Factor Associated with Improvement of VO2 Max after Cardiac Rehabilitation in Patients with Coronary Artery Disease Post Revascularization
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Published:
Jun 17, 2025
Keywords:
Body Mass Index, Coronary Artery Disease, Cardiac Rehabilitation, Cardiovascular Diseases, Percutaneous Coronary Intervention, Sedentary Behavior
Main Article Content
Abstract
Aims: This study aimed to assess the association of cardiovascular risk factors and the number of risk factors with improvement of VO2 Max in patients with coronary artery disease (CAD) post-revascularization by Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI) after completing phase II cardiac rehabilitation (CR).
Methods: This was an analytic study with a cross-sectional design. Data were taken retrospectively using secondary data from medical records. The study population was post-revascularization CAD patients who underwent phase II CR at RSUP Dr. Hasan Sadikin Bandung in 2019-2020, and samples were taken by total sampling method. Data were processed with Microsoft Excel 2016 and Statistical Software R version 4.0.0, then presented analytically. The characteristics were described based on age, sex, body mass index, education, occupation, and the number of risk factors. Characteristic data were grouped based on the CABG and PCI interventions obtained. Correlation analysis was conducted to assess the association of age, family history, physical inactivity, smoking, obesity, hypertension, dyslipidemia, and diabetes mellitus risk factors and the number of risk factors with VO2 Max. Data were analyzed with appropriate statistical tests.
Results: The median (range) of improvement of VO2 Max was 6.00 (1.20, 17.73) (ml/kg/min). Smoking was significantly associated with an improvement of VO2 Max (p-value 0.0197), while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. Patients with a total of seven risk factors had the highest improvement of VO2 Max with 12.88 (3.15, 12.90) (ml/kg/minute), followed by patients with a total of six risk factors with 9.84 (1.80, 16.44) (ml/kg/minute). However, the number of risk factors had no significant association with the improvement of VO2 Max.
Conclusion: Smoking as a CVD risk factor was associated with improvement of VO2 Max, while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. The number of risk factors had no significant association with the improvement of VO2 Max.
Methods: This was an analytic study with a cross-sectional design. Data were taken retrospectively using secondary data from medical records. The study population was post-revascularization CAD patients who underwent phase II CR at RSUP Dr. Hasan Sadikin Bandung in 2019-2020, and samples were taken by total sampling method. Data were processed with Microsoft Excel 2016 and Statistical Software R version 4.0.0, then presented analytically. The characteristics were described based on age, sex, body mass index, education, occupation, and the number of risk factors. Characteristic data were grouped based on the CABG and PCI interventions obtained. Correlation analysis was conducted to assess the association of age, family history, physical inactivity, smoking, obesity, hypertension, dyslipidemia, and diabetes mellitus risk factors and the number of risk factors with VO2 Max. Data were analyzed with appropriate statistical tests.
Results: The median (range) of improvement of VO2 Max was 6.00 (1.20, 17.73) (ml/kg/min). Smoking was significantly associated with an improvement of VO2 Max (p-value 0.0197), while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. Patients with a total of seven risk factors had the highest improvement of VO2 Max with 12.88 (3.15, 12.90) (ml/kg/minute), followed by patients with a total of six risk factors with 9.84 (1.80, 16.44) (ml/kg/minute). However, the number of risk factors had no significant association with the improvement of VO2 Max.
Conclusion: Smoking as a CVD risk factor was associated with improvement of VO2 Max, while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. The number of risk factors had no significant association with the improvement of VO2 Max.
Article Details
How to Cite
Nazir, A., Tiksnadi, B. B., & Syahputra, M. R. G. (2025). Factor Associated with Improvement of VO2 Max after Cardiac Rehabilitation in Patients with Coronary Artery Disease Post Revascularization. Indonesian Journal of Physical Medicine and Rehabilitation, 14(1), 1 - 13. https://doi.org/10.36803/indojpmr.v14i1.426
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Original Article
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References
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9. Giuliano C, Parmenter BJ, Baker MK, Mitchell BL, Williams AD, Lyndon K, et al. Cardiac rehabilitation for patients with coronary artery disease: a practical guide to enhance patient outcomes through continuity of care. Clin Med Insights Cardiol. 2017;11:1179546817710028.
10. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420-5.
11. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116(3):329-43.
12. Prabhu NV, Maiya AG, Prabhu NS. Impact of cardiac rehabilitation on functional capacity and physical activity after coronary revascularization: a scientific review. Cardiol Res Pract. 2020;2020:1236968.
13. Ross R, Blair SN, Arena R, Church TS, Després J-P, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24):e653-e99.
14. Kind S, Brighenti-Zogg S, Mundwiler J, Schüpbach U, Leuppi JD, Miedinger D, et al. Factors associated with cardiorespiratory fitness in a Swiss working population. J Sports Med (Hindawi Publ Corp). 2019;2019:5317961.
