تأثير تمرينات تركيبي بلند مدت (يوگا - توان‌ بخشي قلبي) بر سطوح افسردگي و اضطراب بيماران جراحي باي‌ پس عروق كرونري

The Effects of Long-Term Yoga and Rehabilitation Combined Training on Depression and Anxiety in Patients Undergoing Coronary Artery Bypass Graft Surgery

زمينه و هدف: بيشتر بيماراني كه جراحي باي‌پس عروق كرونري را تجربه كرده‌اند از اختلالات خلق‌و‌خو رنج مي‌برند؛ بنابراين مطالعهٔ حاضر با هدف بررسي تأثير تمرينات تركيبي بلندمدت (يوگا-توان‌بخشي قلبي) بر سطوح افسردگي و اضطراب بيماران جراحي باي‌پس عروق كرونري انجام شد. روش‌ بررسي: تحقيق حاضر كارآزمايي باليني با پيش‌آزمون و پس‌آزمون بود كه به‌شيوهٔ نيمه‌تجربي در سال 1397 اجرا شد. آزمودني‌ها 27 بيمار مرد 40تا 75ساله بودند كه حداقل يك ‌ماه از جراحي باي‌پس عروق كرونري آن‌ها گذشته بود. آزمودني‌ها در گروه گواه (تمرين توان‌بخشي قلبي 13=n) و گروه آزمايش (تمرين تركيبي يوگا-توان‌بخشي قلبي 14=n) جايگزين شدند. سپس سطوح افسردگي و اضطراب آن‌ها به‌وسيلهٔ چك‌ليست اختلالات روان‌شناختي تجديدنظرشده (دروگاتيس، 1986) در بدو ورود و هنگام خروج از مطالعه ارزيابي شد. آزمودني‌هاي گروه‌هاي‌ گواه و آزمايش به‌مدت هشت هفته در مركز توان‌بخشي قلبي بيمارستان قلب شهيد رجايي تهران به‌ترتيب به 24 جلسهٔ يك‌ساعته تمرين توان‌بخشي قلبي (با شدت 60تا85درصد ضربان قلب بيشينه) و تمرين تركيبي (دوازده جلسه يوگا-دوازده جلسه توان‌بخشي قلبي) پرداختند. با درنظرگرفتن معيارهاي خروج از مطالعه در انتها تعداد آزمودني‌هاي گروه‌هاي گواه و آزمايش، هريك به 7 نفر رسيد. به‌منظور مقايسهٔ درون‌گروهي و بين‌گروهي به‌ترتيب از آزمون‌هاي تي‌ وابسته و تي مستقل در سطح معناداري 0٫05 به‌كمك نرم‌افزار SPSS نسخهٔ 22 استفاده شد. يافته‌ها: بين سطوح افسردگي (0٫595=p) و اضطراب (0٫911=p) دو گروه در مرحلۀ پيش‌‌آزمون و نيز سطوح افسردگي (0٫727=p) و اضطراب (0٫268=p) دو گروه در مرحلۀ پس‌آزمون تفاوت معناداري مشاهده نشد. تمرين توان‌بخشي قلبي بر سطوح افسردگي (0٫002=p) و اضطراب (0٫011=p) بيماران گروه گواه تأثير معناداري داشت. تمرين تركيبي نيز بر سطوح افسردگي (0٫006=p) و اضطراب (0٫047=p) بيماران گروه آزمايش داراي تأثير معناداري بود. نتيجه‌گيري: باتوجه به اثربخشي تمرينات بلندمدت توان‌بخشي قلبي و تمرينات تركيبي (يوگا-توان‌بخشي قلبي) در اين مطالعه و نيز ايمني زياد و كم‌هزينه‌بودن تمرينات يوگا، مراكز درماني مي‌توانند باتوجه به امكانات و در صورت تمايل بيماران، تمرينات يوگا را جايگزين بخشي از تمرينات توان‌ بخشي قلبي كنند.

Background & Objectives: Cardiovascular Disease (CVD) is the main reason for morbidity and mortality in developed and developing countries. Among CVDs, coronary artery disease is the most frequent cause of heart disease, especially in the elderly. The most prevalent treatment for CVD is Coronary Artery Bypass Graft (CABG). Most patients that experience this surgery encounter mood disorders. One of the prerequisites for CVD treatment is cardiac rehabilitation, which reduces the risk of cardiac events and improves psychological disorders by physical exercise. However, depression and anxiety are conditions that affect the patient's compliance with medical advice, including cardiac rehabilitation programs. Yoga, as a simultaneous treatment of mind–body, is growing in popularity. Accordingly, the present study was conducted to investigate the effects of long–term combined exercises (yoga–cardiac rehabilitation) on depression and anxiety levels in patients undergoing CABG surgery. Methods: This quasi–experimental study was conducted on 27 male patients (40–75 years old) who experienced CABG surgery at least one month before the research onset in Shahid Rajaie cardiovascular, medical, and research center in Tehran City, Iran, in 2019. They were randomly assigned into the control (Cardiac Rehabilitation Training; CRT, n=13) and experimental (combined yoga–CRT or COMT, n=14) groups. The study inclusion criteria included male gender, the ejection fraction of >35% based on patient's Echocardiography (ECG), the lack of comorbidities, such as kidney failure, diabetes, cancer, and severe neurological disorders, no experience of emergency heart and valve surgery, and not taking drugs for severe psychological disorders. Exclusion criteria included motor disorders that prevent rehabilitation exercises, the lack of regular follow–up and attendance during the training sessions, changes in the patients' ECG, and the aggravation of chest pain. The levels of depression and anxiety were evaluated by a Symptom Checklist–90–Revised (SCL–90–R; Derogatis, 1986) in two stages (before & after interventions). The CTR group performed a one–hour cardiac rehabilitation program with 60%–85% of maximum heart rate for 3 days a week. The COMT group performed a one–hour yoga and cardiac rehabilitation plan for 3 days a week (one session in between, 12 session rehabilitation training, 12 sessions of yoga training). The study subjects completed training sessions for 8 weeks. For understanding yoga training intensity, we used a 20–point scale of Borg’s rate of perceived exertion. The optimal pressure sensation in these patients was considered based on the results of studies equal to 11–13. Subjects who stopped attending the sessions for any reason were excluded from the study (CRT group: n=7; COMT group: n=7). Data analysis was performed using SPSS (α=0.05). The distribution of data related to research variables was studied using Shapiro–Wilk test. Dependent Samples t–test was used for intra–group comparisons and Independent Samples t–test was employed for between– group comparisons. Results: The obtained data suggested no difference between depression (p=0.595) and anxiety (p=0.911) levels in the pretest as well as depression (p=0.727) and anxiety (p=0.268) levels in the posttest between the study groups. Furthermore, we observed a significant reduction in depression (p=0.002) and anxiety (p=0.011) levels in the CRT group. Besides, depression (p=0.006) and anxiety (p=0.047) levels significantly declined in the COMT group. Conclusion: Considering the effectiveness of COMT and CRT interventions in our study, cardiac rehabilitation centers can offer combined training models based on their facilities and patients’ desire post–CABG surgery (i.e., because of the safety and low costs of yoga training).