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Donev N1, Luder G1, Verra M1
1Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
Background: The general effects of cardiac rehabilitation in group based programs have been well researched in adult men under 65 years and showed strong evidence of its effectiveness. However, women and persons over 65 years are less researched and experience various shortcomings in the diagnosis, therapy and treatment of cardiovascular diseases. In addition, women of all ages are referred less often to cardiac rehabilitation than younger male patients ( 65), as are older men (≥65).
Purpose: The aim of this study was to determine whether age and sex have an influence on the effectiveness of outpatient cardiac rehabilitation. We also identified and analysed various predictors for the effectiveness of cardiac rehabilitation.
Methods: 647 patient who commenced a three-month outpatient cardiac rehabilitation programme at the Inselspital, Berne, in the years 2015 till 2017 were included. The group-based training was performed under heart rate monitoring mainly on cycle ergometers and activities like Nordic Walking, resistance exercise and gymnastics. Patients were included after cardiac events with or without surgical intervention, as well as patients with coronary heart disease, heart valve disease and chronic heart failure. Maximum performance was recorded at the beginning and end of the rehabilitation programme by ergometric testing and the metabolic equivalent (MET) calculated. Of all patients comorbidities and risk factors were also recorded. The influence of the predictors sex, age, adherence, cardiac risk factors and comorbidities on performance changes was determined by stepwise linear regression with backward elimination.
Results: The older patients (≥65 years, n=220) improved 0.7 (IQR 0.2, 1.2) MET significantly less than the younger patients ( 65 years, n=427) with 1.0 (IQR 0.4, 1.7) MET. Women (n=127) improved with 0.6 (IQR 0.2, 1.1) MET significantly less than men (n=520) with 1.0 (IQR 0.4, 1.7) MET. Diabetics and patients with chronic renal insufficiency showed low improvements with 0.5 (IQR 0.3, 1.2) MET for Diabetic respectively 0.5 (IQR 0.1, 0.7) MET for patients with chronic renal insufficiency.
Conclusion(s): The results show that female and older patients experience less improvement in their performance and significant differences compared to younger male patients. Diabetes mellitus, chronic renal insufficiency and smoking also have negative effects on performance improvement. These patients demonstrated lower levels of performance at the start of the cardiac rehabilitation programme and might benefit most from it. This indicates that the program should be adapted to the patient situation in order to achieve the best possible result. For this reason, future studies should investigate how and whether rehabilitation programmes for these groups could be optimized.
Implications: It can be useful to ask about the motivating factors and barriers to physical training and to make rehabilitation more individual. More precise data collection with the introduction of additional parameters such as the reason for aborting the stress test, independent training sessions or medication can provide useful information. Furthermore, an adjustment of outpatient rehabilitation, in which the patients can also choose the training form themselves, so that they can move as long as possible and not only during the rehabilitation measure, can be supportive.
Keywords: Physical performance, group based cardiac rehabilitation
Funding acknowledgements: No external funding
Purpose: The aim of this study was to determine whether age and sex have an influence on the effectiveness of outpatient cardiac rehabilitation. We also identified and analysed various predictors for the effectiveness of cardiac rehabilitation.
Methods: 647 patient who commenced a three-month outpatient cardiac rehabilitation programme at the Inselspital, Berne, in the years 2015 till 2017 were included. The group-based training was performed under heart rate monitoring mainly on cycle ergometers and activities like Nordic Walking, resistance exercise and gymnastics. Patients were included after cardiac events with or without surgical intervention, as well as patients with coronary heart disease, heart valve disease and chronic heart failure. Maximum performance was recorded at the beginning and end of the rehabilitation programme by ergometric testing and the metabolic equivalent (MET) calculated. Of all patients comorbidities and risk factors were also recorded. The influence of the predictors sex, age, adherence, cardiac risk factors and comorbidities on performance changes was determined by stepwise linear regression with backward elimination.
Results: The older patients (≥65 years, n=220) improved 0.7 (IQR 0.2, 1.2) MET significantly less than the younger patients ( 65 years, n=427) with 1.0 (IQR 0.4, 1.7) MET. Women (n=127) improved with 0.6 (IQR 0.2, 1.1) MET significantly less than men (n=520) with 1.0 (IQR 0.4, 1.7) MET. Diabetics and patients with chronic renal insufficiency showed low improvements with 0.5 (IQR 0.3, 1.2) MET for Diabetic respectively 0.5 (IQR 0.1, 0.7) MET for patients with chronic renal insufficiency.
Conclusion(s): The results show that female and older patients experience less improvement in their performance and significant differences compared to younger male patients. Diabetes mellitus, chronic renal insufficiency and smoking also have negative effects on performance improvement. These patients demonstrated lower levels of performance at the start of the cardiac rehabilitation programme and might benefit most from it. This indicates that the program should be adapted to the patient situation in order to achieve the best possible result. For this reason, future studies should investigate how and whether rehabilitation programmes for these groups could be optimized.
Implications: It can be useful to ask about the motivating factors and barriers to physical training and to make rehabilitation more individual. More precise data collection with the introduction of additional parameters such as the reason for aborting the stress test, independent training sessions or medication can provide useful information. Furthermore, an adjustment of outpatient rehabilitation, in which the patients can also choose the training form themselves, so that they can move as long as possible and not only during the rehabilitation measure, can be supportive.
Keywords: Physical performance, group based cardiac rehabilitation
Funding acknowledgements: No external funding
Topic: Cardiorespiratory; Disability & rehabilitation; Older people
Ethics approval required: No
Institution: Swissethics
Ethics committee: Cantonal Ethics Commission Berne
Reason not required: According to Swiss legislation, research projects collecting anonymised health-related data do not need individual ethical approval.
All authors, affiliations and abstracts have been published as submitted.
