Cardiac Rehabilitation in Very Old Adults: Effect of Baseline Functional Capacity on Treatment Effectiveness

ObjectivesTo assess the effect of cardiac rehabilitation (CR) and identify predictors of changes in functional capacity with CR in a consecutive series of older adults with a recent cardiac event. DesignObservational. SettingIn-hospital CR unit. ParticipantsIndividuals aged 75 and older referred to an outpatient CR Unit after an acute coronary event (unstable angina pectoris, acute myocardial infarction) or cardiac surgery (coronary artery bypass grafting, heart valve replacement or repair) (N=160, mean age 804). MeasurementsPeak oxygen consumption (VO2 peak, power) during a symptom-limited cardiopulmonary stress test, distance walked in a 6-minute walk test (6MWT, resistance), and peak torque (strength) using an isokinetic dynamometer, were assessed at baseline and at discharge from a 4-week supervised training program. ResultsIndexes of physical performance improved from baseline to discharge (VO2 peak, 10.9%; 6MWT, 11.0%; peak torque, 11.5%). Baseline performance was independently associated with changes in all three indexes, with higher baseline values predicting less improvement (VO2 peak: OR=0.86, 95% confidence interval (CI)=0.77-0.97; 6MWT: OR= 0.99, 95% CI=0.99-1.00; peak torque: OR=0.96, 95% CI=0.94-0.98). ConclusionAn exercise-based CR program was associated with improvement in all domains of physical performance even in older adults after an acute coronary event or cardiac surgical intervention, particularly in those with poorer baseline performance.