\documentclass[11pt,twoside]{article}\makeatletter

\IfFileExists{xcolor.sty}%
  {\RequirePackage{xcolor}}%
  {\RequirePackage{color}}
\usepackage{colortbl}
\usepackage{wrapfig}
\usepackage{ifxetex}
\ifxetex
  \usepackage{fontspec}
  \usepackage{xunicode}
  \catcode`⃥=\active \def⃥{\textbackslash}
  \catcode`❴=\active \def❴{\{}
  \catcode`❵=\active \def❵{\}}
  \def\textJapanese{\fontspec{Noto Sans CJK JP}}
  \def\textChinese{\fontspec{Noto Sans CJK SC}}
  \def\textKorean{\fontspec{Noto Sans CJK KR}}
  \setmonofont{DejaVu Sans Mono}
  
\else
  \IfFileExists{utf8x.def}%
   {\usepackage[utf8x]{inputenc}
      \PrerenderUnicode{–}
    }%
   {\usepackage[utf8]{inputenc}}
  \usepackage[english]{babel}
  \usepackage[T1]{fontenc}
  \usepackage{float}
  \usepackage[]{ucs}
  \uc@dclc{8421}{default}{\textbackslash }
  \uc@dclc{10100}{default}{\{}
  \uc@dclc{10101}{default}{\}}
  \uc@dclc{8491}{default}{\AA{}}
  \uc@dclc{8239}{default}{\,}
  \uc@dclc{20154}{default}{ }
  \uc@dclc{10148}{default}{>}
  \def\textschwa{\rotatebox{-90}{e}}
  \def\textJapanese{}
  \def\textChinese{}
  \IfFileExists{tipa.sty}{\usepackage{tipa}}{}
\fi
\def\exampleFont{\ttfamily\small}
\DeclareTextSymbol{\textpi}{OML}{25}
\usepackage{relsize}
\RequirePackage{array}
\def\@testpach{\@chclass
 \ifnum \@lastchclass=6 \@ne \@chnum \@ne \else
  \ifnum \@lastchclass=7 5 \else
   \ifnum \@lastchclass=8 \tw@ \else
    \ifnum \@lastchclass=9 \thr@@
   \else \z@
   \ifnum \@lastchclass = 10 \else
   \edef\@nextchar{\expandafter\string\@nextchar}%
   \@chnum
   \if \@nextchar c\z@ \else
    \if \@nextchar l\@ne \else
     \if \@nextchar r\tw@ \else
   \z@ \@chclass
   \if\@nextchar |\@ne \else
    \if \@nextchar !6 \else
     \if \@nextchar @7 \else
      \if \@nextchar (8 \else
       \if \@nextchar )9 \else
  10
  \@chnum
  \if \@nextchar m\thr@@\else
   \if \@nextchar p4 \else
    \if \@nextchar b5 \else
   \z@ \@chclass \z@ \@preamerr \z@ \fi \fi \fi \fi
   \fi \fi  \fi  \fi  \fi  \fi  \fi \fi \fi \fi \fi \fi}
\gdef\arraybackslash{\let\\=\@arraycr}
\def\@textsubscript#1{{\m@th\ensuremath{_{\mbox{\fontsize\sf@size\z@#1}}}}}
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\def\abbr{}
\def\corr{}
\def\expan{}
\def\gap{}
\def\orig{}
\def\reg{}
\def\ref{}
\def\sic{}
\def\persName{}\def\name{}
\def\placeName{}
\def\orgName{}
\def\textcal#1{{\fontspec{Lucida Calligraphy}#1}}
\def\textgothic#1{{\fontspec{Lucida Blackletter}#1}}
\def\textlarge#1{{\large #1}}
\def\textoverbar#1{\ensuremath{\overline{#1}}}
\def\textquoted#1{‘#1’}
\def\textsmall#1{{\small #1}}
\def\textsubscript#1{\@textsubscript{\selectfont#1}}
\def\textxi{\ensuremath{\xi}}
\def\titlem{\itshape}
\newenvironment{biblfree}{}{\ifvmode\par\fi }
\newenvironment{bibl}{}{}
\newenvironment{byline}{\vskip6pt\itshape\fontsize{16pt}{18pt}\selectfont}{\par }
\newenvironment{citbibl}{}{\ifvmode\par\fi }
\newenvironment{docAuthor}{\ifvmode\vskip4pt\fontsize{16pt}{18pt}\selectfont\fi\itshape}{\ifvmode\par\fi }
\newenvironment{docDate}{}{\ifvmode\par\fi }
\newenvironment{docImprint}{\vskip 6pt}{\ifvmode\par\fi }
\newenvironment{docTitle}{\vskip6pt\bfseries\fontsize{22pt}{25pt}\selectfont}{\par }
\newenvironment{msHead}{\vskip 6pt}{\par}
\newenvironment{msItem}{\vskip 6pt}{\par}
\newenvironment{rubric}{}{}
\newenvironment{titlePart}{}{\par }

\newcolumntype{L}[1]{){\raggedright\arraybackslash}p{#1}}
\newcolumntype{C}[1]{){\centering\arraybackslash}p{#1}}
\newcolumntype{R}[1]{){\raggedleft\arraybackslash}p{#1}}
\newcolumntype{P}[1]{){\arraybackslash}p{#1}}
\newcolumntype{B}[1]{){\arraybackslash}b{#1}}
\newcolumntype{M}[1]{){\arraybackslash}m{#1}}
\definecolor{label}{gray}{0.75}
\def\unusedattribute#1{\sout{\textcolor{label}{#1}}}
\DeclareRobustCommand*{\xref}{\hyper@normalise\xref@}
\def\xref@#1#2{\hyper@linkurl{#2}{#1}}
\begingroup
\catcode`\_=\active
\gdef_#1{\ensuremath{\sb{\mathrm{#1}}}}
\endgroup
\mathcode`\_=\string"8000
\catcode`\_=12\relax

