HEART
October 21, 2019

Heart Patients and Cardiac Rehab

Exercise is not prescribed after a heart attack as often as it should be. Older patients benefit the most -- mentally and physically -- from a supervised program.

Cardiovascular problems such as a heart attack put seniors at greater risk for complications and a quicker decline in their overall health. A cardiovascular rehabilitation program designed to help patients recover from a cardiovascular event can not only improve their heart function, it can reduce depression and anxiety and help ensure a person's independence, a French study finds.

Older, infirm patients may actually have the most to gain and reap the greatest benefit from cardiac rehabilitation.

“Aging is associated with several factors, such as increased inflammation, that predispose people to cardiovascular diseases,” Gaëlle Deley, lead author of the study, said in a statement. The problem is that too few older patients are likely to be enrolled in these programs. They may not be encouraged to participate or even be referred by their doctor. But older patients actually have the most to gain and reap the greatest benefit from cardiac rehabilitation.

Deley and her team compared the effects of an exercise-based cardiac rehabilitation program on physical and psychological outcomes in young, old and very old patients. The researchers also tried to determine what factors predicted the best outcomes.

All patients in the current study were referred to a cardiac rehab program in Dijon, France, between January 2015 and September 2017. The 733 patients completed a 25-session program. The patients were divided into three groups: young, less than 65 years old; old, between 65 and 80 years old; and very old, more than 80 years old. Physical variables, such as estimated peak oxygen consumption and psychological variables, such as scores of anxiety and depression, were measured for all patients before and after they completed the program.

The rehabilitation involved 25 physical training sessions (5 sessions a week) and an educational program on cardiovascular risk factors and diseases.

After a 5-minute warm-up, each session included three 40-minute periods of aerobic exercise performed on a treadmill, on a bicycle and an arm cycling ergometer. The training session was ended by a 5-minute cooling-down period. A team that included cardiologists, cardiovascular nurse specialists and exercise physiologists supervised the sessions. Exercise intensity was prescribed on an individual basis.

The researchers found all patients experienced improvement after cardiac rehabilitation. Deley said patients with the greatest physical impairment at the beginning of the study, or baseline, got the most benefit from exercise. Those who were under 65 and who reported anxiety at baseline also benefitted from exercise, as did those who were older than 65 and depressed.

“These improvements will have a positive impact on patients’ independence and quality of life, and might help both clinicians and patients realize how beneficial exercise rehabilitation can be,” said Deley, of the Faculty of Sports Sciences of the University of Burgundy Franche-Comté in Dijon.

The study findings should encourage clinicians that older adults can benefit from cardiac rehabilitation if they participate. Codie Rouleau, a clinical psychologist and adjunct assistant professor of psychology at the University of Calgary in Canada, said in an editorial related to the study. The study calls attention to the rehab program's psychosocial benefits. Exercise is well-known to improve mood; and as the editorial points out, it has psychosocial as well as physical benefits for cardiac patients.

The study is published in the Canadian Journal of Cardiology.

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