that DXA and BIA is valid for finding organic structure fat mass

C J LAVIE, MILANI MD ( 1996 )

Concluded that stage 2 cardiac rehabilitation and exercising preparation is effectual in corpulent patients with coronary arteria disease.

WOOD PD ( 1988 )

Concluded that there is a important alteration in plasma lipoids and lipoproteins in fleshy work forces during weight loss through exercising.

YAGESH BHAMBHAMI, GRAY ROWLAND ( 2005 )

Significant alterations were seen in BMI, after circuit preparation in patients with moderate fleshiness.

MARK A ANSHEL ( 2006 )

Concluded that there is important alterations in BMI and organic structure fat per centum after circuit preparation in college pupils

ERIC T, PHILIP A ACHS ( 2000 )

Stated that there is a important alteration in non-obese patients after resisted type circuit preparation.

WILLIAMS P T, KRAURS R M ( 1990 )

Concluded that exercising induced weight loss is effectual in cut downing lipoprotein degree

JOLLIFFE T A, R EESK, TAYLOR R S ( 2005 )

Concluded that exercising based cardiac rehabilitation is really effectual in cut downing lipoprotein degrees

MASKIN C S et Al ( 1986 )

Circuit preparation normally lower the bosom rate, blood force per unit area and lipid degree in cardiac patients

LAVIE C J et Al ( 1996 )

Concluded that stage 2 cardiac rehabilitation is effectual in patients who are overweight.

23. L. BERGFELDT, et al. , ( 1999 )

The physical preparation can be performed without complications in the topics retrieving from an acute coronary event and with a successful alteration of exercising capacity and bosom rate variableness as a consequence.

J.THOMPSON et al. , ( 2009 )

After 12 hebdomads of moderate strength exercisings, the topics decreased with five hazard factors for cardio respiratory disease ; per centum organic structure fat, fasting glucose, LDL cholesterin, systolic blood force per unit area, and sedentary life style.

MARGARET A. MAHER et al. , ( 2003 )

Circuit preparation to cut down one ‘s hazard for cardiovascular disease is strongly recommended in the consensus statement from the centres for Disease control and Prevention and the American College of Sports Medicine.

A.STAHLE et al. , 1999

A regular aerophilic group developing plan me after an acute coronary event can significantly better exercising capacity and modify bosom rate variableness in a prognostically favorable way in aged low-to-intermediate hazard patients, retrieving from an acute coronary event.

KARVONEN M. J et al. , 1957

The mark strength needed to bring on an aerophilic preparation response corresponded to 60 % to 70 % of the person ‘s maximum O consumption.

S.STREUBER et al. , 2009.

The short term aerophilic preparation can favorably modify bosom rate recovery in patients with coronary arteria disease with low exercising capacity.

YOSEFPARDO, M.D. , et al. , 2000

Exercise conditioning improves bosom rate variableness in cardiac patients. It lowers the hazard of sudden cardiac decease via increased pneumogastric tone, which probably beneficially alters ventricular fibrillatory and ischaemic thresholds.

AALOK AGARWALA et al. , 2000

An norm of 10 hebdomads ( scope of 6-12 hebdomads with a mean of 30 Sessionss ) of exercising preparation should be prescribed in patients post cardiac events to accomplish similar consequences in bosom rate variableness.

L. BERGFELDT, et al. , 1999

The physical preparation can be performed without complications in the topics retrieving from an acute coronary event and with a successful alteration of exercising capacity and bosom rate variableness as a consequence.

IMAI K, et al. , 1994.

Heart Rate Recovery is correlated with pneumogastric reactivation, which is thought to be chiefly of import during the first minute after exercising. Because increased pneumogastric tone is associated with decreased hazard of decease among people with and without cardiovascular disease.

M.PUHAN, et.al. 2005.

Resistance preparation should be routinely incorporated in

Cardiac rehabilitation. It improves musculus failing and wasting.

R.GOSSELINK, 2002.

Whole organic structure endurance preparation at a high strength resulted in important betterments in quality of life, exercising and peripheral musculus force in CABG patients.

ORTEGA F, Toral J.

The combination of strength and endurance preparation seems an equal preparation scheme for CABG patients.

SARAH BERNARD ; INSTITUTE DE CARDIOLOGIE et.al. ,

Chronic inaction and musculus deconditioning are the of import factors in the loss in musculus mass and strength.

