Heart recovery journey – Combining shock waves and exercise therapy

Coronary heart disease (CHD) affects a large number of patients. Their survival period with the condition is relatively long. Currently, reperfusion therapies such as medication, thrombolysis, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) can improve symptoms and reduce mortality in patients with CHD. However, many patients still face various residual cardiovascular issues, including intermittent chest pain, progressive coronary atherosclerosis, uncontrolled blood pressure, glucose, and lipid levels, overweight, heart failure, arrhythmias, microcirculatory disorders, and psychological disorders.

Extracorporeal cardiac shock wave therapy (CSWT) is considered a safe, effective, and non-invasive treatment for cardiovascular diseases, with high potential in the treatment of CHD. A new study by Wan et al. investigated the effects and underlying mechanisms of CSWT combined with exercise rehabilitation in patients who had PCI for coronary heart disease¹. The combined approach improved myocardial markers, related anti-inflammatory and anti-atherosclerotic indicators. Moreover, it alleviated myocardial ischemia while enhancing parameters such as oxygen uptake in cardiopulmonary exercise testing (CPET).

Methods

The study is a prospective randomized controlled trial conducted at Yunnan Fuwai Cardiovascular Hospital from 2020 to 2022. It included 74 patients with a diagnosis of CHD who underwent PCI and experienced residual myocardial ischemic symptoms post-operation. They were randomly assigned to two groups: a control group and a study group of 37 patients each.
The intervention consisted of CSWT combined with exercise rehabilitation. Patients in the control group strictly followed the secondary prevention drugs for CHD and underwent regular follow-up. Patients in the study group, in addition to secondary prevention drugs for CHD, received CSWT on the first Monday, Wednesday, and Friday of each month for three consecutive months, totalling nine CSWT sessions per patient. Two ischemic target areas were treated per session with a total of 3,600 pulses and an energy varying between 0.03 mJ/mm² and 0.09 mJ/mm².

Results

Following the intervention, patients in the study group demonstrated a decrease in the levels of creatine kinase (CK), creatine kinase – MB isoenzyme (CK-MB) and homocysteine (HCY), and in the levels of self-rating depression scale (SDS) and resting systolic blood pressure (Rest SBP), as well as an increase in peak oxygen uptake (peak VO2), high-density lipoprotein cholesterol (HDL-C) and maximum heart rate (HRmax) compared to pre-treatment levels. Compared to the control group, the results in the study group showed a decrease in the levels of Pittsburgh sleep quality index (PSQI), and an increase in peak VO2, in oxygen uptake at anaerobic threshold (VO2 @AT) and in respiratory exchange ratio (RER) after the intervention. Follow-ups were assessed at 3 months and at 6 months after treatment. The results presented refer to either the 3 months or the 6 months Follow-ups.

Conclusions

Based on their results, the authors conclude that the combination of CSWT and exercise rehabilitation improved anti-inflammatory and anti-atherosclerosis indicators in CHD patients. It also alleviated anxiety symptoms, enhanced sleep quality, controlled blood pressure, and increased cardiorespiratory oxygen uptake and exercise capacity. During the observation period of the study, no major adverse cardiovascular events occurred. The findings may offer additional insights into anti-ischemic treatment and cardiac rehabilitation for patients with CHD in future clinical practice.

¹ Wan Q, Guo T, Li J, et al. A study of extracorporeal cardiac shock wave therapy combined with exercise rehabilitation in postoperative patients with PCI for CHD. Sci Rep. 2025;15(1):21670. Published 2025 Jul 1. doi:10.1038/s41598-025-05475-2