Exercise Training for Patients With Severe Aortic Stenosis in a Convalescent Rehabilitation Ward　― A Retrospective Cohort Study ―

Abstract

Background: Exercise loading is contraindicated for patients with severe aortic stenosis (AS); however, everyday activities mandate the inclusion of a light load. The aim of this study was to investigate the efficacy and safety of exercise training for patients with severe AS who were admitted to a rehabilitation ward because of physical disability. Methods and Results:This historical cohort study was conducted at a single rehabilitation center in Japan. Patients admitted for rehabilitation of physical disability and those who met the definition of severe AS were analyzed. An exercise training program was implemented for patients with disability and severe AS. Cardiovascular symptoms during hospitalization were evaluated. Improvements in the performance of activities of daily living were assessed using the Functional Independence Measure (FIM). Eighteen patients undertook an exercise training program. The median patient age was 87 years (range 76-95 years). Of these patients, 3 died and another 3 were transferred to another hospital due to causes other than the exercise training program. None of the other patients experienced cardiovascular symptoms, and the FIM scores of 12 patients were significantly improved (median [range] scores at admission and discharge of 63 and 87 , respectively; P<0.001). Conclusions:An exercise training program could be applied to patients with severe AS who were admitted for convalescent rehabilitation, because it can improve FIM scores.

Association between Skeletal Muscle Mass Index and Convalescent Rehabilitation Ward Achievement Index in Older Patients

“…The prescribed standard LOS for patients with a neurological disease (150 or 180 days) is Covariates for CRWAI and adjusters for CRWAI ≥40: age, sex, BMI, hand-grip strength, oral feeding, neurological disease without HBD, neurological disease with HBD, motor disorder, disuse syndrome, chronic heart failure, chronic respiratory disease, dementia, baseline hemoglobin level, baseline serum albumin, FIM-M at admission, FIM-C at admission. longer than that for patients with a motor disorder or disuse syndrome (90 days) 9) ; this fact may have proved advantageous when computing the CRWAI for patients with a longer prescribed standard LOS. Further, since dysphagia is reportedly associated with poorer functional recovery in older hospitalized patients, 18) patients on oral feeding may have had an advantage over those on tube feeding in improvement of ADLs.…”

“…Disuse syndrome is a pathophysiological condition or group of symptoms that occurs after prescribed or unavoidable inactivity; the syndrome affect various body processes, including musculoskeletal, circulatory, and respiratory systems, thereby adversely affecting the performance of ADLs. 9) Patients with no SMI data, those who died or were transferred to other hospitals due to comorbidities, and those aged <65 years of age were excluded from the study. Additionally, patients hospitalized for <7 days were excluded because the effects of rehabilitation cannot be determined accurately within such short periods.…”

“…The rehabilitation protocols were planned for each patient according to Japan's medical insurance system. 9) Three 20min sessions each of physical therapy, occupational therapy, and speech/language therapy (nine sessions per day) were conducted for patients with neurological diseases 9) ; three 20-min sessions each of physical therapy and occupational therapy (six sessions per day) were implemented for patients with motor disorders 9) ; whereas, patients with disuse syndrome received three 20-min sessions each of physical therapy, occupational therapy, and speech-language therapy (a total of nine sessions per day). 9) The prescribed standard lengths of stay (LOS) in the convalescent rehabilitation ward for patients with a neurological disease without hyper brain dysfunction, with a neurological disease with hyper brain dysfunction, with motor disorder, and with disuse syndrome was 150, 180, 90, and 90 days, respectively.…”

“…Dementia was defined as a score of ≤20 points on the Revised Hasegawa's Dementia scale or by the prescription of antidementia drugs. 9,12,13) Laboratory data included the levels of blood hemoglobin, creatinine, blood urea nitrogen, serum total protein, and serum albumin. Anemia was defined as hemoglobin levels <13.0 g/dl in men and <12.0 g/dl in women, as defined by the World Health Organization.…”

“…Anemia was defined as hemoglobin levels <13.0 g/dl in men and <12.0 g/dl in women, as defined by the World Health Organization. 9,14) Within 48 h of hospitalization, patients' hand-grip strength, skeletal muscle mass, and functional independence measure (FIM) scores for motor function (FIM-M) and cognitive function (FIM-C) were measured. The FIM evaluates a patient's independence level in performing ADLs 11) ; the FIM contains 18 items: 13 items are in the physical domain and 5 items relate to cognition.…”