The role of work simulation tests in a comprehensive cardiac rehabilitation program

One of the goals of a comprehensive cardiac rehabilitation (CR) program is the patient's return to his or her usual activities. The aims of this paper were to implement an occupational evaluation protocol in a CR and to assess patients' hemodynamic responses and ventricular arrhythmias during work simulation tests.

After an 8-week outpatient CR, 132 patients performed work simulation, lifting (MH-L) and carrying (MH-C) tests. ECG, heart rate and blood pressure were constantly monitored.

The comparison of physiological responses during work simulation and a standard exercise testing provided the following results: 1) maximal heart rate, blood pressure and double product values during WS and MH tests were significantly lower (p < 0.001) than those measured during exercise testing; 2) higher (p < 0.001) double product values were achieved during MH-C as compared to MH-L and work simulation; 3) arrhythmias were more frequent during MH-L as compared to exercise test (p < 0.001). The increment of double product was reached much faster during work simulation and MH tests as compared to exercise testing: according to the multivariate analysis this was a predictor of a greater incidence of arrhythmias. The incidence of arrhythmias during work simulation tests and MH was significantly higher in patients with reduced tolerance to effort, valvular replacement, arrhythmias during holter monitoring, low ejection fraction and effort silent ischaemia.

Work simulation test provide a more personal functional assessment, complementary to the exercise testing. It appears particularly useful in patients with higher functional impairment who are at a higher risk of arrhythmias.