Improvements in exercise capacity of older adults during cardiac rehabilitation

Bierbauer, Walter; Scholz, Urte; Bermudez, Tania; Debeer, Dries; Coch, Michael; Fleisch-Silvestri, Ruth; Nacht, C. H.; Tschanz, Hansueli; Schmid, Jean‐Paul; Hermann, Matthias

doi:10.1177/2047487320914736

Cited by 34 publications

(24 citation statements)

References 25 publications

(24 reference statements)

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“…The very elderly did as good as the younger subjects: this is good news and confirms the results of previous studies that dealt with outpatient rehabilitation ( 34 , 35 ).…”

Section: Discussionsupporting

confidence: 88%

Beneficial Effect on Exercise Tolerance of a Comprehensive Rehabilitation Program in Elderly Obese Patients Affected With Heart Disease

Gondoni

Nibbio

Titon

2021

Front. Cardiovasc. Med.

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Aims: The number of elderly patients affected with multiple chronic diseases is constantly increasing. Even though multiple studies demonstrated a beneficial effect of cardiac rehabilitation, we do not have data on the outcomes in elderly patients with obesity and heart disease.Methods: We studied 772 consecutive obese subjects (275 women; 35.6%) aged ≥70 years, affected with coronary artery disease and/or heart failure. We conducted a symptom limited exercise test at the beginning and at the end of the program, which consisted of aerobic and strength physical activity, diet, and psychological counseling.Results: Mean body mass index (BMI) at baseline was 37.6 ± 4.4 kg/m2 and decreased to 36.4 ± 4.3 kg/m2 (P < 0.001). At baseline, attained metabolic equivalents (METs) were 4.7 ± 1.7, and by the end of the program, they were 5.6 ± 2.1 (P < 0.001). The mean improvement was 21.6 ± 21.7% (median, 17.6%; 95% CI, 20.0–23.1%). Patients over 80 years old had similar results compared to the younger ones. Diabetics did worse than non-diabetic patients: the improvement they reached was 19.4 ± 18.9% vs. 23.8 ± 23.9% (P = 0.005). The presence of heart failure was significantly related to both the baseline and final performance, but the attained improvement was significantly greater in heart failure patients: 24.3 ± 23.8% vs. 16.3 ± 15.4% (P < 0.001). No patient had adverse events related to the program.Conclusion: This study documents a significant improvement in exercise capacity in elderly obese patients affected with heart disease who underwent a rehabilitation program.

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“…The very elderly did as good as the younger subjects: this is good news and confirms the results of previous studies that dealt with outpatient rehabilitation ( 34 , 35 ).…”

Section: Discussionsupporting

confidence: 88%

Beneficial Effect on Exercise Tolerance of a Comprehensive Rehabilitation Program in Elderly Obese Patients Affected With Heart Disease

Gondoni

Nibbio

Titon

2021

Front. Cardiovasc. Med.

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“…Regarding baseline PV O2, it is known that lower baseline exercise capacity is an important predictor of greater improvements in exercise capacity after ECR. 28,29 This was confirmed in the present study in poor CRT responders with reduced exercise capacity.…”

Section: Differences Between Good and Poor Ecr Responders Among Poor Crt Responderssupporting

confidence: 88%

Exercise-Based Cardiac Rehabilitation Improves Exercise Capacity Regardless of the Response to Cardiac Resynchronization Therapy in Patients With Heart Failure and Reduced Ejection Fraction

Misumi

Nakanishi

Miura

et al. 2021

Circ J

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exercise capacity and the quality of life (QOL) in patients with HFrEF, and reduces the rate of hospitalization due to any cause. 13,14 A meta-analysis showed that participation in an ECR program comprising moderate-intensity exercise increases patients' exercise capacity (measured as peak oxygen uptake [PV O2]) by approximately 13%. 15 In addition, participation in ECR after CRT has been reported to improve patients' PV O2 and QOL. 16 Therefore, cardiac rehabilitation is recommended by current heart failure practice guidelines at the Class I level. 1,17,18 H eart failure is a major public health problem and is associated with high morbidity and mortality. 1-3 In patients with chronic heart failure with reduced ejection fraction (HFrEF), cardiac resynchronization therapy (CRT) improves left ventricular ejection fraction (LVEF), 4-7 exercise capacity, and long-term survival. 5-9 Following CRT, patients' LVEF increases by approximately 10% points and left ventricular (LV) end-diastolic volume decreases by 20%; these changes are associated with better long-term prognoses. 10 However, up to 30% of patients show a poor response to CRT. 11 In these patients, LVEF does not improve after CRT. 12 Exercise-based cardiac rehabilitation (ECR) improves Editorial p ????

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“…Finally, the practical relevance of a more partial perspective and the advantage of the new CPI implementation is illustrated in the recent publication of Bierbauer and colleagues [49], in which the CPI was used to identify which variables contribute to the prediction of improvements in exercise capacity of older adults during cardiac rehabilitation.…”

Section: Resultsmentioning

confidence: 99%

Conditional permutation importance revisited

2020

Self Cite

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Background: Random forest based variable importance measures have become popular tools for assessing the contributions of the predictor variables in a fitted random forest. In this article we reconsider a frequently used variable importance measure, the Conditional Permutation Importance (CPI). We argue and illustrate that the CPI corresponds to a more partial quantification of variable importance and suggest several improvements in its methodology and implementation that enhance its practical value. In addition, we introduce the threshold value in the CPI algorithm as a parameter that can make the CPI more partial or more marginal. Results: By means of extensive simulations, where the original version of the CPI is used as the reference, we examine the impact of the proposed methodological improvements. The simulation results show how the improved CPI methodology increases the interpretability and stability of the computations. In addition, the newly proposed implementation decreases the computation times drastically and is more widely applicable. The improved CPI algorithm is made freely available as an add-on package to the open-source software R. Conclusion: The proposed methodology and implementation of the CPI is computationally faster and leads to more stable results. It has a beneficial impact on practical research by making random forest analyses more interpretable.

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Improvements in exercise capacity of older adults during cardiac rehabilitation

Cited by 34 publications

References 25 publications

Beneficial Effect on Exercise Tolerance of a Comprehensive Rehabilitation Program in Elderly Obese Patients Affected With Heart Disease

Beneficial Effect on Exercise Tolerance of a Comprehensive Rehabilitation Program in Elderly Obese Patients Affected With Heart Disease

Exercise-Based Cardiac Rehabilitation Improves Exercise Capacity Regardless of the Response to Cardiac Resynchronization Therapy in Patients With Heart Failure and Reduced Ejection Fraction

Conditional permutation importance revisited

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