LEVSO, HONVOH F, 1982.

Exercises are a good 1 for the CABG patients and to be bettering the quality of life of CABG patients.

ACSM, ( 1999 ) .

Harmonizing to ACSM ( 1999 ) these recommendation aerobic preparation calls for rhythmical dynamic activity of big musculuss. Performed 3-4 times a hebdomad for 20-30 proceedingss per session at an strength matching to 60-80 % of maximal bosom rate.

ANDREW J ( 1997 )

Moderate strength CWT is safe and can better strength in selected low-risk patients after coronary arteria beltway surgery.

DL BALLOR ( 1988 )

Concluded that weight developing consequences in comparable additions in musculus country and strength for DPE and EO. Adding weight preparation exercising to a thermal limitation plan consequences in care of LBW compared with DO.

MARX, JAMES O ( 2001 )

Significant betterments in muscular public presentation may be attained with either a low-volume single-set plan or a high-volume, periodized multiple-set plan during the first 12 wk of preparation in untrained adult females.

MILLER BJ ( 1994 )

Concluded that circuit preparation has important consequence on cut downing organic structure fat per centum in older work forces.

ACSM ( 1984 )

Concluded that high-intensity, variable-resistance strength preparation produces adaptive betterment in cardiovascular map.

AL HICKS et Al ( 2003 )

Concluded that long-run circuit preparation exercising has important additions in both physical and psychological wellbeing.

Dr. JACK H ( 2004 )

Circuit preparation resulted in improved fittingness and had a positive impact on factors related to quality of life.

DAVID RS, et Al ( 1990 )

In patients with CAD, circuit preparation is effectual method of increasing aerophilic public presentation and strength

JENNIFFER H ( 2003 )

Circuit preparation, can be used as an adjunct to routine therapy, in patients with a history of CAD.

III.METHODOLOGY

3.1 STUDY DESIGN

Comparative Study design

3.2 STUDY Setting

Department of cardiology, K G Hospitals and station alumnus medical institute, Coimbatore

3.3 STUDY DURATION

The continuance of the survey was 6 months

3.4 Sampling Method

All corpulent and non-obese patients with CABG, who are referred to the Department of Physiotherapy, K G Hospital for stage II cardiac rehabilitation, were selected. Among them by utilizing purposive trying method 15 corpulent and non-obese patients with CABG were selected and assigned into Group A and Group B. Group A consists of 15 corpulent patients, Group B consists of 15 non- corpulent patients.

3.5 CRITERIA FOR SELECTION

INCLUSIVE CRITERIA

Corpulent and non- corpulent male patients with and without diabetes mellitus and high blood pressure

Age group between 45-55

Patients who underwent ternary vas CABG

Patients who underwent CABG with warm blood cardioplegia

Non-smoking patients

EXCLUSIVE CRITERIA

Female patients

Patients with acute episodes of myocardial misdemeanor

Patients treated with lipid take downing medicines

Patients who underwent CABG with other methods of cardioplegia.

3.6 DEMOGRAPHIC DATA

NON-OBESE Patients

S NO:

NUMBER OF PATIENTS

Age

Body mass index

BODY FAT PERCENTAGE

Diabetess MELLITUS

High blood pressure

1

3

31

NO

NO

2

1

40

Yes

3

4

35

22

15

NO

NO

4

2

37

Yes

NO

5

5

36

21

17

NO

6

6

20

16

NO

OBESE Patients

S NO:

NUMBER OF PATIENTS

Age

Body mass index

BODY FAT PERCENTAGE

Diabetess MELLITUS

High blood pressure

1

3

31

24

NO

NO

2

2

42

25

NO

3

4

35

28

23

Yes

4

1

32

27

NO

5

2

40

Yes

Yes

6

3

41

26

25

NO

7

5

29

22

NO

Yes

3.7 MEASUREMENT TOOLS

Body Mass Index

Body Fat Percentage

Quality Of Life

3.8 OPERATIONAL TOOLS

Body Fat Analyser ( Omron HBF-306 )

Weighing machine

Inch tape

National Audit Quality Of Life Questionnaire for cardiac rehabilitation

3.9 Procedure

15 corpulent patients were included in Group A and 15 Patients who were non-obese were included in Group B

Each patient ‘s maximal bosom rate was calculated by –

Heart rate ( soap ) = 220-Chronological Age

Targeted bosom rate was calculated utilizing Karvonen ‘s expression –

THR = 60 % to 70 % of maximal bosom rate.