\usepackage[a4paper,twoside,lmargin=1in,rmargin=1in,tmargin=1in,bmargin=1in,marginparwidth=0.75in]{geometry}
\usepackage{framed}

\definecolor{shadecolor}{gray}{0.95}
\usepackage{longtable}
\usepackage[normalem]{ulem}
\usepackage{fancyvrb}
\usepackage{fancyhdr}
\usepackage{graphicx}
\usepackage{marginnote}

\renewcommand{\@cite}[1]{#1}


\renewcommand*{\marginfont}{\itshape\footnotesize}

\def\Gin@extensions{.pdf,.png,.jpg,.mps,.tif}

  \pagestyle{fancy}

\usepackage[pdftitle={Long Term Effect of Cardiac Rehabilitation Program on Patients with Percutaneous Coronary Intervention},
 pdfauthor={}]{hyperref}
\hyperbaseurl{}

	 \paperwidth210mm
	 \paperheight297mm
              
\def\@pnumwidth{1.55em}
\def\@tocrmarg {2.55em}
\def\@dotsep{4.5}
\setcounter{tocdepth}{3}
\clubpenalty=8000
\emergencystretch 3em
\hbadness=4000
\hyphenpenalty=400
\pretolerance=750
\tolerance=2000
\vbadness=4000
\widowpenalty=10000

\renewcommand\section{\@startsection {section}{1}{\z@}%
     {-1.75ex \@plus -0.5ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large\bfseries}}
\renewcommand\subsection{\@startsection{subsection}{2}{\z@}%
     {-1.75ex\@plus -0.5ex \@minus- .2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large}}
\renewcommand\subsubsection{\@startsection{subsubsection}{3}{\z@}%
     {-1.5ex\@plus -0.35ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\large}}
\renewcommand\paragraph{\@startsection{paragraph}{4}{\z@}%
     {-1ex \@plus-0.35ex \@minus -0.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\normalsize}}
\renewcommand\subparagraph{\@startsection{subparagraph}{5}{\parindent}%
     {1.5ex \@plus1ex \@minus .2ex}%
     {-1em}%
     {\reset@font\normalsize\bfseries}}


\def\l@section#1#2{\addpenalty{\@secpenalty} \addvspace{1.0em plus 1pt}
 \@tempdima 1.5em \begingroup
 \parindent \z@ \rightskip \@pnumwidth 
 \parfillskip -\@pnumwidth 
 \bfseries \leavevmode #1\hfil \hbox to\@pnumwidth{\hss #2}\par
 \endgroup}
\def\l@subsection{\@dottedtocline{2}{1.5em}{2.3em}}
\def\l@subsubsection{\@dottedtocline{3}{3.8em}{3.2em}}
\def\l@paragraph{\@dottedtocline{4}{7.0em}{4.1em}}
\def\l@subparagraph{\@dottedtocline{5}{10em}{5em}}
\@ifundefined{c@section}{\newcounter{section}}{}
\@ifundefined{c@chapter}{\newcounter{chapter}}{}
\newif\if@mainmatter 
\@mainmattertrue
\def\chaptername{Chapter}
\def\frontmatter{%
  \pagenumbering{roman}
  \def\thechapter{\@roman\c@chapter}
  \def\theHchapter{\roman{chapter}}
  \def\thesection{\@roman\c@section}
  \def\theHsection{\roman{section}}
  \def\@chapapp{}%
}
\def\mainmatter{%
  \cleardoublepage
  \def\thechapter{\@arabic\c@chapter}
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \pagenumbering{arabic}
  \setcounter{secnumdepth}{6}
  \def\@chapapp{\chaptername}%
  \def\theHchapter{\arabic{chapter}}
  \def\thesection{\@arabic\c@section}
  \def\theHsection{\arabic{section}}
}
\def\backmatter{%
  \cleardoublepage
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \setcounter{secnumdepth}{2}
  \def\@chapapp{\appendixname}%
  \def\thechapter{\@Alph\c@chapter}
  \def\theHchapter{\Alph{chapter}}
  \appendix
}
\newenvironment{bibitemlist}[1]{%
   \list{\@biblabel{\@arabic\c@enumiv}}%
       {\settowidth\labelwidth{\@biblabel{#1}}%
        \leftmargin\labelwidth
        \advance\leftmargin\labelsep
        \@openbib@code
        \usecounter{enumiv}%
        \let\p@enumiv\@empty
        \renewcommand\theenumiv{\@arabic\c@enumiv}%
	}%
  \sloppy
  \clubpenalty4000
  \@clubpenalty \clubpenalty
  \widowpenalty4000%
  \sfcode`\.\@m}%
  {\def\@noitemerr
    {\@latex@warning{Empty `bibitemlist' environment}}%
    \endlist}

\def\tableofcontents{\section*{\contentsname}\@starttoc{toc}}
\parskip0pt
\parindent1em
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\newenvironment{reflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemsep}{0pt}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\itshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{sansreflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\itemsep}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\upshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{specHead}[2]%
 {\vspace{20pt}\hrule\vspace{10pt}%
  \phantomsection\label{#1}\markright{#2}%