15. ACSM. ACSM’s guidelines for exercise testing and prescription 10 ed. Philadelphia: Wolters Kluwer; 2018.
16. Hayta E, Korkmaz O. Cardiac rehabilitation increases the reliability of the 6-minute walk test in patients after coronary artery bypass graft surgery. Heart Surg Forum. 2017;20(6):E247-E51.
17. Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;2014(4):CD003331.
18. Mehanna E, Hamik A, Josephson RA. Cardiorespiratory fitness and atherosclerosis: recent data and future directions. Curr Atheroscler Rep. 2016;18(5):26.
19. Fernström M, Fernberg U, Eliason G, Hurtig-Wennlöf A. Aerobic fitness is associated with low cardiovascular disease risk: the impact of lifestyle on early risk factors for atherosclerosis in young healthy Swedish individuals–the Lifestyle, Biomarker, and Atherosclerosis study. Vasc Health Risk Manag. 2017(13):91-9.
20. Yang X, Li Y, Ren X, Xiong X, Wu L, Li J, et al. Effects of exercise-based cardiac rehabilitation in patients after percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Sci Rep. 2017;7(1):44789.
21. Tiksnadi BB, Aziz M, Chesario MS, Renaldi M, Triadi A, Sastradimaja SB, et al. Functional Capacity Improvement Related to Inflammatory Marker Reduction After Phase II Cardiac Rehabilitation Program in Postrevascularization Coronary Artery Disease Patients. ACI (Acta Cardiol Indones). 2018;5(1):19-34.
22. Putra YVC. Survey of VO2 Max Smoker and Non-Smoker Levels in High School Students. JPESR. 2018;7(3):120-3.
23. Nikolakaros G, Vahlberg T. Obesity, underweight, and smoking are associated with worse cardiorespiratory fitness in Finnish healthy young men: a population-based study. Front Public Health. 2017;5:206.
24. Su F-Y, Wang S-H, Lu HH-S, Lin G-M. Association of tobacco smoking with physical fitness of military males in Taiwan: the CHIEF study. Can Respir J. 2020;2020:5968189.
25. Grote J, Dall P, Oltmanns K, Stolp W. The effect of increased blood carbon monoxide levels on the hemoglobin oxygen affinity during pregnancy. Adv Exp Med Biol. 1994;345:145-50.
26. Lee C-L, Chang W-D. The effects of cigarette smoking on aerobic and anaerobic capacity and heart rate variability among female university students. Int J Womens Health. 2013;5:667-79.
27. Silva LR, Cavaglieri C, Lopes WA, Pizzi J, Coelho-e-Silva MJ, Leite N. Endothelial wall thickness, cardiorespiratory fitness and inflammatory markers in obese and non-obese adolescents. Braz J Phys Ther. 2014;18(1):47-55.
28. Kim C-H, Wheatley CM, Behnia M, Johnson BD. The effect of aging on relationships between lean body mass and VO2max in rowers. PLoS One. 2016;11(8):e0160275.
29. Bryantara OF. Faktor yang berhubungan dengan kebugaran jasmani vo2maks atlet sepakbola. JBE. 2016;4(2):237-49.
30. Noor S, Kinanti RG, Andiana O. Korelasi Obesitas Sentral dan Tingkat VO 2 Maks pada Pria di Kota Malang. J Sport Science. 2017;7(1):1-11.
31. Tayade PT, Chitta SS, Rode MV, Phatak MS. Correlation between glycated haemoglobin (Hba1c) and VO2 Max. In type-2 diabetic subjects in Central India: a cross sectional study. IOSR J Dent Med Sci. 2017;16:41-6.
32. Ramos AM, Alves JCC, de S Vale RG, Scudese E, Senna GW, Cabral RH, et al. Maximum Oxygen Intake in Hypertensive Women Submitted to Combined Training Programs with Different Orders. J Exerc Physiol Online. 2019;22(2).
2. Pusat Data dan Informasi Kemeterian Kesehatan RI. Situasi Kesehatan Jantung. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI. Jakarta; 2014.
3. Ambrose JA, Singh M. Pathophysiology of coronary artery disease leading to acute coronary syndromes. F1000Prime Rep. 2015;7:08.
4. Mendis S, Puska P, Organization WH. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization; 2011.
5. Brown JC, Gerhardt TE, Kwon E. Risk factors for coronary artery disease. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
6. Hussain MA, Al Mamun A, Peters SA, Woodward M, Huxley RR. The burden of cardiovascular disease attributable to major modifiable risk factors in Indonesia. J Epidemiol. 2016;26(10):515-21.
7. Zhai C, Cong H, Hou K, Hu Y, Zhang J, Zhang Y. Clinical outcome comparison of percutaneous coronary intervention and bypass surgery in diabetic patients with coronary artery disease: a meta-analysis of randomized controlled trials and observational studies. Diabetol Metab Syndr. 2019;11:110.
8. Fatima K, Yousuf-Ul-Islam M, Ansari M, Bawany FI, Khan MS, Khetpal A, et al. Comparison of the Postprocedural Quality of Life between Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention: A Systematic Review. Cardiol Res Pract. 2016;2016:7842514.
