This study aims to evaluate the contrasting effects of circuit training with and without upper and lower limb resistance training on paroxysmal nocturnal dyspnea, functional capacity and endurance on post-CABG patients.

A randomized controlled trial underlined that dynamic strength training dramatically increased peripheral muscular strength and power when combined with endurance training, which may enhance patient prognosis, according to a study done on patients with cardiovascular disease. According to the study, dynamic strength training is therefore advised as a crucial part of cardiovascular rehabilitation. The results showed that strength training was associated with lesser increases in intra-arterial blood pressure and cardiac output, indicating sufficient cardiovascular safety. All things considered, this study questions accepted therapeutic practice and reignites the discussion about the best dynamic strength training. highlighted the importance of lower limb muscle strengthening in an RCT following CABG surgery; Phase II cardiac rehab showed significant gains in lower limb strength and overall physical and cardiorespiratory performance 6 weeks following hospital discharge, as determined by the Short Physical Performance Battery and 6MWT. Although, cardiac rehabilitation following coronary artery bypass graft (CABG), has been shown to increase functional capacity and quality of life. Significant gaps exist in determining the exact exercise prescription for symptom alleviation and functional recovery. Existing researches primarily focused on conventional continuous aerobic training (CAT) or the circuit-based training alone, with little attention on targeted upper and lower limb resistance training in clinical settings. Furthermore, the majority of the literature assesses the outcomes such as peak oxygen uptake (V̇O₂max), six-minute walk distance (6-MWD) or general dyspnea scores. While paroxysmal nocturnal dyspnea is clinically significant and unpleasant condition among post-CABG patients, is understudied. Dyspnea is usually examined using non-specific tools and techniques during rehabilitation programs but a few studies used cardiac-specific symptom classification tools in post-CABG rehabilitation. In addition, there is a lack of randomized clinical trials that investigate combined effects of circuit-resistance training in Phase-II cardiac rehabilitation on multiple domains like dyspnea severity, muscle strength, endurance and functional capacity within a single-structured rehabilitation program. Some studies include small sample sizes or shorter study durations which limit the validity of the findings and the ability to derive clinically significant conclusions. Furthermore, insufficient information is available from low and middle-income nations where patient characteristics and healthcare resources are differ from those in high-income countries. This emphasizes the importance of doing context-specific to help define evidence based cardiac rehabilitation procedures. Therefore, the current study addresses the gaps by systematically comparing the effects of circuit training with and without targeted upper and lower limb resistance training using a complete set of outcome variables.

Inclusion Criteria:

• • Adult CABG surgery candidates aged between 35 and 65 years who underwent uncomplicated CABG surgery within past 3-6 months.

  • No history of pre-existing pulmonary disease.
  • Clinically stable cardiac status and approval for participation in phase-II cardiac rehabilitation from the cardiac surgeon.
  • Patients that presented with the symptoms of mild to moderate levels of paroxysmal nocturnal dyspnea (PND). (38)
  • Willingness and availability to participate in the phase-II cardiac rehabilitation program for the study duration.
  • Physical ability to perform both upper and lower limb strength training exercise.
  • Absence of pre-existing severe orthopedic limitations that could interfere with the exercise performance.

Exclusion Criteria:

• Uncontrolled hypertension, cardiac arrhythmias or any unstable cardiovascular complication that was an absolute contraindication to participate in clinical exercise program.
• Severe pre-existing pulmonary conditions such as COPD or Asthma that could interfere with exercise capacity.
• Severe orthopedic limitations such as arthritis, recent fractures and sternal site infections post-surgery.
• Neurological complications, including stroke, severe neuropathy, balance and coordination abnormalities that could impede physical performance.
• Cognitive impairments that may possibly affect the ability to understand and follow the exercise protocols.
• Participation in some other structured rehabilitation program within the past month.