  \pdfbookmark[2]{#2}{#1}%
  \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}%
  }{}
      \def\TheFullDate{2015-07-15 (revised: 15 July 2015)}
\def\TheID{\makeatother }
\def\TheDate{2015-07-15}
\title{Long Term Effect of Cardiac Rehabilitation Program on Patients with Percutaneous Coronary Intervention}
\author{}\makeatletter 
\makeatletter
\newcommand*{\cleartoleftpage}{%
  \clearpage
    \if@twoside
    \ifodd\c@page
      \hbox{}\newpage
      \if@twocolumn
        \hbox{}\newpage
      \fi
    \fi
  \fi
}
\makeatother
\makeatletter
\thispagestyle{empty}
\markright{\@title}\markboth{\@title}{\@author}
\renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@
\belowdisplayskip \abovedisplayskip
\abovedisplayshortskip \z@ plus2\p@
\belowdisplayshortskip 4\p@ plus2\p@ minus2\p@
\def\@listi{\leftmargin\leftmargini
               \topsep 2\p@ plus1\p@ minus1\p@
               \parsep 2\p@ plus\p@ minus\p@
               \itemsep 1pt}
}
\makeatother
\fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm}
\fancyhf{} 
\setlength{\headheight}{14pt}
\fancyhead[LE]{\bfseries\leftmark} 
\fancyhead[RO]{\bfseries\rightmark} 
\fancyfoot[RO]{}
\fancyfoot[CO]{\thepage}
\fancyfoot[LO]{\TheID}
\fancyfoot[LE]{}
\fancyfoot[CE]{\thepage}
\fancyfoot[RE]{\TheID}
\hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true}
\fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}}

\date{}
\usepackage{authblk}

\providecommand{\keywords}[1]
{
\footnotesize
  \textbf{\textit{Index terms---}} #1
}

\usepackage{graphicx,xcolor}
\definecolor{GJBlue}{HTML}{273B81}
\definecolor{GJLightBlue}{HTML}{0A9DD9}
\definecolor{GJMediumGrey}{HTML}{6D6E70}
\definecolor{GJLightGrey}{HTML}{929497} 

\renewenvironment{abstract}{%
   \setlength{\parindent}{0pt}\raggedright
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
   \textcolor{GJBlue}{\large\bfseries\abstractname\space}
}{%   
   \vskip8pt
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
}

\usepackage[absolute,overlay]{textpos}

\makeatother 
      \usepackage{lineno}
      \linenumbers
      
\begin{document}

             \author[1]{Mohammed  Ali}

             \affil[1]{  Cairo University, Egypt}

\renewcommand\Authands{ and }

\date{\small \em Received: 10 June 2015 Accepted: 30 June 2015 Published: 15 July 2015}

\maketitle


\begin{abstract}
        


Background: Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) is mainly involved with secondary prevention which relies on early detection of the disease process and application of interventions to prevent the progression of disease. These interventions include education; counseling and behavioral strategies to promote lifestyle change and modify risk factors. The aim of this study was to determine the long term effect of CR on patients with percutaneous coronary intervention (PCI).Subjects and Methods: Sixty patients of both sexes (41 men and 19 women) had been recruited from National Heart Institute, Cairo. All patients underwent PCI. They were randomly assigned to two equal groups in number.

\end{abstract}


\keywords{percutaneous coronary intervention, cardiac rehabilitation, functional capacity, cardiovascular risk factors, quality of life.}

\begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) 
\textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark}
\end{textblock*}

\begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) 
\textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}}
\end{textblock*}