Both the Groups underwent stage 2 cardiac rehabilitation.

The protocol consisted of 3 stages

Warm-up 2. Circuit developing 3. Cool down stage.

Frequency- 2 to 3 times day-to-day

5 Sessionss per hebdomad

Intensity – 60 % -75 % of bosom rate ( soap )

Time – 30 proceedingss of conditioning exercising

10 proceedingss of tune-up

10 proceedingss of cool-down

Type – Aerobic / Endurance preparation in dynamic motion.

WARM UP PHASE

This stage consists of 10 proceedingss of continuance which includes visible radiation exercisings affecting maximal figure of articulations with big musculus groups. Continuous Training is performed at sub-maximal degree of exercising including Free Exercises, Stretching, Calisthenics and Light Isometric Exercises.

CIRCUIT Training

This stage extends up to 30 proceedingss dwelling of 6 Stationss. Each station is attended by the patients for 5 proceedingss of continuance.

Stations

Treadmill

Bicepss curl

Cycling

Lateral arm raise/alternate articulatio genus rise

Measure March

Wall pushup

Out of this treadmill, cycling and measure March is used for cardiovascular endurance and biceps coil, sidelong arm rise and wall imperativeness ups are used for muscular strength endurance development.

Progression

The accent should be on bettering cardiovascular endurance and greater continuance of cardiovascular work may be achieved by persons being encouraged to follow some of the cardiovascular options at even station Numberss.

Station 1 Treadmill – via velocity / Gradient

Station 2 Biceps Curls – via increasing the scope of gesture

Station 3 rhythm – via opposition scene

Station 4 sidelong Arm rise – via increasing scope of gesture

Station 5 measure march – via increasing the tallness of the stairss

Station 6 Wall Press Up – via increasing the scope of gesture

The strength of the MSE constituent may be progressed by presenting dumbbells or opposition sets

Although persons will change well in the sum of cardiovascular work they can accomplish it is suggested that for the treadmill, a walking velocity of 2.5 to 3.0 stat mis per hr can be prescribed with the gradient altered to arouse a bosom response within the mark developing bosom rate scope.

The rhythm, 50 to 55 revolutions per minute is prescribed and the measure height altered to arouse a bosom response within the mark developing bosom rate scope.

The stairss, a stepping velocity between 18 to 24 rhythms per minute is prescribed and the measure height altered to arouse a bosom rate response within the mark developing bosom rate scope.

COOL DOWN PHASE

This stage widen up to 10 proceedingss of continuance. This consists of visible radiation graded exercisings like isometric and big group musculus stretch

3.10 STATISTICAL TOOLS

Paired ‘t ‘ trial

Where,

n = Total figure of topics

SD = Standard divergence

vitamin D = Difference between initial and concluding value

= Mean difference between initial and concluding value.

IV. DATA ANALYSIS AND INTERPRETATION

Table: I

BODY MASS INDEX- PRE TEST AND POST TEST VALUES OF GROUP A

S. NO:

Body mass index

Improvement

Paired ‘t ‘ trial

( P & gt ; 0.05 )

Percentage Difference

Mean

Average difference

Standard divergence

1.

Pre trial

27.5

5

1.33

14.3

17.98 %

2.

Post trial

22.5

From the above tabular array, the deliberate value of ‘t ‘ was greater than the tabulated value of ‘t ‘ ( 1.833 ) at 5 % degree of significance. The consequence showed that there is a important difference in pre and station trial values of BMI in group A.

GRAPH 1

GRAPHICAL REPRESENTATION OF BODY MASS INDEX FOR GROUP A

Table: 2

BODY FAT PERCENTAGE – PRE TEST AND POST TEST VALUES OF GROUP A

S. NO:

Body Fat Percentage

Improvement

Paired ‘t ‘ trial

( P & gt ; 0.05 )

Percentage Difference

Mean

Average difference

Standard divergence

1.

Pre trial

23.3

10.7

0.61

66.9

45.85 %

2.

