Changes in Aerobic Capacity Over Time in Elderly Patients With Acute Myocardial Infarction During Cardiac Rehabilitation

Abstract

Objective To test the hypothesis that a longer duration of phase II cardiac rehabilitation is required to recover the exercise capacity of elderly patients compared to younger patients. Methods We retrospectively reviewed and analyzed the medical records of patients who were referred to our cardiac rehabilitation (CR) center and underwent percutaneous coronary intervention for acute myocardial infarction (AMI). A total of 70 patients were enrolled who underwent an exercise tolerance test (ETT) 3 weeks after the occurrence of an AMI (T0), 6 weeks after the first ETT (T1), and 12 weeks after the first ETT (T2). Patients older than 65 years were assigned to the elderly group (n=24) and those aged 65 years and younger to the younger group (n=46). Both groups performed center-based or home-based CR for 12 weeks (3 times per week and 1 session per day). Exercise intensity for each individual was based on the target heart rate calculated by the Karvonen formula. The change in maximal metabolic equivalents (MET max ) of the two groups was measured at each assessment point (T0, T1, and T2) to investigate the recovery of exercise capacity. Results The younger group showed improvement in MET max between T0 and T1. However, MET max of the elderly group showed no significant improvement between T0 and T1. The exercise capacity, measured with MET max , of all groups showed improvement between T0 and T2. Conclusion Elderly patients with AMI need a longer duration of CR (>6 weeks) than younger patients with AMI.

Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements

“…5,6 Exercise outcomes from CR can vary substantially, which may be related to both patient and CR program factors. For instance, patient age 7 and sex 8 are known to independently contribute to variations in exercise capacity outcomes, as is the presence of metabolic, musculoskeletal, and respiratory comorbidities, 9 and psychological symptoms such as anxiety and depression. 10 Furthermore, ethnic minority status 11 and exercise capacity levels at CR entry may also influence improvement rate.…”

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

“…Although a lot of studies are currently being conducted, authors use different physical exercise programs in an effort to find out the best one: of what intensity, frequency, and duration the CR should be and what type of exercises are most suitable for elderly patients. A recent study by Kim et al, published in 2020, reported that elderly patients needed CR of a longer duration than their younger counterparts: younger patients (<65 years) with acute myocardial infarction who had CR sessions 3 times a week showed an improvement in CPET parameters after 6 weeks, meanwhile in elderly patients (≥65 years), CPET parameters improved only after 12 weeks [ 23 ]. Other study showed a positive impact of a two month CR, given five times a week, on physical parameters such as 6MWD and VO 2 in all age groups, even in very old (≥80 years) patients [ 24 ].…”

Predictors for one-year outcomes of cardiorespiratory fitness and cardiovascular risk factor control after cardiac rehabilitation in elderly patients: The EU-CaRE study

“…An additional decade in age was related to a reduced recovery in peak VO 2 by 1.1 ml/kg/min, while in non-surgery patients the reduction was only 0.4 ml/kg/min, suggesting that older age may not only reduce the effect of a physical training stimulus but also have an adverse effect on the healing process from surgery [ 22 ]. A previous study on patients undergoing CR has found older age to be a negative predictor for improvement in CRF [ 9 ], and another study found a smaller increase in CRF in elderly compared to younger patients [ 23 ]. However, other studies have found similar or even greater improvements in peak VO 2 with increasing age [ 24 ].…”