\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
oronary artery disease (CAD) is the main cause of death worldwide. \hyperref[b0]{(1)} It is potentially fatal disease with high lifetime prevalence. In terms of mortality it represents the most important disease in the group of all CVD, which, in turn, are responsible for most of the deaths in developing and in industrialized countries. \hyperref[b1]{(2)} In Egypt, and Similar to other Arab countries, ischemic heart disease and stroke are the second and fourth common cause of death in 1990 but in 2010 they shifted to be the first and second cause respectively. CAD mortality accounts for 46\% of total deaths, all ages and both sexes, according to  {\ref WHO (2014)}. Trends in CAD mortality in the last few years show a minor reduction due to preventive efforts especially against smoking, an operational action plan to reduce the burden of tobacco use. \hyperref[b2]{(3)}The development of CAD is multicausal and is related to a variety of risk factors, many of them strongly influenced by individual behavior, such as smoking, exercise, diet, diabetes mellitus, hypertension and hypercholesterolemia. (4) It has been suggested that modification of these modifiable risk factors could reduce the burden of CAD by approximately 90\%. These risk factors, however, also strongly influence the prognosis of patients with established CAD. In addition to the well established pharmacological management of patients with CAD, behavioral changes to modify these lifestyle factors in affected individuals are therefore recommended to form the basis of all secondary prevention strategies of CAD. \hyperref[b1]{(2)} Cardiac rehabilitation programs have become an integral part of the standard of care in modern cardiology. Their scope has shifted from the emphasis on exercise therapy to comprehensive secondary prevention strategies managing risk factors, nutritional, psychological, behavioral and social factors that can affect patient outcomes. While the importance of primary prevention measures aimed at delaying or preventing the onset of cardiovascular disease is obvious and cannot be emphasized enough, CR is mainly involved with secondary prevention which relies on early detection of the disease process and application of The American Heart Association (AHA) defined CR as a "medically supervised program to help heart patients recover quickly and improve their overall physical and mental functioning". (  {\ref 6}) Goals for CR include improving aerobic endurance and muscular strength, and modifying cardiovascular risk factors, including losing weight, lowering cholesterol, improving blood glucose, controlling blood pressure, and smoking cessation. \hyperref[b6]{(7)} Recent research has shown that people who have experienced cardiac events can handle more frequent and intense exercise than originally thought. (8) \hyperref[b8]{(9)} Quality of life reflects the functional effect of an illness and its therapy from the patient's point of view. Poor QoL has been associated with poorer outcomes, such as lower survival rates, increases in the number of hospitalizations, decreased capacity to perform activities of daily living, and decreased compliance with treatments in other populations like cardiac patients. \hyperref[b9]{(10)} This study was conducted to find out the long term effect of CR on patients with PCI, and the potential effect CR to improve functional status, cardiovascular risk factors presented with these patients, and its effect to improve their QoL. 
\section[{II. Patients and Methods}]{II. Patients and Methods}\par
This study was conducted in physiotherapy department of National Heart Institute (NHI). 60 Patients of both sexes, their age was 40-60 years old, within the first year after PCI, their mean BMI was ? 35Kg/m 2 , were selected and assigned to two equal groups in number. The study group (30 patients, 21 men and 9 women) that had been received aerobic mild to moderate exercise training and educational program of secondary prevention, while the control group (30 patients, 20 men and 10 women) that had been received instructions about risk factors after PCI once and were followed up after one year.\par
Exclusion criteria were patients with renal failure, chronic liver disease, Patients with arrhythmia, Chest disease, and patient who could not fulfill the questionnaire or cooperate through the performed procedures.\par
Before starting the study, a meeting was done for all patients to record demographic data and risk factors (smoking status, BMI, fasting blood glucose, systolic and diastolic blood pressure, and blood lipid levels) presented with each patient. In that stage a face to face instructions and administration of SF-36 questionnaire to all participants was given. 6-MWT was introduced to each patient along the 20 m straight corridor of the physiotherapy department of NHI. All patients were taking their medications normally. Participants in the CR program were requested to attend their exercise program three times/week for a period of six months.\par