Post trial

12.6

From the above tabular array, the deliberate value of’t ‘ was greater than the tabulated value of ‘t ‘ ( 1.833 ) at 5 % degree of significance. The consequence showed that there is a important difference in pre and station trial values of Body Fat Percentage in group A.

GRAPH 2

GRAPHICAL REPRESENTATION OF BODY FAT PERCENTAGE FOR GROUP A

Table: 3

Quality OF LIFE – PRE TEST AND POST TEST VALUES OF GROUP A

S. NO:

Quality Of Life

Improvement

Paired ‘t ‘ trial

( P & gt ; 0.05 )

Percentage Difference

Mean

Average difference

Standard divergence

1.

Pre trial

38.7

21.2

1.22

67.4

54.9 %

2.

Post trial

17.5

From the above tabular array, the deliberate value of ‘t ‘ was greater than the tabulated value of ‘t ‘ ( 1.833 ) at 5 % degree of significance. The consequence showed that there is a important difference in pre and station trial values of Quality Of Life in group A.

GRAPH 3

GRAPHICAL REPRESENTATION OF QUALITY OF LIFE FOR GROUP A

Table:4

BODY MASS INDEX- PRE TEST AND POST TEST VALUES OF GROUP B

S. NO:

Body mass index

Improvement

Paired ‘t ‘ trial

( P & gt ; 0.05 )

Percentage Difference

Mean

Average difference

Standard divergence

1.

Pre trial

20.8

1.1

0.99

4.43

5.43 %

2.

Post trial

19.7

From the above tabular array, the deliberate value of ‘t ‘ was greater than the tabulated value of ‘t ‘ ( 1.833 ) at 5 % degree of significance. The consequence showed that there is a important difference in pre and station trial values of BMI in group B.

GRAPH 4

GRAPHICAL REPRESENTATION OF BODY MASS INDEX OF GROUP B

Table:5

BODY FAT PERCENTAGE- PRE TEST AND POST TEST VALUES OF GROUP B

S. NO:

Body Fat Percentage

Improvement

Paired ‘t ‘ trial

( P & gt ; 0.05 )

Percentage Difference

Mean

Average difference

Standard divergence

1.

Pre trial

16.1

4.2

0.83

19.2

25.76 %

2.

Post trial

11.9

From the above tabular array, the deliberate value of ‘t ‘ was greater than the tabulated value of ‘t ‘ ( 1.833 ) at 5 % degree of significance. The consequence showed that there is a important difference in pre and station trial values of Body Fat Percentage in group B.

GRAPH 5

GRAPHICAL REPRESENTATION OF BODY FAT PERCENTAGE OF GROUP B

Table: 6

Quality OF LIFE – PRE TEST AND POST TEST VALUES OF GROUP B

S. NO:

Quality Of Life

Improvement

Paired ‘t ‘ trial

( P & gt ; 0.05 )

Percentage Difference

Mean

Average difference

Standard divergence

1.

Pre trial

38.5

12.3

2.13

22.5

32 %

2.

Post trial

26.2

From the above tabular array, the deliberate value of ‘t ‘ was greater than the tabulated value of ‘t ‘ ( 1.833 ) at 5 % degree of significance. The consequence showed that there is a important difference in pre and station trial values of Quality Of Life in group B.

GRAPH 6

GRAPHICAL REPRESENTATION OF QUALITY OF LIFE OF

GROUP B

GRAPH 7

GRAPHICAL REPRESENTATION OF PERCENTAGE DIFFERENCE BETWEEN GROUP A AND GROUP B FOR BODY MASS INDEX

GRAPH 8

GRAPHICAL REPRESENTATION OF PERCENTAGE DIFFERENCE BETWEEN GROUP A AND GROUP B FOR BODY FAT PERCENTAGE

GRAPH 9

GRAPHICAL REPRESENTATION OF PERCENTAGE DIFFERENCE BETWEEN GROUP A AND GROUP B FOR QUALITY OF LIFE

V. DISCUSSION

Coronary arteria disease is a status in which plaque builds up inside the coronary arterias which supply blood to the bosom. Many patients have to undergo coronary arteria beltway grafting in order to reconstruct equal blood supply to the myocardium. Physiotherapy has to be started prior to the surgery which continues in 4 stages after the surgery. The 2nd stage is the early out-patient stage where the patient is trained for developing both his cardio vascular endurance every bit good as muscular strength.

