الفهرس 
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Abstract
Cardiac Rehabilitation is categorized by the American College of Cardiology as a class IA level of recommendation in the treatment of CAD. Cardiac rehabilitation improves functional capacity in post-MI patients. One of every four MI patients is found to have DM.
Diabetic peripheral neuropathy is one of the major complications of DM. Recent studies show that exercise training can reverse the symptoms and progress of DPN. To our knowledge, no studies have reported whether DPN can alter the results of CR program or not. Therefore, the impact of DPN on patients attending CR program requires further research.
The aim of this study was to define the effect of DPN on the outcome measures of a CR program (phase II) in post-MI patients with type II DM.
The study population consisted of thirty post-MI patients with type II DM. Fifteen patients (exercise group) were enrolled in CR program, while the other fifteen patients (control group) were not enrolled in CR program. Controls were advised to maintain their regular daily living and medications.
The baseline evaluation included: demographic data collection, history taking, clinical examination, electrophysiological studies for detection of DPN, TNS-r to assess DPN severity, DASI questionnaire to assess patients’ physical activity level, 6MWT and symptom limited treadmill EST using Bruce protocol.
The CR program included: First, warm up of 10 minutes of stretching exercises. Second, aerobic exercise training using a treadmill 3 days/week for 8 weeks. Each session lasted from 30 to 60 minutes/session with target heart rate set as 45 – 75% of the heart rate reserve. Third, cool down of 10 minutes of light intensity walking on treadmill.
The follow- up evaluation included: DASI, 6MWT and symptom limited EST to assess METs.
The Outcome measures were DASI, 6MWD, functional capacity in METs, HR, BP and RPP at a given workload.
Electrophysiological studies done to the exercise group showed that 7 patients had DPN and 8 patients didn’t have DPN. Accordingly, patients were divided into 3 groups: Exercise group A: 7 patients with DPN, exercise group B: 8 patients without DPN and control group: 15 patients.
The DASI score at follow-up evaluation significantly increased in groups A (P = 0.018) and B (P = 0.011) compared to baseline evaluation, signifying increase in self-reported functional capacity. No change was found in the control group.
The 6MWD at follow-up evaluation significantly increased in groups A (P=0.002) and B (P<0.001). On the other hand, the 6MWD of the control group significantly decreased (P<0.001).
The functional capacity represented in METs at follow-up evaluation significantly increased in groups A (P=0.002) and B (P<0.001). No change was found in the control group.
The HR at a given workload at follow-up evaluation significantly decreased in groups A (P=0.004) and B (P=0.006). No change was found in the control group.
The SBP at a given workload at follow-up evaluation significantly decreased in groups A (P=0.004) and B (P<0.001). On the other hand, the control group showed significant increase (P=0.010) in SBP at a given workload at follow-up evaluation.
The RPP at a given workload at follow-up evaluation significantly decreased in groups A (P=0.001) and B (P<0.001). On the other hand, the control group showed significant increase (P=0.020) in RPP at a given workload at follow-up evaluation.
There was no significant difference between groups A and B regarding any of the outcome measures of the CR program.