Mild to moderate intensity exercise is prescribed based on Borg's rating of perceived exertion (RPE) scale. The scale is comprised of 15 points where a rating of 6 means no exertion and a rating of 20 means maximal exertion. Patients were encouraged to achieve a rating between 11 (fairly light) and 14 (hard), as many cardiac patients may use beta blockers in their treatment medications, that work to reduce resting and maximal heart rate. \hyperref[b10]{(11)} For participants in the CR program involved in this study, each exercise session is comprised of a 5 -10 minute warming up, 5-10 minutes cooling down, and approximately 30 minutes of aerobic exercise. Aerobic exercise was the dominant mode of exercise which implemented using bicycle ergometer in the CR program 3 times/week for 6 month. Patients were given an idea about risk factors control and secondary prevention according to AHA guidelines for secondary prevention 2011. (  {\ref 12}) After one year, risk factors were measured, and also SF-36 and 6 MWT were measured again.\par
Data were analyzed with SPSS software version 17. Parametric data was analyzed using the student ttest. Non parametric data was analyzed using McNemar test for the same group, and Mann-whitney test to compare between both groups. The level of significance was set at P < 0.05. Paired t-test was applied for each group to compare pre and post values within the same group. Unpaired t-test was applied to compare pre and post values between both groups of the study. 
\section[{III. Results}]{III. Results}\par
Base line measurements had shown no statistical significant differences between both groups (P>0.05). The baseline and final values of each group (Table  {\ref 1}) had shown highly significant differences in 6MWT, smoking cessation rate, BMI, TC, HDL and LDL (P<0.001), FBG and TG had improved significantly (P<0.05), SBP and DBP did not improve significantly in the study group (P>0.05). The control group had shown significant improves in 6MWT and BMI, other parameters did not change significantly (P>0.05).\par
All risk factors were improved significantly in the study group when compared with the control group after the program (P<0.05). The increase in 6MWT was highly significant (P<0.001). 
\section[{Global Journal of Medical Research}]{Global Journal of Medical Research}\par
Volume XV Issue IV Version IYear 2 015 ( D D D D ) I\par
As shown in (table 2) the 8 domains of SF-36 of the study group had increased highly significantly (P<0.001). The control group had shown highly significant increase in PF and GH (P<0.001), and significant increase in E/F (P<0.05), other parameters did not increase significantly (P>0.05).\par
All domains of SF-36 were improved significantly in the study group when compared with the control group after the program (P<0.05), and EW increased highly significantly (P<0.001).  
\section[{IV. Discussion}]{IV. Discussion}\par
The benefits of exercise-based CR on cardiovascular risk factors, QoL, exercise tolerance, cardiac morbidity and mortality have been widely established in CAD patients. \hyperref[b0]{(1)} The aim of this study was to determine the long term effect of CR on patients with PCI, and its potential effect on risk factors control and the subsequent improvement in their QoL. The results of the current study showed significant About smoking, percent of reduction were 75\% â??" and 21\% â??" in the study and control groups respectively. Reduction in the study group was statistically significant and also, comparison between both groups after CR. The results were supported by Wood et al. The proportions of patients with CHD who quit smoking at 1 year were significantly higher in the study group than in usual-care group. In the intervention group, 58\% of the volunteers were not smokers at 1 year compared with 47\% in the usual-care group. (  {\ref 13}) Along with the same results Redfern et al. had reported significant reductions in smoking behaviors in the study group compared to the control group. (  {\ref 14}) Although Judith et al. had reported a non significant difference between intervention and control groups at one year about smoking cessation, he reported a significant improvement results at two and three years. \hyperref[b14]{(15)} In current study the patients of study group revealed highly significant increase in their functional capacity, and control group increased significantly, Percent of change was (18\% ? and 3\% ?) respectively, when measured by 6-MWT, that was reflected in improvement of the physical functioning score section of SF-36 for both groups (Percent of change was 29.8\% ?and 21.4\% ?) respectively. Changes in control group reflected the positive effects of PCI on physical function of the patients. Comparison of both groups revealed highly significant increase in the study group at the end of the program, which, in turn reflect the more beneficial effect of CR on patient when added to PCI effect. Supporting the study results Fatimah et al. revealed an increase in functional capacity after the CR program measured by 6-MWT and no significant differences were seen in their control group and mean distance walked was increased 19.3\% in the study group. (  {\ref 16} Consequently, the results was coincided with results achieved by Yu et al. who showed significant improvement in the frequency, duration of physical activities and total score of self efficacy scale in the experimental group, which can effectively improve the patients exercise