Having the above statement in head, the focal point of the survey was to measure the comparative effects of a peculiar stage of cardiac rehabilitation on the Body Mass Index, Body Fat Percentage and finally the Quality Of Life in a characteristically diverse population who are corpulent who underwent coronary arteria beltway grafting surgery for coronary arteria disease and compared the same parametric quantities with patients non classified as corpulent.

15 corpulent patients and 15 non-obese patients were taken who underwent CABG, carry throughing the inclusive and sole standards. By purposive trying method they were divided into Group A and Group B, were Group A was corpulent patients and Group B was non-obese patients.

On reexamining assorted literatures between 1960 to 1994, overall per centum of corpulent population has increased from 12.8 % to 22.5 % , where in males it seems to hold from 10.4 % to 19.9 %

Harmonizing to Riyun Jin et al. , 2005, Obesity is a major hazard factor for coronary artery disease formation which is the root cause for myocardial infarction. High degrees of LDL cholesterin history for this ground.

Corpulent acute coronary syndrome patients are hospitalized more often during the first 10 old ages of their unwellness than non-obese patients. They besides tend to increase higher cumulative inmates medical costs, particularly in really corpulent patients. Findingss highlights the chances for curative benefits that aggressive weight direction and secondary bar that may supply this population better result.

Obesity research ( 2002 ) Duke clinical research institute, North Carolina. Kristine Napier. , 2006, concluded that fleshiness is strongly related with the cause for the formation of blocks in the coronary arterias. Peter C Hill et al. , 2008, concluded that about 75 % of patients undergo CABG for the intent of reconstructing equal blood supply to the myocardium.

The correlativity between Body Mass Index, Body Fatness is reasonably strong ; nevertheless the correlativity varies by sex, race and age. For illustration Men and Women can portion the same BMI, but adult females can hold more Body fat than work forces. Similarly, at the same BMI, older people on mean tend to hold more organic structure fat than younger grownups.

Therefore it was of import to retrieve that BMI is non a direct step of organic structure blubber and that BMI is calculated from an person ‘s weight and tallness, where weight includes both musculus and fat. ( Centre for disease Control and Prevention, July 27, 2009 )

Keeping this above statement in head, it was decided to take both BMI, Body fat per centum are two different result steps for the survey.

An increasing proportion of patients undergoing coronary arteria beltway grafting are corpulent and are thought to transport a higher morbidity and mortality in association with surgery, but informations on whether wellness related Quality of Life better likewise after coronary arteria beltway grafting in corpulent and non-obese patients are limited. ( Jarvinan O, World Journal Surgery Feb 2007 )

Subjects with abnormally higher BMI values are prone for CAD to greater extends, harmonizing to Malina R M et al. , 2005. Brochu M et al. , 2000, concluded that Body Fat Percentage has got a direct relation with the incidence of happening of CAD in work forces. Harmonizing to D Caprio L et al. , 1980, Quality Of Life is increased to a greater extend in patients after CABG.

Harmonizing to Marek Farenc et al. , 2006, non corpulent patients have a reduced hazard of developing CAD. Another chief hazard factors predisposing to CAD are high blood pressure and diabetes. Urata H. , 2004, concluded that high blood pressure is a major hazard factor taking to CAD. Harmonizing to Coll Cardiol. , 2003, diabetes is a major hazard factor for unstable CAD.

Phase 2 cardiac rehabilitation is an out-patient stage of rehabilitation which consists of assorted rehabilitation protocols. This normally begins anyplace between 1 and 4 hebdomads after been discharged from the infirmary.

Cardiac rehabilitation and exercising preparation have been proven to hold good effects on coronary bosom disease hazard factors including bettering plasma lipoids, insulin sensitiveness, fleshiness persons, exercising capacity and favourability impacting psychological map, behavioral features and overall Quality of life.

Recent surveies besides have indicated important effects of cardiac rehabilitation on cut downing cardiac mortality even after coronary arteria beltway grafting.

