THE EFFECTS OF CARDIOVASCULAR REHABILITATION ON EXERCISE STRAIN TOLERANCE AND QUALITY OF LIFE IN ELDERLY WITH CORONARY ARTERY DISEASE
Keywords:
coronary artery disease, cardiovascular rehabilitation, exercise strain tolerance, quality of life, gender
Abstract
Background/Aim. The aim of our paper was to examine whether elderly patients with coronary artery disease (CAD) benefit equally from cardiovascular rehabilitation (CVR) program as CAD patients of younger age. Methods. The study involved 1697 patients referred to the CVR program after surviving myocardial infarction, percutaneous coronary intervention or surgical myocardial revascularization. Patients were divided in two groups – in group I were patients younger than 65 years (1099 patients, 64.76%), and in group II patients 65 years old or older (598 patients, 35.24%). At the beginning and at the end of CVR exercise stress tests were done (EST1 and EST2). Also, the quality of life was assessed at the beginning and at the end of CVR by validated questionnaire Short-Form 36 Health Status Survey (SF-36). Results were compared between the groups. Results. Younger patients showed better strain tolerance on EST1 and EST2. However, both groups showed better strain tolerance on EST2. Namely, in both groups patients achieved higher strain level and longer duration on EST2 compared to EST1. Also, higher percentage of patients finished test by achieving submaximal heart rate on EST2 compared to EST1. Also, our patients showed a significant improvement in all QOL areas except borderline statistically significant limitation due to emotional health in patients ≥65 of age. Conclusion. Our study showed that CVR improves the quality of life and physical strain tolerance in elderly CAD patients. This is why the utilization rate and adherence of these patients to CVR programs should be vigorously encouraged.
References
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27. Taylor RS, Dalal HM, Zwisler AD. Cardiac rehabilitation for heart failure: 'Cinderella' or evidence-based pillar of care? Eur Heart J. 2023;44(17):1511-1518. doi: 10.1093/eurheartj/ehad118. PMID: 36905176; PMCID: PMC10149531.
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31. WHO
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35. Brouwers RWM, Houben VJG, Kraal JJ, Spee RF, Kemps HMC. Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study. Netherlands Heart Journal. 2021;29:151–157.
36. 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 Jul 15;76(3):177-9. doi: 10.1016/s0002-9149(99)80054-x. PMID: 7611156.
37. Yamamoto S, Hotta K, Ota E, Mori R, Matsunaga A. Effects of resistance training on muscle strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: A meta-analysis. J Cardiol. 2016;68(2):125-34. doi: 10.1016/j.jjcc.2015.09.005.
38. Doll JA, Hellkamp A, Ho M. Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction. JAMA. 2015; 175(10):1700–1702.
39. 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(4):571-584.e2. doi: 10.1016/j.ahj.2011.07.017.
40. Gielen S, Hambrecht R. Effects of exercise training on vascular function and myocardial perfusion. Cardiol Clin. 2001;19(3):357-68. doi: 10.1016/s0733-8651(05)70222-8.
41. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, 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.
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43. Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. J Am Heart Assoc. 2018;7(4):e007725. doi: 10.1161/JAHA.117.007725..
44. Huang R, Palmer SC, Cao Y, Zhang H, Sun Y, Su W, et al. Cardiac Rehabilitation Programs for Chronic Heart Disease: A Bayesian Network Meta-analysis. Can J Cardiol. 2021;37(1):162-171. doi: 10.1016/j.cjca.2020.02.072.
45. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021;11(11):CD001800. doi: 10.1002/14651858.CD001800.pub4.
46. McGregor G, Powell R, Kimani P, Underwood M. Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis. BMJ Open. 2020;10:e036089.
47. Angst F, Giger RD, Lehmann S, Sandor PS, Teuchmann P, Csordas A. Mental and psychosocial health and health related quality of life before and after cardiac rehabilitation: a prospective cohort study with comparison to specific population norms. Health Qual Life Outcomes. 2022;20(1):91. doi: 10.1186/s12955-022-01994-y.
48. Marchionni N, Fattirolli F, Fumagalli S, Oldridge N, Del Lungo F, Morosi L, 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(17):2201-6. doi: 10.1161/01.CIR.0000066322.21016.4A.
49. Stewart KJ, Turner KL, Bacher AC, DeRegis JR, Sung J, Tayback M, et al. Are fitness, activity, and fatness associated with health-related quality of life and mood in older persons? J Cardiopulm Rehabil. 2003;23(2):115-21. doi: 10.1097/00008483-200303000-00009.
50. Norekvål TM, Allore HGCardiac rehabilitation in older adults: is it just lifestyle? Heart 2020;106:1035-1037.
51. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484.
2. Ralapanawa U, Sivakanesan R. Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review. J Epidemiol Glob Health. 2021;11(2):169-177. doi: 10.2991/jegh.k.201217.001.
