Effects of a structured physical activity intervention on measures of physical performance in frail elderly patients after cardiac rehabilitation: a pilot study with 1-year follow-up

Abstract

The objective of this prospective randomized controlled study was to compare the long-term effects of a structured physical activity intervention with those of aerobic exercises alone, in a cohort of elderly patients who had undergone elective cardiac surgery, and who were classified as frail at the end of rehabilitation based on their Short Physical Performance Battery (SPPB) score. At the end of rehabilitation, 140 frail elderly patients were randomly allocated either to the intervention group (IG) or to the control group (CG). CG participants received the usual aerobic exercise prescription, while IG participants were also taught additional exercises for strength, flexibility, balance and coordination. The improvement in SPPB score after 1 year was the outcome of the study. IG showed a significant improvement in SPPB score (9.0 ± 1.1 vs. 7.7 ± 1.4, p \ 0.001), while no significant change was found in CG (7.7 ± 1.6 vs. 7.6 ± 1.5, p = 0.252). IG also showed a significantly higher proportion of participants who improved their SPPB score of at least 1 point (70 vs. 37%, p \ 0.001). In conclusions, our structured physical activity intervention significantly improves the SPPB score in frail elderly patients who have undergone elective cardiac surgery. An intervention that improves the SPPB score might delay the occurrence of mobility disability.

The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) – standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial

“…The aims of this restriction are to promote sternal osteosynthesis and bone healing by minimising motion between the sternal edges [8, 15, 63]. However, the effect of sternal precautions on patient outcomes is unknown, with significant variation among institutions worldwide [8, 13, 14, 26]. In addition, there is limited evidence to support their widespread application in clinical practice [8, 13, 15, 18, 62, 64, 65].…”

“…The Short Physical Performance Battery (SPPB) is a functional test that measures daily functional activities in the acute care in-patient older population, including cardiac surgery [26]. The test is a well-established and validated measure of lower extremity performance and is designed to simulate routine physical activities in older adults [27].…”

“…The SPPB was selected because it assesses overall functional performance that reflects physical function required to perform everyday tasks. It is hypothesised that the intervention will impact overall functional performance because this is the primary concern of most patients at medium- to long-term follow-up (6 weeks to 12 months) [26, 30]. The test has established validity and reliability in measuring physical performance in the elderly [27, 31, 32] with an intra-class correlation coefficient (ICC) equal to 0.82 [32], and it is a strong predictor of disability in non-disabled older persons [33].…”

Directly Measured Physical Function in Cardiac Rehabilitation

“…One study found no change in SPPB following 1.6 years of a maintenance exercise program 16 while another resulted in improvements at 1 year in elderly frail patients who incorporated strength, flexibility, balance, and coordination exercises in addition to aerobic exercise. 17 …”

Influence of the Flo-Dynamics Movement System© intervention on measures of performance in older persons

“…It is important to evaluate effective, low-impact, and enjoyable physical activity strategies for older persons, to prevent frailty and loss of independence. It has been suggested that any exercise intervention that improves the SPPB score might delay the occurrence of movement disability in elderly individuals 25,26. To date, no scientific data exist on the efficacy of FDMS training with the Wun-Jo device.…”