Directly Measured Physical Function in Cardiac Rehabilitation

Abstract

Purpose The Short Physical Performance Battery (SPPB) is a strong predictor for risk of physical disability in older adults. Roughly half of individuals participating in phase II cardiac rehabilitation (CR) are ≥65 years of age, many presenting with low aerobic capacities and may be at increased risk for physical disability. Methods The cohort consisted of 196 consecutive patients (136 males), aged ≥65 years, entering CR were prospectively assessed by SPPB. Data were also obtained for age, self-reported physical function (Medical Outcomes Short Form-36), and peak aerobic capacity. Measures were repeated when patients completed CR for those individuals that completed the program. Results The average age of patients was 74±0.5 years. At baseline, total SPPB score was 9.7±0.2 (out of 12). Follow-up data was obtained on 133 (68%) patients with a mean improvement of 0.8±0.1 (p<0.0001), which was not clinically significant (≥1 point). Focusing on patients with a low baseline SPPB, 72 subjects scored 9 or below (7.1±0.2) with 45 completing exit measures. Improvements were found in gait speed (0.5±0.1, p<0.0001), chair-stand (1.0±0.1, p<0.0001), and total SPPB (1.6±0.3, p<0.0001) in this more disabled group. Measures of VO2peak was significantly reduced in the low SPPB group (13.5±0.4 vs 17.5±0.4 ml/kg/min, p<0.0001). VO2peak (R2=26%, p<0.0001) and self-reported physical function score (R2= 5%, p=0.02) were the only multivariate predictors of baseline SPPB. Conclusion For patients who enter CR with low SPPB scores (37%) significant improvements in physical function are noted, largely explained by improved walking speed and leg strength (chair-stand).

The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial

“…However, in frail older adults patients (SPPB score ≤ 8) who participated in exercise-based CR (involving resistance, flexibility, balance exercise) after surgery, Molino-Lova et al [ 14 ] demonstrated significant improvements in SPPB score compared to CG one year after discharge from CR. Furthermore, results from Rengo et al [ 15 ] show patients who were admitted to CR with SPPB score ≤ 8 as experiencing significantly more pronounced improvement in gait speed and leg strength (chair-stand) compared to the overall CR population as a result of participation in combined aerobic/resistance training. Moreover, high-speed resistance exercise participation training for older adults living in a community demonstrably improves their SPPB score [ 35 ].…”

“…This trend was observed at all three time points in our study. This could be explained by the concerns regarding SPPB score and its ceiling effect for individuals with higher fitness levels [ 10 , 15 , 38 ]. In our study, the physical frailty level improved in both groups during the observation period.…”

“…We used SPPB (0–7 points – frail, 8–9 pre-frail, 10–12 – robust) [ 10 , 18 – 20 ] and gait speed test, using 5MWT (≤0,69 m/s – frail, 0,7–0,99 m/s – pre-frail, ≥1,0 m/s – robust) [ 10 , 19 – 21 ] to evaluate physical frailty level [ 10 , 14 , 15 , 18 , 20 ].…”

“…Adding resistance/ balance training to usual CR care led to a significant increase in time to Timed up and go (TUG) test in older patients after bypass surgery [13]. While several small studies demonstrate improvements in Short Physical Performance Battery test (SPPB) score in frail patients as a result of long-term exercise training [14][15][16], no other studies have evaluated the short or medium term CR impact on physical frailty measured by SPPB score or gait speed exclusively in patients after valve surgery/ intervention.…”

Contribution of common chronic conditions to midlife physical function decline: The Study of Women’s Health Across the Nation

“…Physical activity levels are generally low among even high-functioning stroke survivors, potentially contributing to further declines in physical function [34]. For heart disease, exercise-based cardiac rehabilitation is beneficial for improving fitness and health [35], and improvements in physical function have also been noted [36]. We do not have information in the current study as to whether participants who reported a stroke or heart disease were in cardiac rehabilitation, and therefore cannot determine if our results are reflective of patients who completed these programs.…”