Stepwise versus symptom-limited in-hospital mobilisation after acute myocardial infarction

Abstract

This randomised study compared two in-hospital mobilisation models in 232 patients after acute myocardial infarction (AMI). One model comprised seven levels of physical activity with predetermined stepwise increments of activity each day. The other model was symptom-limited and allowed the patients to move about freely from the first day on depending on their symptoms of chest pain, dyspnoea and fatigue. After 7–10 days, a bicycle ergometer test was performed. The patients in the stepwise group spent more days in hospital compared with the symptom-limited group (1129 vs 967 days). There were five in-hospital deaths among the stepwise group and four among the symptom-limited group. Non-fatal reinfarctions occurred in three stepwise mobilised and four symptom-limited patients. During aftercare, more furosemide injections, short-acting nitrates and sedatives were required by the stepwise group. Exercise performance was similar in the two groups. Females rated significantly higher degrees of fatigue and worry than males, irrespective of the group to which they belonged. Symptom-limited mobilisation after AMI appears to be as safe as, and in some respects preferable to, the stepwise model.