ISSN 1671-5411 CN 11-5329/R
Volume 17 Issue 9
Oct.  2020
Turn off MathJax
Article Contents
Marta Fontes-Oliveira, Maria Trêpa, Patrícia Rodrigues, Preza Fernandes, Sandra Magalhães, Sofia Cabral, Mário Santos, Severo Torres. Cardiovascular rehabilitation in patients aged 70-year-old or older: benefits on functional capacity, physical activity and metabolic profile in younger vs. older patients. J Geriatr Cardiol 2020; 17(9): 544-553. doi: 10.11909/j.issn.1671-5411.2020.09.003
Citation: Marta Fontes-Oliveira, Maria Trêpa, Patrícia Rodrigues, Preza Fernandes, Sandra Magalhães, Sofia Cabral, Mário Santos, Severo Torres. Cardiovascular rehabilitation in patients aged 70-year-old or older: benefits on functional capacity, physical activity and metabolic profile in younger vs. older patients. J Geriatr Cardiol 2020; 17(9): 544-553. doi: 10.11909/j.issn.1671-5411.2020.09.003

Cardiovascular rehabilitation in patients aged 70-year-old or older: benefits on functional capacity, physical activity and metabolic profile in younger vs. older patients

doi: 10.11909/j.issn.1671-5411.2020.09.003
More Information
  • Corresponding author: Marta Fontes-Oliveira, Centro Hospitalar Universitário do PortoɃHospital de Santo António, Cardiology Department, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal. E-mail: marta.fontes.oliveira@gmail.com
  • Received Date: 2020-06-15
  • Accepted Date: 2020-09-25
  • Rev Recd Date: 2020-09-23
  • Available Online: 2020-09-28
  • Publish Date: 2020-10-17
  •  Background The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only improvements on daily physical activity and HbA1c were dependent on age. Conclusion As their younger counterparts, older patients, significantly improved functional capacity, metabolic parameters and level of daily physical activity after EBCR.
  • loading
  • [1]
    Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381. doi: 10.1093/eurheartj/ehw106
    [2]
    Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016; 67: 1–12. https://pubmed.ncbi.nlm.nih.gov/26764059/
    [3]
    Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise- based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011; 162: 571–584.e2. doi: 10.1016/j.ahj.2011.07.017
    [4]
    Salzwedel A, Jensen K, Rauch B, et al. Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-Ⅱ). Eur J Prev Cardiol 2020; 2047487320905719. doi: 10.1177/2047487320905719
    [5]
    Ibanez B, James S, Agewall S, Antunes MJ, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119–177. doi: 10.1093/eurheartj/ehx393
    [6]
    Smith SC, Benjamin EJ, Bonow RO, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation Endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011; 58: 2432–2446. doi: 10.1016/j.jacc.2011.10.824
    [7]
    Yeh RW, Sidney S, Chandra M, et al. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010; 362: 2155–2165. doi: 10.1056/NEJMoa0908610
    [8]
    Bourgeois FT, Orenstein L, Ballakur S, et al. Exclusion of elderly persons in randomized clinical trials of drugs for ischemic heart disease. J Am Geriatr Soc 2017; 65: 2354–2361. doi: 10.1111/jgs.14833
    [9]
    Devlin G. Women and elderly: subgroups under-represented in clinical trials. Curr Opin Cardiol 2010; 25: 335–339. doi: 10.1097/HCO.0b013e328338bcab
    [10]
    Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2016; CD001800. http://europepmc.org/abstract/MED/21735386
    [11]
    Dusseldorp E, van Elderen T, Maes S, Meulman J, Kraaij V. A meta-analysis of psychoeduational programs for coronary heart disease patients. Health Psychol 1999; 18: 506–519. doi: 10.1037/0278-6133.18.5.506
    [12]
    Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004; 116: 682–692. doi: 10.1016/j.amjmed.2004.01.009
    [13]
    McConnell TR, Laubach CA, Memon M, et al. Quality of life and self efficacy in cardiac rehabilitation patients over 70 years of age following acute myocardial infarction and bypass revascularization surgery. Am J Geriatr Cardiol 2000; 9: 210–218. doi: 10.1111/j.1076-7460.2000.80040.x
    [14]
    Ades PA, Waldmann ML, Meyer WL, et al. Skeletal muscle and cardiovascular adaptations to exercise conditioning in older coronary patients. Circulation 1996; 94: 323–330. doi: 10.1161/01.CIR.94.3.323
    [15]
    Audelin MC, Savage PD, Ades PA. Exercise-based cardiac rehabilitation for very old patients (> or =75 years): focus on physical function. J Cardiopulm Rehabil Prev 2008; 28: 163–173. doi: 10.1097/01.HCR.0000320066.58599.e5
    [16]
    Listerman J, Bittner V, Sanderson BK, Brown TM. Cardiac rehabilitation outcomes: impact of comorbidities and age. J Cardiopulm Rehabil Prev 2011; 31: 342–348. doi: 10.1097/HCR.0b013e31822f189c
