One-Year Adherence to Exercise in Elderly Patients Receiving Postacute Inpatient Rehabilitation After Cardiac Surgery

Macchi C, Polcaro P, Cecchi F, Zipoli R, Sofi F, Romanelli A, Pepi L, Sibilio M, Lipoma M, Petrilli M, Molino-Lova R: One-year adherence to exercise in elderly patients receiving postacute inpatient rehabilitation after cardiac surgery. Objective: Promoting an active lifestyle through an appropriate physical exercise prescription is one of the major targets of cardiac rehabilitation. However, information on the effectiveness of cardiac rehabilitation in promoting lifestyle changes in elderly patients is still scant. Design: In 131 patients over the age of 65 yrs (86 men, and 45 women, mean age 75 yrs ± 6 SD) who have attended postacute inpatient cardiac rehabilitation after cardiac surgery, we tested the 1-yr adherence to the physical exercise prescription received at the end of the cardiac rehabilitation by using a questionnaire on physical activity and the 6-min walk test. Results: All of the 36 patients who reported an active lifestyle and 49 of the 95 patients who reported a sedentary lifestyle in the year preceding the cardiac operation reported at least 1 hr/day on 5 days each week of light regular physical activity in the year after the cardiac rehabilitation. Further, the distance walked at the follow-up 6-min walk test was significantly related to the physical activity score gathered from the questionnaire. Conclusions: Our data show that 65% of the elderly patients who have attended postacute inpatient cardiac rehabilitation after cardiac surgery are still capable of recovering or even increasing their regular physical activity and of maintaining these favorable lifestyle changes at least for 1 yr.

[1]  J. Myers,et al.  Maintenance of exercise capacity and physical activity patterns 2 years after cardiac rehabilitation. , 2005, Journal of cardiopulmonary rehabilitation.

[2]  N. Wareham,et al.  The validation of physical activity instruments for measuring energy expenditure: problems and pitfalls , 1998, Public Health Nutrition.

[3]  H. Arthur,et al.  Determinants of referral to cardiac rehabilitation programs in patients with coronary artery disease: a systematic review. , 2006, American heart journal.

[4]  E. Hannan,et al.  Multicenter experience in revascularization of very elderly patients. , 2005, American heart journal.

[5]  ATS statement: guidelines for the six-minute walk test. , 2002, American journal of respiratory and critical care medicine.

[6]  Luigi Ferrucci,et al.  Subsystems Contributing to the Decline in Ability to Walk: Bridging the Gap Between Epidemiology and Geriatric Practice in the InCHIANTI Study , 2000, Journal of the American Geriatrics Society.

[7]  Li Wang,et al.  Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older , 2006, Annals of Internal Medicine.

[8]  N. Oldridge,et al.  Improved Exercise Tolerance and Quality of Life With Cardiac Rehabilitation of Older Patients After Myocardial Infarction: Results of a Randomized, Controlled Trial , 2003, Circulation.

[9]  Thomas J. Schnitzer,et al.  Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update , 2000 .

[10]  M. Belyea,et al.  Barriers to physical activity maintenance after cardiac rehabilitation. , 2004, Journal of cardiopulmonary rehabilitation.

[11]  R. Paffenbarger,et al.  Physical activity, all-cause mortality, and longevity of college alumni. , 1986, The New England journal of medicine.

[12]  J. Myers,et al.  Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure , 2007, Clinical rehabilitation.

[13]  B E Ainsworth,et al.  Compendium of physical activities: an update of activity codes and MET intensities. , 2000, Medicine and science in sports and exercise.

[14]  P. Savage,et al.  Exercise‐Based Cardiac Rehabilitation for Very Old Patients (≥75 Years): FOCUS ON PHYSICAL FUNCTION , 2008, Journal of cardiopulmonary rehabilitation and prevention.

[15]  M. Lauer,et al.  Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Su , 2005, Circulation.

[16]  Orthopaedic Surgeons Panel On Falls Prevention.  Guideline for the Prevention of Falls in Older Persons , 2001 .

[17]  L. Dei Cas,et al.  The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation programme. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[18]  E. McAuley,et al.  Is social desirability associated with self-reported physical activity? , 2005, Preventive medicine.

[19]  G. Gensini,et al.  Early and Late Rehabilitation and Physical Training in Elderly Patients After Cardiac Surgery , 2007, American journal of physical medicine & rehabilitation.

[20]  Michael E. Miller,et al.  Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[21]  B. Murphy,et al.  An Evaluation of Self‐report Physical Activity Instruments Used in Studies Involving Cardiac Patients , 2008, Journal of cardiopulmonary rehabilitation and prevention.

[22]  M. Izal,et al.  The Geriatric Depression Scale: A Review of Its Development and Utility , 1996, International Psychogeriatrics.

[23]  A. King,et al.  Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. , 2007, Medicine and science in sports and exercise.

[24]  Suzanne G. Leveille,et al.  Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[25]  Pedro Teixeira,et al.  Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy , 2003, Osteoporosis International.

[26]  A Re-examination of the Metabolic Equivalent Concept in Individuals With Coronary Heart Disease , 2007, Journal of cardiopulmonary rehabilitation and prevention.

[27]  M. Fiatarone,et al.  Randomized Controlled Trial of the Effect of Exercise on Sleep , 2001 .

[28]  G. Gensini,et al.  Left-Ventricular Function and Physical Performance on the 6-min Walk Test in Older Patients After Inpatient Cardiac Rehabilitation , 2008, American journal of physical medicine & rehabilitation.

[29]  G. Locke,et al.  American Gastroenterological Association Medical Position Statement: guidelines on constipation. , 2000, Gastroenterology.

[30]  P. Enright,et al.  The 6‐min Walk Test: A Quick Measure of Functional Status in Elderly Adults. , 2003, Chest.

[31]  Pamela W. Duncan,et al.  Guideline for the Prevention of Falls in Older Persons , 2001 .