Exercise-based rehabilitation programs for heart patients
are tied to health benefits even among the most elderly, according to a new
"Unfortunately, there are some people even now who
believe (some patients are) too old to go into such programmes. We don't believe
so. It's quite the reverse. You do get a benefit from this," said Dr
Killian Robinson, one of the study authors from Wake Forest University Baptist
Medical Center in Winston-Salem, North Carolina.
So-called cardiac rehabilitation is often prescribed for
patients who have had heart surgery or a major cardiac problem, such as a heart
It usually involves returning to the hospital several times
a week for a few months for monitored exercise, taking medication to control
heart-related risk factors and making lifestyle improvements. Numerous studies
have found that cardiac rehabilitation can improve patients' health and reduce
their chances of dying early (see Reuters Health report of June 10, 2011 here: Cardiac rehabilitation is probably the best kept secret in cardiovascular
It's underutilised for those who are eligible for the
program, and especially underutilised for older adults," said Dr Randal
Thomas, director of the Cardiovascular Health Clinic at the Mayo Clinic in
Rochester, Minnesota, who was not part of the study. It’s estimated that only
about 30% of eligible patients attend a cardiac rehab program.
Doctors are expected to refer patients to cardiac rehab, but
very few people take advantage of it for a number of reasons, including
difficulty traveling to the hospital regularly, a lack of insurance coverage or
not understanding its benefits, Thomas told Reuters Health.
To see whether cardiac rehab can help older patients as much
as younger people, Robinson and his colleagues collected information on
patients' weight, quality of life, exercise abilities, blood pressure and
cholesterol before and after a rehab program.
Out of 1 112 heart patients in the study, 79 were over 80
years old. Both younger and older patients improved on nearly all measures by
the end of 36 rehab sessions, the researchers report in The American Journal of
Cardiology. For example, systolic blood pressure the top number in a blood pressure reading dropped by 3.8 mm Hg in the younger group from
a starting point of 122 mm Hg and by 5.5 mm Hg among older patients, from 129
Healthy levels are considered below 120 mm Hg. Patients'
exercise capacity, measured by the highest level of exertion they could
achieve, also improved in both groups. A metabolic equivalent (MET) score of
three represents low or moderate intensity exercise, such as walking, while a
score of five requires more exertion, such as with dancing.
The younger patients increased their exercise capacity to
5.1 points, on average, up from 2.7 at the beginning of the study.
The elderly patients went from a peak exertion of 2.2 points
up to 3.2. MEANINGFUL IMPROVEMENTS Dr Carl Lavie, medical director of cardiac
rehabilitation and prevention at the John Ochsner Heart and Vascular Institute
at the University of Queensland School of Medicine in New Orleans, said fitness
is a crucial component of health and longevity.
Although the improvements in exercise capacity among the
very old were not as large as the gains seen among younger patients, they are
still meaningful, said Lavie, who wasn't involved in the research.
"The elderly are more debilitated, so this very small
improvement could make a real significant improvement in their quality of life
and allow them to do things they wouldn't ordinarily be able to do from a
functional standpoint," he told Reuters Health.
Robinson said the study shows that cardiac rehabilitation
works for the oldest patients, and that doctors should be more assertive in
getting their patients on board. He told Reuters Health cardiac rehab is
considered safe for the vast majority of patients well enough to undergo heart surgery.
It would not be recommended for patients with crippling arthritis, orthopedic
issues or debilitating cancers or those having other surgeries or facing the
end of life.
The new study did not randomly assign patients to receive
cardiac rehab or not, so the researchers can't say how patients would have
fared without the program. It’s also possible that patients in the study were a
healthier bunch than the average person who might be referred for cardiac
Lavie said there are plenty of other studies, however,
showing that patients in cardiac rehab have better outcomes than those who
don't attend."It's a therapy that's been absolutely proven to decrease
mortality and to improve quality of life and improve functional capacity,"