    [17]
    Rodrigues P, Santos M, Sousa MJ, et al. Cardiac rehabilitation after an acute coronary syndrome: the impact in elderly patients. Cardiology 2015; 131: 177–185. doi: 10.1159/000381824
    [18]
    Suaya JA, Stason WB, Ades PA, et al. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol 2009; 54: 25–33. doi: 10.1016/j.jacc.2009.01.078
    [19]
    Pasquali SK, Alexander KP, Peterson ED. Cardiac rehabilitation in the elderly. Am Heart J 2001; 142: 748–755. doi: 10.1067/mhj.2001.119134
    [20]
    Cortés O, Arthur HM. Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review. Am Heart J 2006; 151: 249–256. doi: 10.1016/j.ahj.2005.03.034
    [21]
    Ades PA, Waldmann ML, McCann WJ, Weaver SO. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med 1992; 152: 1033–1035. doi: 10.1001/archinte.1992.00400170113021
    [22]
    Kumar KR, Pina IL. Cardiac rehabilitation in older adults: new options. Clin Cardiol 2019; 43: 163–170. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1161/CIR.0000000000000747
    [23]
    Piepoli MF, Corrà U, Adamopoulos S, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol 2014; 21: 664–681. doi: 10.1177/2047487312449597
    [24]
    Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate; a longitudinal study. Ann Med Exp Biol Fenn 1957; 35: 307–315. http://onlinelibrary.wiley.com/resolve/reference/PMED?id=13470504
    [25]
    Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW2017052520149418
    [26]
    Mezzani A, Hamm LF, Jones AM, et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 2013; 20: 442–467. doi: 10.1177/2047487312460484
    [27]
    Kim Y, Park I, Kang M. Convergent validity of the international physical activity questionnaire (IPAQ): meta-analysis. Public Health Nutr 2013; 16: 440–452. doi: 10.1017/S1368980012002996
    [28]
    Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB
    [29]
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1–39.e14. doi: 10.1016/j.echo.2014.10.003
    [30]
    Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612. doi: 10.7326/0003-4819-150-9-200905050-00006
    [31]
    Johnson N, Fisher J, Nagle A, et al. Factors associated with referral to outpatient cardiac rehabilitation services. J Cardiopulm Rehabil 2004; 24: 165–170. doi: 10.1097/00008483-200405000-00005
    [32]
    Barber K, Stommel M, Kroll J, et al. Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation. J Clin Epidemiol 2001; 54: 1025–1030. doi: 10.1016/S0895-4356(01)00375-4
    [33]
    Hämmig O. Health risks associated with social isolation in general and in young, middle and old age. PLoS One 2019; e0219663. http://www.researchgate.net/publication/334554650_Health_risks_associated_with_social_isolation_in_general_and_in_young_middle_and_old_age
    [34]
    Krumholz HM, Butler J, Miller J, et al. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation 1998; 97: 958–964. doi: 10.1161/01.CIR.97.10.958
    [35]
    Al Quait A, Doherty P. Does cardiac rehabilitation favour the young over the old? Open Heart 2016; 3: e000450. doi: 10.1136/openhrt-2016-000450
    [36]
    Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise capacity and the risk of death in women: the St James Women Take Heart Project. Circulation 2003; 108: 1554–1559. doi: 10.1161/01.CIR.0000091080.57509.E9
    [37]
    Kokkinos P, Myers J, Kokkinos JP, et al. Exercise capacity and mortality in black and white men. Circulation 2008; 117: 614–622. doi: 10.1161/CIRCULATIONAHA.107.734764
    [38]
    Lavie CJ, Milani RV. Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in a large elderly cohort. Am J Cardiol 1995; 76: 177–179. doi: 10.1016/S0002-9149(99)80054-X
    [39]
    Marchionni N, Fattirolli F, Fumagalli S, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation 2003; 107: 2201–2206. doi: 10.1161/01.CIR.0000066322.21016.4A
    [40]
    Sandercock G, Hurtado V, Cardoso F. Changes in cardiorespiratory fitness in cardiac rehabilitation patients: a meta-analysis. Int J Cardiol 2013; 167: 894–902. doi: 10.1016/j.ijcard.2011.11.068
    [41]
    Hammonds TL, Gathright EC, Goldstein CM, Penn MS, Hughes JW. Effects of exercise on C-reactive protein in healthy patients and in patients with heart disease: A meta-analysis. Heart Lung 2016; 45: 273–282. doi: 10.1016/j.hrtlng.2016.01.009
    [42]
    Milan-Mattos JC, Anibal FF, Perseguini NM, et al. Effects of natural aging and gender on pro-inflammatory markers. Braz J Med Biol Res 2019; 52: e8392. doi: 10.1590/1414-431x20198392
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(3)

    Article Metrics

    Article views (266) PDF downloads(16) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return