Study strengths and limitations
INSULIN RESISTANCE
The main strength of our study is that it is the first randomized clinical trial that investigates PCSK9 level in post CABG patients who performed resistance training. This study also proves that resistance training can be done safely in post-CABG patients. Further studies are required to demonstrate the relationship between resistance exercise training and patients’ anthropometric and cardiometabolic parameters. Additionally, further studies are warranted to explain the mechanism of resistance exercise training in decreasing the PCSK9 level, especially via the proposed mechanism such as Annexin A2, adiponectin, and insulin resistance measured with HOMA-IR.Several limitations must be acknowledged within this study. Firstly, we were unable to analyze cardiorespiratory fitness due to equipment limitations related to gas analyzers. Moreover, patients in our study received a reduced statin dosage due to restrictions imposed by the National Health Insurance System, potentially influencing the lipid profiles of the subjects. The dietary choices of our patients may have introduced confounding factors into our study. It is worth noting that lipid profiles are influenced by dietary preferences in addition to physical activities and the use of statins. To address these limitations in future research, we recommend mitigating potential statin effects by assessing lipid profiles when they are already stabilized, thereby measuring the true impact of resistance training on PCSK9. Additionally, the dietary habits of the participants deserve attention. Our study's population size is relatively small and exhibits an uneven distribution of male and female subjects. Finally, further investigation is warranted to explore the effects during phase III of cardiac rehabilitation.