Long-term functional outcomes after cardiac rehabilitation in older patients. Data from the Cardiac Rehabilitation in Advanced aGE: EXercise TRaining and Active follow-up (CR-AGE EXTRA) randomised study

Abstract

Aim Cardiac rehabilitation promotes functional recovery after cardiac events. Our study aimed at evaluating whether, compared to usual care, a home-based exercise programme with monthly reinforcement sessions adds long-term functional benefits to those obtained with cardiac rehabilitation in the elderly. Methods After a 4-week outpatient cardiac rehabilitation, 160 of 197 patients aged 75 years and older screened for eligibility with different indications for cardiac rehabilitation, were randomly assigned to a control (C) or an active treatment (T) group. During a 12-month follow-up, C patients received usual care, while T patients were prescribed a standardised set of home-based exercises with centre-based monthly reinforcements for the first 6 months. The main (peak oxygen consumption) and three secondary outcome measures (distance walked in 6 minutes, inferior limbs peak 90° Torque strength, health-related quality of life) were assessed at baseline, at random assignment and at 6 and 12-month follow-ups with the cardiopulmonary exercise test, 6-minute walking test, isokinetic dynamometer and the Short Form-36 questionnaire, respectively. Results Both C and T groups obtained a significant and similar improvement from baseline to the end of the 4-week cardiac rehabilitation programme in the three functional outcome measures. However, at univariable and age and gender-adjusted analysis of variance for repeated measures, changes from random assignment to 6 or 12-month follow-up in any outcome measure were similar in the C and T groups. Conclusion Results from this randomised study suggest that a home-based exercise programme with monthly reinforcements does not add any long-term functional benefit beyond those offered by a conventional, 4-week outpatient cardiac rehabilitation programme. Trial registration ClinicalTrial.gov Identifier: NCT00641134.

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

“…106,107 Many of these favourable results may be maintained in the mediumlong term. 108 Larger cohort registries including elderly patients participating in cardiac rehabilitation have also reported reduced mortality or hospitalization, even though the role of possible selection bias and hidden confounders has still not been clarified. 109,110 Although these studies demonstrate a benefit of cardiac rehabilitation in the elderly, it is doubtful whether these results may be reproducible also in very elderly or frail patients, who represent an increasing burden of hospital care.…”

Cardiac rehabilitation expands into the elderly

“…Elderly patients show comparable improvement and no more complications or adverse outcomes of exercise training at an elderly age were described in any study. 8 So elderly patients of both genders should be strongly encouraged to participate in exercise-based cardiac rehabilitation. Elderly and/or frail patients usually require individualised therapy.…”

“…A relevant finding of the Cardiac Rehabilitation in Advanced aGE: Exercise TRaining and Active followup (CR-AGE EXTRA) randomised trial was that even a short (4 weeks) outpatient cardiac rehabilitation programme is effective in producing a sustained improvement in functional capacity measures in patients beyond the age of 75 years who are at increased risk of functional deterioration after hospitalisation. 8 The process of cardiac rehabilitation in elderly patients must take into account the nature of the cardiac problem, concomitant illnesses and the physiological response to both exercise activity and the medical management of any underlying cardiac condition. Elderly patients usually show substantial functional improvement when participating in a cardiac rehabilitation programme and comply well with prescribed exercise.…”

The proper care for elderly cardiac patients before rehabilitation

“…1,2 Even in patients aged 75 years and older cardiac rehabilitation improves functional parameters (such as peak oxygen consumption, distance walked in 6 min and inferior limbs peak 90 torque strength) and quality of life (QoL), as shown in the CR-AGE EXTRA study. 3 Exercise capacity was proved to be a strong predictor of mortality. 4 This holds true also for elderly patients enrolled in cardiac rehabilitation programmes after an episode of heart failure decompensationthe physical activity scale for the elderly was shown to be a strong and independent predictor of mortality.…”