Changes in Exercise Capacity Following Cardiac Rehabilitation in Elderly vs. Younger Cardiac Patients
Bharathi Reddy M.D., Keosik Lee, M.S. R.C.E.P., Nancy Rullo, M.S. M.A., Donna Cheslik, R.N., M.S.N., John Nicholson, M.D
Background: Cardiac Rehabilitation (CR) Programs have been shown to favorably affect the functional capacity in cardiac patients; however few studies observed the effect of CR in older populations. Improved cardiovascular care has markedly extended the survival of patients with cardiac disease which has resulted in a greater number of older patients who are eligible for CR. We speculate traditional CR will benefit functional capacity in elderly patients to a similar level of that observed in younger cardiac patients.
Objective: To compare functional capacity in older patients (age > 70yrs) to younger patients (age < 55yrs) enrolled in the Cardiac Rehabilitation Program at The Cardiac Health Center, New York Hospital Queens.
Methods: We analyzed functional capacity pre- and post- CR in 317 patients, who participated in CR from 1994-2008, completed thirty-six sessions of exercise training in twelve weeks. Patients were categorized into three groups as per AACVPR Risk Stratification, as low functional capacity (FC) group (108 pts), moderate FC group (106 pts) and high FC group (103 pts); We compared improvement in functional capacity between pts< 55yrs (n=16, 9 males, 7 females) to pts >70yrs (n=45, 29 males, 16 females) in low FC group whose baseline FC< 5METS. Exercise testing was performed on all patients’ pre and post CR utilizing standard Bruce Protocol and paired t-test was used to compare the MET levels.
Results: Of 108 patients in low FC group, 17pts are < 55yrs and 52 pts are > 70yrs and both patient groups demonstrated similar improvement in functional capacity post CR. There was an improvement in exercise capacity in younger patients (3.8+0.8 to 7.9+2.2, 4.1+2.1 p<0.05) and in the older patients (4.0+ 0.5 to 5.9+2.0, 1.9+ 1.8 p<0.05). There was significant difference between the two groups (pre 0.2 METS to post 2.0 METS, p<0.05).
Conclusion: The results of the study confirm that CR improves functional capacity in both younger and older patients in low FC group since we know low FC harbingers bad outcomes. This trend appears to be consistent in both male and female patients in both age groups. We observed that both younger and older patients had improvement in FC, however there was a significant change in between those patient groups which leads us to conclude that older patients continue to be at risk therefore a more novel approach to CR including alternate cardiac programs should be focus of future study in geriatric population with cardiovascular disease.