Effectiveness of phase II cardiac rehabilitation on lower limb function in patients after coronary artery bypass graft (CABG) surgery.

INTERVENTION: Patients will be qualified to Phase II cardiac rehabilitation in accordance with the standards of cardiac rehabilitation which is up to 4 weeks after CABG surgery on the basis of an exercise test using the modified Bruce protocol. Participants will be randomised to two groups. One group will take part in the early hospital rehabilitation (3 weeks ‐ this is the overall duration of the program), while the second group will take part in ambulatory rehabilitation (8 weeks). For the group of patients undergoing 3‐week early hospital rehabilitation, rehabilitation sessions will be carried out five times a week. Cardiac rehabilitation is composed of: a) aerobic exercise on a stationary cycle ergometer 3‐5day/week, 30 minutes b) resistance training ‐ 3 days/week, 3 session, 6 different exercises, 15 repetitions at 70% HR, 25 minutes for session c) general development exercises (exercise to increase physical performance) ‐ 5 days/week, 20 different exercises, the intensity selected in accordance with the result of exercise testing (exercises for the upper limbs, lower limbs, breathing exercises), 30 minutes. Physical activity will be carried out in the form of training on cycle ergometer each time to achieve the patient's submaximal heart rate (submaximal heart rate is 85% of maximum heart rate. Maximum heart is calculated using the formula: 220 ‐ age). Exercises take place in a group carried by a physiotherapist. CONDITION: Heart disease PRIMARY OUTCOME: ‐ Composite measure of strength of dorsal and plantar flexors assessed by EMG of gastrocnemius and anterior tibial muscles; ‐ Temperature distribution in lower half of both lower limbs assessed using VarioCam thermal imaging camera; ‐ Venous blood flow in lower limbs assessed by photoplethysmogram; SECONDARY OUTCOME: ‐ Exercise tolerance, assessed by 6MWT. ‐ Quality of life, assessed using SF‐36 and WHOQOL‐BREF ; ‐ physical activity assessment using IPAQ (International Physical Activity Questionnaire) INCLUSION CRITERIA: 1. eligible participants must have coronary heart disease and must have been scheduled to undergo CABG surgery 2. Participants written consent, 3. Age between 50‐70 years, 4. Stable condition, without periods of exacerbations occurring during the 4 weeks from the surgery, before the start of the rehabilitation program, 5. Patients will be qualified to Phase II cardiac rehabilitation in accordance with the standards of cardiac rehabilitation which is up to 4 weeks after CABG surgery on the basis of an exercise test using the modified Bruce protocol 6. Not participating in rehabilitation programs within a year of the start of the study.