compliance, promote the willingness of physical exercise and help the patients establish healthy behaviors. \hyperref[b17]{(18)} As a result, promoting the recovery of cardiac function. Consistent with the results, Judith et al. who reported significant improvements in the study group compared to the control group in maximal workload. \hyperref[b14]{(15)} In current study, following CR program, study group achieved positive reduction in weight and BMI. BMI was decreased highly significantly in the study group, also control group decreased significantly. Comparing two groups showed four times reduction in study group more than control group, Percent of reduction was (8.4 \% â??" and 2\% â??") for study and control groups respectively. Masoumeh et al. showed that obese patients in the study group had greater improvement in weight reduction and subsequent BMI that was statistically significant when compared with control group. \hyperref[b18]{(19)} Another study by  {\ref Manzoni et al.} showed the positive effects of short term CR program on weight reduction and functional capacity in obese patients with CAD. \hyperref[b19]{(20)} In contrast, results of Kiat et al. suggested CR program didn't had effect on weight reduction, while it is useful in increasing levels of functional capacity. (  {\ref 21}) Pantaleo et al. estimated that at baseline, there was no significant difference in BMI between the study and usual care groups, at 6months, it increased by 0.7\% in the study group and 0.9\% in the usual care group, there was a 0.2\% lower increase in BMI in the study group. At the end of his study, BMI increased by 1.7\% and 2.1\% in the study and usual care groups, respectively, a difference that was statistically significant. \hyperref[b22]{(22)} Fasting blood glucose was highly significantly reduced in the study group after the program, without significant change in the control group. Percent of reduction was (18.8 \% â??" and 1.2\% â??") for study and control groups respectively; comparison of both groups had showed significant decrease in the study group after program. 
\section[{Global}]{Global}\par
Both SBP and DBP changed to levels that were statistically significant when comparing both groups after the program, although changes in both groups separately were not significant. Percent of change in SBP was (4.2 \% â??" and 2.1\% ?) and DBP was (2.6\% â??" and 2.3\% ?) for study and control groups respectively. Improvement of study group and deterioration of control group showed the positive effect of CR program. Diabetes mellitus is a chronic condition with devastating cardiovascular complications, the prevalence of diabetes was reported as 13.5\% in Egypt and it is closely associated with a concomitant rise in obesity rates. \hyperref[b23]{(23)}  \hyperref[b24]{(24)} Going with the same effects of CR on FBG and blood pressure control Bestehorn et al. mentioned that at discharge FBG values decreased to 104 mg/dl (108 mg/dl at entry), mean SBP and DBP decreased also to 122/73 mmHg (131/77 mmHg at entry) which were statistically significant. (  {\ref 25} on hemodynamic responses such as resting and maximum systolic and diastolic blood pressure. \hyperref[b15]{(16)} In a systemic review by Judith et al. significant improvements in SBP and DBP in study group patients compared to control groups, at one, two, and three years were seen. \hyperref[b14]{(15)} The results of this study indicated that exercise and educating patients of PCI during CR program could improve lipid profile levels. The patients of the study group had achieved significant reductions in TC, TG and LDL levels and significant increase in HDL levels, no significant changes were seen in control group. Significant improvements were seen in the study group when compared to the control group after the program. Percents of changes were (11.5\% â??" and 0.75\% â??" for TC, 10.9\% â??" and 0.86\% â??" for TG, 5.3\% ? and 3.6\% â??" for HDL, and 16.3\% â??" and 0.44\% ? for LDL) for study and control groups respectively. Both groups were taking lipid lowering drug therapy as prescribed by the physicians, which explains the effect of exercise training and awareness program on lipid profile for the study group. The greater effect of exercise and education on the study group suggests a possible additional effect on adherence to physical activity, prescribed medications and healthy life style.  {\ref Masoumeh}  Nine months after completion of the different programs, QoL was significantly higher among patients who had undergone CR, regardless of duration, and there were no significantly different effects between CR programs of more than or less than 6 months, also he note that the increased patient compliance observed in the shorter programs. (29) Yohannes et al. results demonstrated the benefits of CR in improving QoL and physical activity, and in reducing anxiety and depression. Furthermore, these benefits were maintained at 12 month follow up. (30)\par
There is a significant and positive relationship between changes in secondary prevention and changes in QoL. Patients started the study with low level of QoL scores and had shown significant increases in QoL scores following the CR programme. Also, the ability of patients to exercise had increased significantly. As the physical abilities of patients increased, they reported feeling less pain, more energy and better emotional state. Increased physical ability was associated with a brighter outlook on current and expected future health status. 