Vibhuthi N Singh et al. , 2008, concluded that stage II cardiac rehabilitation is effectual and safe for patients who had undergone CABG. Lavie C J. , 1997, concluded that stage II cardiac rehabilitation is effectual in cut downing organic structure fat per centum and bettering functional ability of station CABG patients. Lavie C J. , 1996, concluded that stage II cardiac rehabilitation is really effectual in cut downing fat in corpulent patients which is a major hazard factor. Richard V Milani 1998, concluded that stage II cardiac rehabilitation is holding less influence on fat decrease in non corpulent patients but important betterments in exercising capacity.

VI. Decision

Statistical analysis was done utilizing Student paired ‘t ‘ trial which was used to compare between the pre trial and station trial values. The alterations in parametric quantities for both the groups were analyzed by ciphering the per centum difference, which had occurred after the intervention.

The consequences showed that there was a important decrease in BMI ( 17.98 % ) , Body Fat Percentage ( 45.85 % ) and improved Quality Of Life ( 54.9 % ) in corpulent patients. Although alterations occurred in non corpulent patients besides, the decrease in BMI ( 5.48 % ) , Body Fat Percentage ( 25.76 % ) and betterment in Quality of Life ( 32 % ) was non good pronounced as in the corpulent group. So, relatively phase II cardiac rehabilitation in which circuit preparation was included had better effects on Group A ( corpulent patients ) compared to Group B ( non corpulent patients ) .

This survey hence rejects the void hypothesis and supports the alternate hypothesis.

VII. LIMITATION AND RECOMMENDATION

Restriction

Dichotomous variables were chosen for the survey

Heterogeneity of groups

Merely male patients were included

Small sample size

Pre- morbid position of the patients were non taken into history

Merely patients with coronary arteria beltway grafting are taken

Psychological position non evaluated

Dietary form was non considered

Diabetic and Hypertension medicines taken by the patients was an unmanageable factor

Recommendation

Monogenecity of groups to be considered

Female patients can be included for the survey

Larger age group can be considered

Sample size can be increased

Pre-morbid position should be considered

Patients who underwent intervention with Percutaneous Transluminal Angioplasty, Stent Placement or other intercessions for coronary arteria disease can be included for the farther survey

Psychological and Dietary factors can be considered

VIII. BIBLIOGRAPHY

Diaries:

Amodeo C, Messerli FH. Hazard for developing cardiovascular hazard factors: fleshiness. Cardiol Clin 1986 ; 4:47-52

Hubert NB, Feinleib M, McNamara PM, et Al. Obesity as an independent hazard factor for cardiovascular disease: a 26- twelvemonth follow up of participants in the Framingham Heart Study. Circulation 1983 ; 67:968-77

Manson SE, colditz GA, Stamfer MJ, et Al. A prospective survey of fleshiness and hazard of coronary bosom disease in adult females. N Engl J Med 1990 ; 322:882-89

Wood PD, Stephanick ML, Dreon D, et Al. Changes in plasma lipoids and lipoproteins in fleshy work forces during weight loss through dieting as compared with exercising. N Engl J Med 1988 ; 319:1173-79

Williams PT, Krauss RM, Vranizan KM, et Al. Changes in lipoprotein sub fractions during diet-induced and exercise-induced weight loss in reasonably fleshy work forces. Circulation 1990 ; 81:1293-1304

Alpert MA, Terry BE, Kelly DL. Effect of weight loss on cardiac chamber size, wall thickness, and left ventricular map in morbid fleshiness. Am J Cardiol 1985 ; 55:783-86

Squires RW, Gau GT, Miller TD, et Al. Cardiovascular rehabilitation: position, 1990. Mayo Clin Proc 1990 ; 65:731-55

Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercising preparation in secondary coronary bar in the aged. J Am Coll Cardiol 1993 ; 22:678-83

Lavie CJ, Milani RV. Effectss of cardiac rehabilitation and exercising preparation on exercising capacity, coronary hazard factors, behavioral features, and quality of life in adult females. Am J Cardiol 1995 ; 75:340-43

Lavie CJ, Milani RV. Factors foretelling betterments in lipoids following cardiac rehabilitation and exercising preparation. Arch Intern Med 1993 ; 153:982-88

O’Connor GT, Buring JE, Yusef S, et Al. An overview of randomised tests of rehabilitation with exercising after myocardial infarction. Circulation 1989 ; 80:234-44

Oldridge NB, Guyatt GH, Fischer ME, et Al. Cardiac rehabilitation after myocardial infarction, combined experience of randomised clinical tests. JAMA 1988 ; 260:945-50

