An exploration of the role of exercise in the secondary prevention of coronary artery disease

Abstract

Background: Exercise may reduce inflammation in coronary artery disease (CAD) patients. However, the molecular mechanisms that orchestrate this cardioprotective effect are yet to be elucidated. Moreover, CAD patient participation rates in cardiac rehabilitation (CR) and long-term exercise are poor. Thus, this thesis aimed to further scientific understanding of the role of exercise in the secondary prevention of CAD by investigating these areas. In addition, the factors that influence CAD patient participation in CR and long-term exercise training were qualitatively explored.

Methods: The evidence generated by randomised studies that investigated the effect of exercise on inflammatory biomarkers in CAD patients was examined by a systematic review and meta-analysis (Study 1). A pilot prospective cohort study (Study 2) was performed in post-acute myocardial infarction (AMI) patients who had been invited to a phase-III CR programme. Finally, Study 3 comprised semi-structured interviews with post-AMI patients and their significant others.

Results: Study 1 demonstrated an anti-inflammatory effect of exercise in CAD patients, as indicated by a reduction in C-reactive protein, fibrinogen, and von Willebrand factor post-intervention. The outcome of Study 2 resulted in a future prospective cohort study being deemed feasible with minor amendment (recruitment strategy). Moreover, preliminary evidence for a beneficial effect of exercise on sirtuin-1 in post-AMI patients was generated. Regarding Study 3, post-AMI patients and their significant others reported that health benefits were the primary motive for participating in CR and long-term exercise, with aspects related to motivation, extrinsic influences, and CR experience underpinning the decision.
Conclusion: The results of Study 1 and Study 2 further scientific understanding of the role of exercise in the secondary prevention of CAD, and offer future directions to stimulate progress in this area. Finally, the novel qualitative findings of Study 3 may inform future strategies to promote patient participation in CR and long-term exercise.

Date of Award	Apr 2021
Original language	English
Sponsors	Department for the Economy
Supervisor	Ciara Hughes (Supervisor), Jacqui Crawford (Supervisor) & Gareth Davison (Supervisor)