\section[{V. Conclusion}]{V. Conclusion}\par
Global Journal of  
\begin{quote}
Medical Research\end{quote}
\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}C}\end{figure}
     \begin{figure}[htbp]
\noindent\textbf{(} \par 
\begin{longtable}{P{0.08469750889679716\textwidth}P{0.12039145907473309\textwidth}P{0.14701067615658361\textwidth}P{0.0695729537366548\textwidth}P{0.13370106761565836\textwidth}P{0.1397508896797153\textwidth}P{0.05565836298932384\textwidth}P{0.09921708185053381\textwidth}}
\tabcellsep \tabcellsep Study group\tabcellsep \tabcellsep \multicolumn{2}{l}{Control group}\tabcellsep \tabcellsep P value\\
Variables\tabcellsep Pre program\tabcellsep Post program\tabcellsep P\tabcellsep Pre program\tabcellsep Post program\tabcellsep P\tabcellsep for both groups\\
\tabcellsep Mean ±SD\tabcellsep Mean ±SD\tabcellsep Value\tabcellsep Mean ±SD\tabcellsep Mean ±SD\tabcellsep Value\tabcellsep after program\\
6MWT (m)\tabcellsep 414.8±57.4\tabcellsep ?489±54.8\tabcellsep 0.000*\tabcellsep 419±50.2\tabcellsep ?430.5±47.3\tabcellsep 0.01*\tabcellsep 0.000*\\
Smoking\tabcellsep 67\%\tabcellsep â??"17\%\tabcellsep 0.000*\tabcellsep 63.3\%\tabcellsep â??"50\%\tabcellsep 0.13\tabcellsep 0.007*\\
BMI (Kg/m 2)\tabcellsep 30.8±1.9\tabcellsep â??"28.2±2.6\tabcellsep 0.000*\tabcellsep 30.2±1.7\tabcellsep â??"29.6±2.1\tabcellsep 0.03*\tabcellsep 0.03*\\
FBG (mg/dl)\tabcellsep 131.7±47.3\tabcellsep â??"106.8±36.5\tabcellsep 0.01*\tabcellsep 128.5±54.5\tabcellsep â??"127±38.3\tabcellsep 0.86\tabcellsep 0.04*\\
SBP (mm/Hg)\tabcellsep 129.2±18.7\tabcellsep â??"123.8±13.5\tabcellsep 0.22\tabcellsep 128.5±16.6\tabcellsep ?131.2±14.6\tabcellsep 0.47\tabcellsep 0.05*\\
DBP (mm/Hg)\tabcellsep 81.3±8.8\tabcellsep â??"79.2±7.8\tabcellsep 0.31\tabcellsep 82.8±9.2\tabcellsep ?84.6±8.2\tabcellsep 0.38\tabcellsep 0.01*\\
TC (mg/dl)\tabcellsep 199.1±48.9\tabcellsep â??"176.3±42.1\tabcellsep 0.000*\tabcellsep 198.8±41.7\tabcellsep â??"197.3±39.4\tabcellsep 0.71\tabcellsep 0.05*\\
TG (mg/dl)\tabcellsep 148.2±34.2\tabcellsep â??"132.1±28.8\tabcellsep 0.01*\tabcellsep 151.1±32.5\tabcellsep â??"149.8±35.1\tabcellsep 0.65\tabcellsep 0.04*\\
HDL (mg/dl)\tabcellsep 35.6±8.5\tabcellsep ?37.5±8.8\tabcellsep 0.001*\tabcellsep 33.3±7.8\tabcellsep â??"32.1±7.4\tabcellsep 0.72\tabcellsep 0.01*\\
LDL (mg/dl)\tabcellsep 134±49.1\tabcellsep â??"112.1±44.6\tabcellsep 0.000*\tabcellsep 135.2±45.3\tabcellsep ?136±41.5\tabcellsep 0.88\tabcellsep 0.04*\\
\tabcellsep \multicolumn{2}{l}{Study group}\tabcellsep \tabcellsep \multicolumn{2}{l}{Control group}\tabcellsep \tabcellsep P value\\
Variables\tabcellsep Pre program Mean ±SD\tabcellsep Post program Mean ±SD\tabcellsep P Value\tabcellsep Pre program Mean ±SD\tabcellsep Post program Mean ±SD\tabcellsep P Value\tabcellsep for both groups after program\\
PF\tabcellsep 64.3±7.1\tabcellsep ?83.5±6.5\tabcellsep 0.000*\tabcellsep 63.2±6.9\tabcellsep ?76.7±10.6\tabcellsep 0.000*\tabcellsep 0.01*\\
RLPH\tabcellsep 35±24.2\tabcellsep ?62.5±23.4\tabcellsep 0.000*\tabcellsep 40.8±23.2\tabcellsep ?50.8±20.2\tabcellsep 0.11\tabcellsep 0.04*\\
RLEP\tabcellsep 34.1±23.7\tabcellsep ?61.1±21.6\tabcellsep 0.000*\tabcellsep 41.8±21.1\tabcellsep ?49.9±19.1\tabcellsep 0.09\tabcellsep 0.04*\\
E/F\tabcellsep 51.7±7.8\tabcellsep ?66±11.1\tabcellsep 0.000*\tabcellsep 51.3±7.9\tabcellsep ?57.7±11.7\tabcellsep 0.01*\tabcellsep 0.01*\\
EW\tabcellsep 61.3±6.2\tabcellsep ?69.5±2.6\tabcellsep 0.000*\tabcellsep 59.1±6.1\tabcellsep ?61.5±7.5\tabcellsep 0.18\tabcellsep 0.000*\\
SF\tabcellsep 50.9±10.5\tabcellsep ?67.5±19\tabcellsep 0.000*\tabcellsep 51.7±10.9\tabcellsep ?56.3±16.3\tabcellsep 0.23\tabcellsep 0.02*\\
P\tabcellsep 65.2±9.7\tabcellsep ?79.6±18.4\tabcellsep 0.000*\tabcellsep 62.7±10.2\tabcellsep ?67.9±15.9\tabcellsep 0.07\tabcellsep 0.01*\\
GH\tabcellsep 28.2±5\tabcellsep ?43±7.9\tabcellsep 0.000*\tabcellsep 27.3±4.8\tabcellsep ?38.5±8.8\tabcellsep 0.000*\tabcellsep 0.04*\end{longtable} \par
  {\small\itshape [Note: Table\hyperref[b1]{(2)} : Changes of 8 domains of SF-36 from baseline to the end of the program within each group and between groups]} 
\caption{\label{tab_0}Table ( 1}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.85\textwidth}}
that found that both aerobic interval training and\\
continuous training improved HDL levels significantly in\\
both groups. (1)\\
Bassem et al. mentioned affection in the QoL in\\
patients with CAD in the form of presence of symptoms\\
limiting their activity, such as chest pain due to angina\\
attacks, shortness of breath, palpitation. Also, the daily\\
activities may be limited in usual daily activities as\\
moderate activities. Lifting or carrying groceries,\\
climbing several flights of stairs, climbing one flight of\\
stairs, bending, kneeling, stooping, walking for a bus\\
station distance, bathing or dressing himself, and sexual\\
dysfunction, and recurrent sick leaves due to his or her\\
heart condition. (26)\\
The results obtained in the present study\\
revealed statistical significant increases in SF-36\\
variables.\end{longtable} \par
 