Colditz GA. Economic costs of fleshiness. Am J Clin Nutr 1992 ; 55 ( suppl 2 ) :503S-07S

American College of Sports Medicine. Guidelines for exercising testing and prescription. 3rd erectile dysfunction. Philadelphia: Lea & A ; Febiger,1986 ; 157-72

Schotte DE, Stunkard AJ. The effects of weight decrease of blood force per unit area in 201 corpulent patients. Arch Intern Med 1990 ; 150:1701-04

Scherrer U, Nussberger J, Torriani S, et Al. Consequence of weight decrease in reasonably fleshy patients on recorded ambulatory blood force per unit area and free cytosolic thrombocyte Ca. Circulation 1991 ; 83:552-58c Lavie CJ, Milani RV.

Effectss of cardiac rehabilitation and exercising preparation to better low-density lipoprotein cholesterin in patients with hypertryglyceridemia and coronary arteria disease. Am J Cardiology 1994 ; 74:1192-9

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Blair SN, Kohl HW III, Barlow CE, et Al. Changes in physical fittingness and all-cause mortality: a prospective survey of healthy and unhealthy work forces. JAMA 1995 ; 273:1093-98

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Books:

ACSM ‘S guidelines for exercising testing and prescription, 6th edition, Lippincott Williams and Wilkinss.

Carolyn Kisner, MS, PT, Therapeutic Exercise Foundation and Techniques, 4th Edition, Jaypee Brothers, Newdelhi 2003.

Donna frownfelter, PT, Dpumat, Cardiovascular and Pulmonary Physical Therapy 4th Edition, Mosby Elsevier Company, Philidelphia 2006.

Ellen A Hillegan, Ed.D, PT CCC, Essentials Of Cardiopulmonary Physical Therapy, 2nd Edition, WA Saunders Company, USA 2000.

Jennifer A Pryor, MBA, Msc, FNZS, Physiotherapy for Respiratory and Cardiac Problems, 3rd Edition, Elseiver, INDIA, 2004.

Jonnathan N Myer, Phd, Essentials Of Cardiopulmonary Exercises Testing, Human Kinetics, USA 1996.

Kothari, CR. Research Methodology Methods and Techniques, edition -1991, Vishwaprakasam, Newdelhi, 2001.

Mandy Smith, MCSP, SRP, Cash Textbook of Cardiovascular Respiratory Physiotherapy, Mosby Elsevier, UK 2005.

Michael I Powllock, Phd, Heart Disease and Rehabilitation, 3rd Edition, Human Kinetics USA 1995.

P.S.S. Sundar Rao and J. Richard, Introduction to Biostatistics, 3rd edition, 2001, Prentice Hall Of India, Pp:77-80.

Rob Hebert, BAppsc, Mappsc, Phd, Practical Evidence Based Physiotherapy, Elsevier, USA 2005.

Robert A, ROBERGS, Phd, FASEP, Fundamental Principles Of Exercise Physiology. The Mc Grawhill Companies USA 2000.

Scott Irwin, DPT, CCS, Cardiopulmonary Physiotherapy, 4th Edition, Mosby Elsevier Company, Philadelphia 2004.

Stuart BA.Porter, Bsc Hons Gard Dip Phys MCSP, SRP Cer MHS, Tidy ‘s Physiotherapy, 13th edition, Elsevier scientific discipline limited, New Delhi 2005.

William vitamin D megahertz cardle, Exercise Physiology, 4th Edition A Wolters Kluwer Company, Baltimori Maryland 1996.

William vitamin E Deturk, PT, Phd, Cardiovascular and Pulmonary Physical Therapy.

