Reduced Executive Functioning Is Associated With Poorer Outcome in Cardiac Rehabilitation

Abstract

Patients with cardiovascular disease and cognitive impairment show reduced adherence to treatment. No study has examined whether cognitive impairment may also predict reduced benefit from cardiac rehabilitation (CR). It appears that cognitively impaired patients may exhibit poorer adherence to CR and limited gains in cardiovascular fitness and/or quality of life (QOL). Forty‐four older adults who enrolled in a CR program and completed measures at enrollment and discharge were included. Cognitive functioning was assessed using the Trail Making Test B. Estimated metabolic equivalents (METs) were derived from a treadmill stress test to provide a measure of cardiovascular fitness. QOL was measured with the Short Form‐36 (SF‐36) physical and mental component scales (PCS and MCS, respectively). Repeated measures analysis of variance showed improvements in METs [METs; F(1,36)=77.6, P<.001] and physical [SF‐36 PCS; F(1,36)=14.14, P=.001)] and mental QOL [SF‐36 MCS; F(1,36)=11.55, P=.002)]. Partial correlations indicated that poorer Trail Making Test B performance was associated with lower METs at discharge (r=−0.30, P<.05), but not PCS or MCS. Mini‐Mental State Examination scores were not related to outcome variables. Current findings suggest that patients with poorer executive functioning derive reduced benefit from CR. CR programs may consider screening patients at baseline for low cognitive functioning to help identify those patients at greatest risk for poor outcome. Prev Cardiol. 2010;13:100–103.©2009 Wiley Periodicals, Inc.

Maximal Cardiorespiratory Fitness Testing in Individuals With Chronic Stroke With Cognitive Impairment: Practice Test Effects and Test-Retest Reliability

“…Studies on CF evaluation in stroke, however, have either excluded participants with cognitive impairment 8,13 or they did not specifically evaluate cognitive function. 6,11,12 Given that cognitive impairment is present after 65% to 82% of all strokes 17,18 and seems to influence rehabilitation outcomes, [19][20][21][22][23] it would appear prudent to evaluate the reliability of CF tests in stroke individuals with cognitive impairment.…”

Physical Activity, Weight Loss, and Cardiac Rehabilitation to Reduce Recurrent Cardiovascular Events

“…Although several mechanisms (e.g., cardiovascular risk reduction, added medical surveillance) may account for the survival advantage, a moderate-to-high exercise capacity has been shown to be inversely related to mortality in patients with ST-elevation myocardial infarction treated with emergent coronary angioplasty [34]. However, clinical depression [47], cognitive impairment [54], or both are associated with less favorable improvement in exercise tolerance after cardiac rehabilitation.…”

Cognitive Performance Does Not Limit Physical Activity Participation in the Lifestyle Interventions and Independence for Elders Pilot Study (Life-P)

“…However, recent studies have shown that older adults with lower cognitive function (reduced executive functioning) were less adherent to a 3-month exercise-based cardiac rehabilitation program. Importantly, participants with low adherence had poorer outcomes following their exercise intervention (9). Similarly, Tiedemann et al demonstrated that impaired global cognitive function (assessed using the Mini-Mental State Examination) was a significant independent predictor of low physical activity adherence during a 6–12 month intervention among older retirement village residents (10).…”