\caption{\label{tab_1}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_2}}\end{figure}
 			\footnote{© 2015 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[ Internet J Cardiovas Res ()]{b21}\label{b21} 	 		\textit{},  	 	 		\textit{Internet J Cardiovas Res}  		2008. 7  (1) .  	 
\bibitem[Viviane et al. ()]{b0}\label{b0} 	 		‘Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease’.  		 			C Viviane 		,  		 			P Nele 		,  		 			Catherine De 		.  	 	 		\textit{International Journal of Cardiology}  		2015. 179 p. .  	 
\bibitem[Smith et al. ()]{b11}\label{b11} 	 		‘AHA/ACCF Secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update’.  		 			S Smith 		,  		 			B Emelia 		,  		 			B Robert 		,  		 			T Lynne 		,  		 			A Mark 		,  		 			A Barry 		,  		 			J Raymond 		,  		 			M Scott 		,  		 			F Loren 		,  		 			W Daniel 		,  		 			M Donald 		,  		 			Margo M Lori 		,  		 			M Eric 		,  		 			D Ralph 		,  		 			L John 		,  		 			S James 		,  		 			H Kathryn 		,  		 			A 		.  	 	 		\textit{J. Am. Coll. Cardiolvol}  		2011. 58 p. .  	 
\bibitem[Warner ()]{b4}\label{b4} 	 		‘Cardiac rehabilitation past, present and future: an overview’.  		 			M Warner 		.  	 	 		\textit{Cardiovasc Diagn Ther},  				2012. 2 p. .  	 
\bibitem[Redfern et al. ()]{b13}\label{b13} 	 		‘Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-year follow-up of the CHOICE (Choice of Health Options in prevention of Cardiovascular Events)’.  		 			J Redfern 		,  		 			T Briffa 		,  		 			E Ellis 		.  	 	 		\textit{Heart}  		2009. 95  (6)  p. .  	 
\bibitem[Keteyian et al. ()]{b5}\label{b5} 	 		‘Clinical role of exercise trainingin the management of patients with chronic heart failure’.  		 			S Keteyian 		,  		 			I Pina 		,  		 			B Hibner 		.  	 	 		\textit{Journal of Cardiopulmonary Rehabilitation and Prevention}  		2010. 30 p. .  	 
\bibitem[Havik et al. ()]{b9}\label{b9} 	 		‘Depressive symptoms and all-cause mortality after heart transplantation’.  		 			O Havik 		,  		 			B Sivertsen 		,  		 			A Relbo 		.  	 	 		\textit{Transplantation}  		2007. 84 p. .  	 
\bibitem[Masoumeh et al. ()]{b18}\label{b18} 	 		‘Does significant weight reduction in men with coronary artery disease manage risk factors after cardiac rehabilitation program?’.  		 			S Masoumeh 		,  		 			G Fatemeh 		,  		 			R Katayoun 		.  	 	 		\textit{J Res Med Sci}  		2013. 18 p. .  	 
\bibitem[Falk et al. ()]{b1}\label{b1} 	 		‘Effectiveness of nonpharmacological secondary prevention of coronary heart disease’.  		 			M Falk 		,  		 			M Charlotte 		,  		 			D Kathrin 		.  	 	 		\textit{European Journal of Cardiovascular Prevention \& Rehabilitation}  		2010. 17 p. .  	 
\bibitem[Graham et al. ()]{b3}\label{b3} 	 		‘European guidelines on cardiovascular disease prevention in clinical practice’.  		 			I Graham 		,  		 			D Atar 		,  		 			K Borch 		.  	 	 		\textit{Eur J Cardiovasc Prev Rehabil}  		2007. 14  (2)  p. .  	 	 (Suppl) 
\bibitem[Fatemeh et al. ()]{b15}\label{b15} 	 		‘Exercise-based cardiac rehabilitation improves hemodynamic responses after coronary artery bypass graft surgery’.  		 			E Fatemeh 		,  		 			S Masoumeh 		,  		 			M Seyed 		.  	 	 		\textit{ARYA Atherosclerosis Journal}  		2012. 7 p. .  	 
\bibitem[Pantaleo et al. ()]{b22}\label{b22} 	 		‘Global secondary prevention strategies to limit event recurrence after myocardial infarction’.  		 			G Pantaleo 		,  		 			T Pier 		,  		 			M Roberto 		.  	 	 		\textit{Arch Intern Med}  		2008. 168 p. .  	 
\bibitem[Hany et al.]{b24}\label{b24} 	 		 			Y Hany 		,  		 			R Tamer 		,  		 			E Khaled 		.  		\textit{Impact of gender difference on PCI outcome in Egyptian diabetic patients: Prospective two center registry},  				 	 
\bibitem[Rahim et al. (2014)]{b2}\label{b2} 	 		\textit{Health in the Arab world: a view from within 2 Noncommunicable diseases in the Arab world and The Lancet},  		 			Abdul Rahim 		,  		 			H Sibai 		,  		 			A Khader 		,  		 			Y 		.  		January. 2014. p. .  	 
\bibitem[Kemi and Wisloff ()]{b7}\label{b7} 	 		‘High-intensity aerobic exercise training improves the heart in health and disease’.  		 			J Kemi 		,  		 			U Wisloff 		.  	 	 		\textit{Journal of Cardiopulmonary Rehabilitation and Prevention}  		2010. 30 p. .  	 
\bibitem[Wood et al. ()]{b12}\label{b12} 	 		‘Nursecoordinated multidisciplinary, family-based cardiovascular disease prevention programme for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease’.  		 			D Wood 		,  		 			K Kotseva 		,  		 			S Connolly 		.  	 	 		\textit{Lancet}  		1999-2012, 2008. 371.  	 
\bibitem[Borg and Linderholm ()]{b10}\label{b10} 	 		‘Perceived exertion and pulse rate during graded exercise in various age groups’.  		 			G Borg 		,  		 			H Linderholm 		.  	 	 		\textit{Acta Medica Scandinavia}  		1967. 181  (472)  p. .  	 
\bibitem[Raymond et al. ()]{b16}\label{b16} 	 		‘Predictors of Improvement in Exercise Tolerance after Cardiac Rehabilitation in Patients with Acute ST Elevation Myocardial Infarction Received Primary Percutaneous Coronary Intervention in Hong Kong’.  		 			C Raymond 		,  		 			L Leonard 		,  		 			L Linda 		.  	 	 		\textit{JACC}  		2014. 63.  	 	 (Issue 12, abstract) 
\bibitem[Christensen and Jordan ()]{b6}\label{b6} 	 		\textit{Pumping up cardiac rehab, exercise guidelines for post-heart surgery clients},  		 			K Christensen 		,  		 			M Jordan 		.  		2008. American Fitness. 26 p. .  	 
\bibitem[Manzoni et al. ()]{b19}\label{b19} 	 		‘Short-term effects of a multidisciplinary cardiac rehabilitation programme on psychological well-being exercise capacity and weight in a sample of obese inpatients with coronary heart disease: A practicelevel study’.  		 			G Manzoni 		,  		 			V Villa 		,  		 			A Compare 		.  	 	 		\textit{Psychol Health Med}  		2011. 16 p. .  	 
\bibitem[Susan and Nigel ()]{b14}\label{b14} 	 		‘Systematic review of the effect of diet and exercise lifestyle interventions in the secondary prevention of coronary heart disease’.  		 			Judith A Susan 		,  		 			M Nigel 		,  		 			H 		.  		 ID 232351.  	 	 		\textit{Cardiology Research and Practice}  		2011. 2011. 2011 p. 25.  	 
\bibitem[Yu et al. ()]{b17}\label{b17} 	 		‘The application of the transtheoretical model in patients rehabilitative exercise after percutaneous coronary intervention’.  		 			L Yu 		,  		 			Y Gu 		,  		 			X Feng 		.  	 	 		\textit{JACC}  		2014. 64.  	 	 (Suppl C, Abstracts) 
\bibitem[Tarik ()]{b23}\label{b23} 	 		‘The rising menace of diabetes in the Middle East: time for action’.  		 			A Tarik 		.  	 	 		\textit{Saudi J Health Sci}  		2012. 1  (1)  p. .  	 
\bibitem[Munkvik et al. ()]{b8}\label{b8} 	 		‘Training effects on skeletal muscle calcium handling in human chronic heart failure’.  		 			M Munkvik 		,  		 			T Rehn 		,  		 			G Slettalokken 		.  	 	 		\textit{Medicine \& Science in Sports \& Exercise}  		2010. 42 p. .  	 
\bibitem[Kiat et al.]{b20}\label{b20} 	 		\textit{Weight loss and fitness in patients with coronary artery disease through cardiac rehabilitation -A long term follow-up},  		 			A Kiat 		,  		 			E Cook 		,  		 			H Kiat 		.  		 	 
\end{bibitemlist}
 			 		 	 
\end{document}