9. Giuliano C, Parmenter BJ, Baker MK, Mitchell BL, Williams AD, Lyndon K, et al. Cardiac rehabilitation for patients with coronary artery disease: a practical guide to enhance patient outcomes through continuity of care. Clin Med Insights Cardiol. 2017;11:1179546817710028.
10. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420-5.
11. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007;116(3):329-43.
12. Prabhu NV, Maiya AG, Prabhu NS. Impact of cardiac rehabilitation on functional capacity and physical activity after coronary revascularization: a scientific review. Cardiol Res Pract. 2020;2020:1236968.
13. Ross R, Blair SN, Arena R, Church TS, Després J-P, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24):e653-e99.
14. Kind S, Brighenti-Zogg S, Mundwiler J, Schüpbach U, Leuppi JD, Miedinger D, et al. Factors associated with cardiorespiratory fitness in a Swiss working population. J Sports Med (Hindawi Publ Corp). 2019;2019:5317961.
15. ACSM. ACSM’s guidelines for exercise testing and prescription 10 ed. Philadelphia: Wolters Kluwer; 2018.
16. Hayta E, Korkmaz O. Cardiac rehabilitation increases the reliability of the 6-minute walk test in patients after coronary artery bypass graft surgery. Heart Surg Forum. 2017;20(6):E247-E51.
17. Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;2014(4):CD003331.
18. Mehanna E, Hamik A, Josephson RA. Cardiorespiratory fitness and atherosclerosis: recent data and future directions. Curr Atheroscler Rep. 2016;18(5):26.
19. Fernström M, Fernberg U, Eliason G, Hurtig-Wennlöf A. Aerobic fitness is associated with low cardiovascular disease risk: the impact of lifestyle on early risk factors for atherosclerosis in young healthy Swedish individuals–the Lifestyle, Biomarker, and Atherosclerosis study. Vasc Health Risk Manag. 2017(13):91-9.
20. Yang X, Li Y, Ren X, Xiong X, Wu L, Li J, et al. Effects of exercise-based cardiac rehabilitation in patients after percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Sci Rep. 2017;7(1):44789.
21. Tiksnadi BB, Aziz M, Chesario MS, Renaldi M, Triadi A, Sastradimaja SB, et al. Functional Capacity Improvement Related to Inflammatory Marker Reduction After Phase II Cardiac Rehabilitation Program in Postrevascularization Coronary Artery Disease Patients. ACI (Acta Cardiol Indones). 2018;5(1):19-34.
22. Putra YVC. Survey of VO2 Max Smoker and Non-Smoker Levels in High School Students. JPESR. 2018;7(3):120-3.
23. Nikolakaros G, Vahlberg T. Obesity, underweight, and smoking are associated with worse cardiorespiratory fitness in Finnish healthy young men: a population-based study. Front Public Health. 2017;5:206.
24. Su F-Y, Wang S-H, Lu HH-S, Lin G-M. Association of tobacco smoking with physical fitness of military males in Taiwan: the CHIEF study. Can Respir J. 2020;2020:5968189.
25. Grote J, Dall P, Oltmanns K, Stolp W. The effect of increased blood carbon monoxide levels on the hemoglobin oxygen affinity during pregnancy. Adv Exp Med Biol. 1994;345:145-50.
26. Lee C-L, Chang W-D. The effects of cigarette smoking on aerobic and anaerobic capacity and heart rate variability among female university students. Int J Womens Health. 2013;5:667-79.
27. Silva LR, Cavaglieri C, Lopes WA, Pizzi J, Coelho-e-Silva MJ, Leite N. Endothelial wall thickness, cardiorespiratory fitness and inflammatory markers in obese and non-obese adolescents. Braz J Phys Ther. 2014;18(1):47-55.
28. Kim C-H, Wheatley CM, Behnia M, Johnson BD. The effect of aging on relationships between lean body mass and VO2max in rowers. PLoS One. 2016;11(8):e0160275.
29. Bryantara OF. Faktor yang berhubungan dengan kebugaran jasmani vo2maks atlet sepakbola. JBE. 2016;4(2):237-49.
30. Noor S, Kinanti RG, Andiana O. Korelasi Obesitas Sentral dan Tingkat VO 2 Maks pada Pria di Kota Malang. J Sport Science. 2017;7(1):1-11.
31. Tayade PT, Chitta SS, Rode MV, Phatak MS. Correlation between glycated haemoglobin (Hba1c) and VO2 Max. In type-2 diabetic subjects in Central India: a cross sectional study. IOSR J Dent Med Sci. 2017;16:41-6.
32. Ramos AM, Alves JCC, de S Vale RG, Scudese E, Senna GW, Cabral RH, et al. Maximum Oxygen Intake in Hypertensive Women Submitted to Combined Training Programs with Different Orders. J Exerc Physiol Online. 2019;22(2).