Feasibility and Utility of Recumbent Ergometer-Based Cardiopulmonary Exercise Test in Phase 1 Cardiac Rehabilitation...

Background/Objectives: Recent guidelines have emphasized the importance of early mobilization and rehabilitation of patients following cardiac surgery. However, studies on the optimal targets and prescription methods for phase I cardiac rehabilitation (CR) are lacking. This study aimed to evaluate the feasibility and utility of an early phase 1 submaximal cardiopulmonary exercise test (CPET) using a recumbent ergometer in patients who have undergone cardiac surgery. Methods: Twenty ambulatory patients who underwent cardiac surgery between December 2021 and February 2023 were referred to the CR department on the fifth postoperative day, and a CR program was initiated. The program was conducted five times a week, with hour-long sessions consisting of warm-up exercises, resistance training, aerobic exercises, and a cool-down period. A recumbent ergometer-based submaximal CPET was performed approximately nine days after the surgery, prior to discharge. Participants initiated the test at 0 W, and the workload was increased by 20 W after 2 min. During the test, researchers evaluated parameters including submaximal peak values of oxygen consumption (VO₂), metabolic equivalents of task, respiratory exchange ratio (RER), blood pressure, heart rate (HR), and rating of perceived exertion (RPE). The grip strength test, 6 min walk test (6MWT), Korean Activity Scale/Index (KASI), EuroQol-5 dimension (EQ-5D), and short-form 36-item health survey (SF-36) values were also measured prior to discharge. Results: Twenty patients (75% male, average age 62.50 ± 1.99 years) underwent CPET at a median of 9.0 (8.0; 12.5) days postoperative. The average exercise duration of the CPET was 411.75 ± 168.25 s. During the test, their submaximal peak VO₂ was 12.32 ± 0.75 mL/kg/min (corresponding to 46.65 ± 2.08% of VO₂ max). The submaximal peak RER was 1.01 (0.98-1.12), and the submaximal peak RPE was 15.00 ± 0.51. Furthermore, the submaximal peak HR was 111.8 ± 3.76 beats/min (equivalent to 70.95 ± 2.09% of age-predicted maximal HR). After adjustment for age and sex, statistically significant positive correlations were observed between the submaximal peak VO₂ and 6MWT, squat endurance test, KASI, EQ-5D, and the physical component summary (PCS) of the SF-36 questionnaire. The 6MWT, squat endurance test, KASI, and PCS of SF-36 showed a correlation coefficient (r) of 0.522 (p = 0.026), 0.628 (p = 0.005), 0.586 (p = 0.011), and 0.546 (p = 0.019), respectively. No significant cardiac events, such as ST elevation/depression or hemodynamic instability, were observed during the test. Conclusions: Our findings suggest that performing recumbent ergometer-based CPET during early phase 1 CR is safe and feasible. These results highlight the potential of recumbent ergometer-based CPET as a valuable tool for guiding the appropriate prescription of early CR programs following hospital discharge in patients undergoing cardiac surgery.