IX. APPENDIX

APPENDIX – I

CARDIO PULMONARY ASSESSMENT

DEMOGRAPHIC DATA:

Name: Age:

Sexual activity:

Occupation: Date of admittance:

Height: Date of appraisal:

Weight:

Present complains:

History

Past medical history:

Present medical history:

Family history:

Social history:

Associated jobs:

Critical marks

Blood force per unit area:

Respiratory rate:

Heart rate:

Temperature:

OBJECTIVE ASSESSMENT

On observation:

Built:

Coloring material:

Chest Shape:

Symmetry:

Breathing form:

Respiratory rate:

Chest motion:

Intercostals abjuration:

Periphery/extremities:

Clubbing:

Cyanosis:

Oedema:

Respiratory hurt:

Type of respiration:

Use of accessary musculuss:

Vocal fremitus:

On tactual exploration:

Tracheal divergence:

Chest enlargement

Axillary degree:

Nipple degree:

Xiphoid degree:

Tenderness

Oedema

On scrutiny

On auscultation

Lung sounds:

Breath sounds:

Heart sounds:

Percussion:

Probe

X ray:

Electrocardiogram:

Echocardiogram:

ABG analysis:

Blood trial:

Exercise tolerance:

Diagnosis

APPENDIX II

CHARTS AND QUESTIONAIRE

BMI ( www.weightloss.co.cc )

BODY FAT PERCENTAGE ( www.builtlean.com )

NATIONAL AUDIT CARDIAC REHABILITATION

Quality OF LIFE QUESTIONAIRE ( www.cardiacrehabilitation.org.uk )

PHYSICAL FITNESS During the past hebdomad what was the hardest physical activity you could make far at least 2 proceedingss?

Very heavy 1

Heavy 2

Moderate 3

Light 4

Very light 5

FEELINGS During the past hebdomad how much have you been bothered by emotional jobs such as experiencing dying, down, cranky or downhearted and blue?

Not at all 1

Slightly 2

Reasonably 3

Quite a spot 4

Highly 5

Daily ACTIVITIES During the past hebdomad how much trouble have you had making your usual activities or undertaking, both inside and outside the house because of your physical and emotional wellness?

No trouble at all 1

A small spot of trouble 2

Some trouble 3

Much trouble 4

Could non make 5

SOCIAL ACTIVITIES During the past hebdomad has your physical and emotional wellness limited your societal activities with household, friends, neighbors or groups?

Not at all 1

Slightly 2

Reasonably 3

Quite a spot 4

Highly 5

PAIN During the past hebdomad how much bodily pain have you by and large had?

No hurting 1

Very mild hurting 2

Mild pain 3

Moderate hurting 4

Severe hurting 5

CHANGE IN HEALTH How would you rate your overall wellness now compared to a hebdomad ago?

Much better 1

A small better 2

About the same 3

A small worse 4

Much worse 5

Overall HEALTH During the past hebdomad how would you rate your wellness in general?

Excellent 1

Very good 2

Good 3

Fair 4

Poor 5

SOCIAL SUPPORT During the past hebdomad was person available to assist you if you needed aid?

Equally much as I wanted 1

Quite a spot 2

Some 3

A small 4

Not at all 5

Quality OF LIFE How have things been traveling for you during the past hebdomad?

Very good 1

Reasonably good 2

Good 3

Reasonably bad 4

Very bad 5

APPENDIX III

Machine

BODY FAT ANALYZER ( Omron HBF-306 )

Omron offers a radical new manner of mensurating new manner of mensurating Bioelectric Impedance Analyses that is faster, easier, less intensive and includes a lightweight portable and hand-held device doing this a simple one measure procedure.

Input signal of personal values of tallness, weight, gender and age into the organic structure logic procedure base with both pess somewhat apart.

Keep the clasp electrodes with outstretched arm and wrap in-between finger around the channel in the grip. Put the thenar of manus on the top and bottom electrode. Put pollex up, resting on the unit.

Hold arm straight out at a 90 grade angle to organic structure. Do n’t travel during measuring.

Push the start button. The show starts bend on.

Electrodes in the manus detector tablets send a low, safe signal through the organic structure.

Body fat content and Body mass index is calculated automatically and displayed in 7 seconds.

APPENDIX IV

CONSENT FORM

This is to attest that I, _______________________________ wholly agree to be a topic for the undertaking work “ A STUDY TO ANALYZE THE EFFECT OF PHASE II CARDIAC REHABILITATION ON BODY MASS INDEX, BODY FAT PERCENTAGE AND QUALITY OF LIFE FOR OBESE AND NON-OBESE PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING ” and I assure that I will non originate or undergo any other intervention or coincident exercising plan during the class of this survey.

I own all the duties of my wellness status, if any indecent development happened during the classs of this survey.

Date: Signature of the Patient

Date: Signature of the research worker

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