3. Shahjehan RD, Bhutta BS. Coronary Artery Disease. 2023 Feb 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33231974.
4. Dani SS, Lone AN, Javed Z, Khan MS, Zia Khan M, Kaluski E, et al. Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019. J Am Heart Assoc. 2022 Jan 4;11(1):e021682. doi: 10.1161/JAHA.121.021682.
5. Leong DP, Joseph PG, McKee M, Anand SS, Teo KK, Schwalm JD, et al. Reducing the global burden of cardiovascular disease, part 2: prevention and treatment of cardiovascular disease. Circ Res. 2017;121:695–710. doi: 10.1161/CIRCRESAHA.117.311849.
6. den Uijl I, van den Berg-Emons RJG, Sunamura M, Lenzen MJ, Stam HJ, Boersma E, et al. Effects of a Dedicated Cardiac Rehabilitation Program for Patients With Obesity on Body Weight, Physical Activity, Sedentary Behavior, and Physical Fitness: The OPTICARE XL Randomized Controlled Trial. Phys Ther. 2023;103(9):pzad055. doi: 10.1093/ptj/pzad055.
7. Chaves GSDS, Ghisi GLM, Grace SL, Oh P, Ribeiro AL, Britto RR. Effects of comprehensive cardiac rehabilitation on functional capacity in a middle-income country: a randomised controlled trial. Heart. 2019;105(5):406-413. doi: 10.1136/heartjnl-2018-313632.
8. Deljanin Ilić M, Kocić G, Lazarević G, Simonović D, Stojanović M, Ilić S, et al. Exercise training and inflammatory markers in coronary artery disease patients. Acta facultatis medicae Naissensis 2022;39(2):173-184.
9. Stojanović M, Deljanin-Ilić M, Ilić S, Petrović D, Ilić B. The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with coronary artery disease. Vojnosanitetski pregled 2022;79(5):419-426.
10. Stojanović M, Vuković A, Stanković M, Igrutinović-Novković J, Igić I, Deljanin-Ilić M, et al. Effects of cardiac rehabilitation on quality of life and exercise capacity in patients with coronary artery disease-do women benefit equally? Srpski arhiv za celokupno lekarstvo 2023,(00):37-37.
11. Choi HE, Kim C, Lee DJ, Joo JE, Kim HS. Participation and Prognostic Impact of Cardiac Rehabilitation After Acute Coronary Syndrome: Big-Data Study of the Korean National Health Insurance Service. J Korean Med Sci. 2023;38(15):e119. doi: 10.3346/jkms.2023.38.e119.
12. Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. Eur Heart J. 2023;44(6):452-469. doi: 10.1093/eurheartj/ehac747.
13. Choi HE, Kim C, Lee DJ, Joo JE, Kim HS. Participation and Prognostic Impact of Cardiac Rehabilitation After Acute Coronary Syndrome: Big-Data Study of the Korean National Health Insurance Service. J Korean Med Sci. 2023;38(15):e119. doi: 10.3346/jkms.2023.38.e119.
14. Deljanin-Ilić M, Stojanović M, Ilić S. The effect of cardiovascular rehabilitation on physical strain tolerance: Does gender really matter?. Vojnosanitetski pregled 2021;78(8):844-850.
15. Stojanović M, Deljanin Ilić M, Ilić Stevan. The effects of cardiovascular rehabilitation in patients with reduced, mildly reduced, and preserved ejection fraction-do they benefit equally? Srce i krvni sudovi 2022; 41(2): 39-43
16. Atherton JJ, Sindone A, De Pasquale CG, Driscoll A, MacDonald PS, Hopper I, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart Lung Circ. 2018;27(10):1123-1208. doi: 10.1016/j.hlc.2018.06.1042.
17. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Rev Esp Cardiol (Engl Ed). 2022;75(5):429.
18. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368.
19. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. doi: 10.1093/eurheartj/ehz425.
20. Taylor RS, Dalal HM, McDonagh STJ. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol. 2022;19(3):180-194. doi: 10.1038/s41569-021-00611-7.
21. BHF. National Audit of Cardiac Rehabilitation (NACR) Quality and Outcomes Report 2019. https://www.bhf. org.uk/informationsupport/publications/statistics/national- audit-of- cardiac-rehabilitation- quality-and-outcomes-report-2019 (2019).
22. Redfern J, Gallagher R, O'Neil A, Grace SL, Bauman A, Jennings Get, al. Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future. Front Cardiovasc Med. 2022 ;9:842567. doi: 10.3389/fcvm.2022.842567. PMID: 35571195; PMCID: PMC9091441.
23. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021;11(11):CD001800. doi: 10.1002/14651858.CD001800.pub4.
24. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al.; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982-3021. doi: 10.1016/j.jacc.2020.11.010.
25. Khadanga S, Gaalema DE, Savage P. Underutilization of Cardiac Rehabilitation in Women: BARRIERS AND SOLUTIONS. J Cardiopulm Rehabil Prev. 2021;41(4):207-213. doi: 10.1097/HCR.0000000000000629. PMID: 34158454; PMCID: PMC8243714.
26. Braga M, Nascimento H, Pinto R, Araújo P, Nunes A, Rodrigues J, et al. Cardiac rehabilitation in older patients: Indication or limitation? Rev Port Cardiol (Engl Ed). 2021;40(1):13-20.
27. Taylor RS, Dalal HM, Zwisler AD. Cardiac rehabilitation for heart failure: 'Cinderella' or evidence-based pillar of care? Eur Heart J. 2023;44(17):1511-1518. doi: 10.1093/eurheartj/ehad118. PMID: 36905176; PMCID: PMC10149531.
28. Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, et al. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus. 2020;12(7):e9349. doi: 10.7759/cureus.9349.
29. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol. 2019;234(10):16812-16823. doi: 10.1002/jcp.28350
30. Gupta A, Tsang S, Hajduk A, Krumholz HM, Nanna MG, Green P, et al. Presentation, Treatment, and Outcomes of the Oldest-Old Patients with Acute Myocardial Infarction: The SILVER-AMI Study. Am J Med. 2021;134(1):95-103.
31. WHO
32. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016;2016(1):CD001800. doi: 10.1002/14651858.CD001800.pub3. Update in: Cochrane Database Syst Rev. 2021
33. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420-425. doi: 10.1016/j.tcm.2017.02.005.
34. Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. a position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology. 2020;28:460–495.
35. Brouwers RWM, Houben VJG, Kraal JJ, Spee RF, Kemps HMC. Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study. Netherlands Heart Journal. 2021;29:151–157.
36. 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 Jul 15;76(3):177-9. doi: 10.1016/s0002-9149(99)80054-x. PMID: 7611156.
37. Yamamoto S, Hotta K, Ota E, Mori R, Matsunaga A. Effects of resistance training on muscle strength, exercise capacity, and mobility in middle-aged and elderly patients with coronary artery disease: A meta-analysis. J Cardiol. 2016;68(2):125-34. doi: 10.1016/j.jjcc.2015.09.005.
38. Doll JA, Hellkamp A, Ho M. Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction. JAMA. 2015; 175(10):1700–1702.
39. 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(4):571-584.e2. doi: 10.1016/j.ahj.2011.07.017.
40. Gielen S, Hambrecht R. Effects of exercise training on vascular function and myocardial perfusion. Cardiol Clin. 2001;19(3):357-68. doi: 10.1016/s0733-8651(05)70222-8.
41. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, 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.
42. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise‐based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta‐analysis. J Am Coll Cardiol. 2016;67:1–12.
43. Winzer EB, Woitek F, Linke A. Physical Activity in the Prevention and Treatment of Coronary Artery Disease. J Am Heart Assoc. 2018;7(4):e007725. doi: 10.1161/JAHA.117.007725..
44. Huang R, Palmer SC, Cao Y, Zhang H, Sun Y, Su W, et al. Cardiac Rehabilitation Programs for Chronic Heart Disease: A Bayesian Network Meta-analysis. Can J Cardiol. 2021;37(1):162-171. doi: 10.1016/j.cjca.2020.02.072.
45. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021;11(11):CD001800. doi: 10.1002/14651858.CD001800.pub4.
46. McGregor G, Powell R, Kimani P, Underwood M. Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis. BMJ Open. 2020;10:e036089.
47. Angst F, Giger RD, Lehmann S, Sandor PS, Teuchmann P, Csordas A. Mental and psychosocial health and health related quality of life before and after cardiac rehabilitation: a prospective cohort study with comparison to specific population norms. Health Qual Life Outcomes. 2022;20(1):91. doi: 10.1186/s12955-022-01994-y.
48. Marchionni N, Fattirolli F, Fumagalli S, Oldridge N, Del Lungo F, Morosi L, 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(17):2201-6. doi: 10.1161/01.CIR.0000066322.21016.4A.
49. Stewart KJ, Turner KL, Bacher AC, DeRegis JR, Sung J, Tayback M, et al. Are fitness, activity, and fatness associated with health-related quality of life and mood in older persons? J Cardiopulm Rehabil. 2003;23(2):115-21. doi: 10.1097/00008483-200303000-00009.
50. Norekvål TM, Allore HGCardiac rehabilitation in older adults: is it just lifestyle? Heart 2020;106:1035-1037.
51. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. doi: 10.1093/eurheartj/ehab484.
Published
2025/11/20
Section
Originalni rad / Original article