Cardiac Rehabilitation and Complementary Physical Training in Elderly Patients after Acute Coronary Syndrome: A Pilot Study

Abstract

Background and Objectives: Nearly 23% of elderly patients hospitalized due to acute coronary syndrome have reduced muscle strength. It is assumed that these patients would better benefit from a complex training—a combination of endurance, strength, balance, coordination, and flexibility—in order to reduce the loss of muscle strength and mass and improve functional capacity. The aim of this study was to assess the effectiveness and safety of two different complementary resistance and balance training programs during short-term cardiac rehabilitation (CR) in elderly patients after a percutaneous or surgical intervention due to acute coronary syndrome. Materials and Methods: This randomized controlled trial was conducted from January 2020 to February 2021 in one Lithuanian rehabilitation hospital. A total of 63 participants who met the inclusion criteria were randomly assigned to three groups (at the ratio of 1:1:1): control (CG, n = 19), intervention 1 (IG-1, n = 26), and intervention 2 (IG-2, n = 18). All the patients attended a usual inpatient CR program of a mean duration of 18.7 ± 1.7 days, while the patients assigned to the intervention groups (IG-1 and IG-2) additionally received different resistance and balance training programs three days a week. Functional capacity, with 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET), as well as physical performance, with the short physical performance battery (SPPB) test and one repetition maximum test (1RM) for leg press, were assessed at baseline and after CR. Results: The mean age of the participants was 72.9 ± 5.5 years; 73% were men. All parameters of functional capacity and physical performance improved significantly after CR (p < 0.05), except for peak VO2 that improved only in the IG-1. Comparison of CR effectiveness among the groups revealed no significant differences. Conclusions: All three rehabilitation programs were safe and well tolerated by elderly patients aged ≥65 years as well as improved functional capacity (6-minute walk distance and peak workload) and physical performance (SPPB and 1RM). Complementary resistance and balance training with traditional physical therapy means and exercises with mechanical devices did not show greater benefits for the results of physical performance compared with the usual CR program.

Prehabilitation Using a Cardiac Rehabilitation Program for a Patient With a Total Artificial Heart Prior to Heart Transplantation

“…A mean 18-d rehabilitation program in various patients with HF (angina pectoris, myocardial infarction, and cardiac surgery) led to a 31% increase in the 6-min walk test. 16,17 Similarly, a multicenter study confirmed a more modest, but very significant, +16% improvement in a large and varied cohort of patients with HF following completion of a 3-to 4-wk CR program. 18 These data are in accordance with our observations, although the CR duration of our protocol was shorter.…”

Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome

“…The present study was carried out from January 2020 to September 2021 and is continuation of a larger clinical, randomized controlled trial conducted in a single rehabilitation center (Kulautuva Rehabilitation Hospital, Lithuanian University of Health Sciences, Kaunas, Lithuania) [15]. The study was approved by Kaunas Regional Biomedical Research Ethics Committee (permission No.…”

“…Every item on the scale is rated by a score of 0 to 2; the maximal score achievable is 17, and this indicates severe frailty. During this study, the patients were classified based on their EFS score into the following categories as suggested on the official EFS website (Edmontonfrailscale.org): fit (score of 0 to 3), vulnerable (score of 4 to 5), and frail (score of 6 to 17) [15]. In addition, all of the participants passed a clinical evaluation of gait speed, using the 5 m walk test (5MWT).…”

“…The detailed complementary training programs and comprehensive study methodology are described in the previously published article [15]. Briefly, the IG-1 underwent complementary training with traditional means of physical therapy, while the IG-2 underwent complementary training with mechanical devices.…”

Physical activity, inactivity and sleep in older patients with coronary artery disease following percutaneous coronary intervention: a longitudinal, observational study

“…In a recent meta-analysis of 10 randomized controlled trials, patients with CAD who exercised following PCI resulted in improved left ventricular ejection fraction, decreased incidence of cardiac death, myocardial infarction (MI), coronary angioplasty, angina pectoris and restenosis compared to controls [17]. Likewise, cardiac rehabilitation in elderly patients after ACS has resulted in significant improvements in functional capacity and physical performance [18]; however, the longitudinal patterns of physical activity, sedentary behaviours and sleep in older patients (≥75 years) following PCI are scarce. The purpose of the present study was to evaluate the physical activity levels, inactivity and sleep patterns of older patients with CAD following PCI, longitudinally over 12 months.…”