A new study in the Canadian Journal of Cardiology showed that older individuals have the most to gain and may gain the most from rehabilitation programs, but this need is often ignored.
Regular exercise is highly beneficial for all patients with cardiovascular disease regardless of age, report investigators in the Canadian Journal of Cardiology, published by Elsevier. Their results showed that the patients who benefited most from cardiac rehabilitation were those who started out with the greatest physical impairment.
Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event, yet older patients are largely underrepresented in rehabilitation programs. Studies have shown that this might be due to a lack of referral and encouragement to attend cardiac rehabilitation in older patients.
“Aging is associated with several factors such as increased inflammation or oxidative stress that predispose people to cardiovascular diseases. As a result, elderly patients are usually less fit than their younger counterparts, and deconditioning is accelerated once cardiovascular disease is established,” explained lead investigator Gaëlle Deley, PhD, INSERM UMR1093 – CAPS, Faculty of Sports Sciences, University of Burgundy Franche-Comté, Dijon, France. “However, there are few data about the impact of patient age on the physical and psychological effectiveness of cardiac rehabilitation.”
Several studies have looked at the effects of cardiac rehabilitation in older adults. However, these data often focus on patients above the age of 65 with no distinction between old and very old patients and examine either physical or psychological outcomes but not both.
The goal of this study was to compare the effects of an exercise-based cardiac rehabilitation program on physical and psychological parameters in young, old, and very old patients. It also aimed to identify the features that best predicted cardiac rehabilitation outcomes.
All patients referred to Cardiac Rehabilitation at the Clinique Les Rosiers, Dijon, France from January 2015 to September 2017 were included in this single-center prospective study. Investigators examined 733 patients who completed a 25-session cardiac rehabilitation program. They were divided into three subgroups: less than 65 years old; between 65 and 80 years old; and 80 years or older. Physical and psychological variables such as scores of anxiety and depression were evaluated for all patients before and after cardiac rehabilitation.
Following the intervention, all patients experienced improvements. “We found a few weeks of exercise training not only significantly improved exercise capacity, but also decreased anxiety and depression. Patients with the greatest physical impairments at baseline benefited the most from exercise,” commented Dr. Deley. “Another interesting result was that patients younger than 65 who were very anxious before rehabilitation benefited the most from exercise training. A similar result was found for depressed patients older than 65. These improvements will surely have a great positive impact on patients’ independence and quality of life and might help both clinicians and patients to realize how beneficial exercise rehabilitation can be.”
In an accompanying editorial, Codie R. Rouleau, PhD, RPsych, Clinical Psychologist, Adjunct Assistant Professor in Psychology, and James A. Stone, MD, PhD, Clinical Professor of Medicine, both at the University of Calgary and TotalCardiology Research Network in Calgary, AB, Canada, point out that the study’s conclusion that age does not limit physical performance outcomes is inconsistent with some previous research showing that advancing age, especially for patients 60 years and older, is associated with smaller cardiorespiratory fitness gains during cardiac rehabilitation. The reasons may relate to different program characteristics, different methods of physical performance measurement, or the exceptional adherence rate reported in the study (average 98.6 percent prescribed sessions attended).
“Older adults who are eligible for cardiac rehabilitation have a decreased likelihood of receiving a referral compared to their younger counterparts and the present report may serve as a catalyst for clinicians to recognize that older adults with coronary artery disease stand to benefit only if referred and given the opportunity to participate,” commented Dr. Rouleau.
“A strength of this work is the examination of changes in psychosocial well-being during cardiac rehabilitation–an understudied outcome that is often highly valued by patients,” added Dr. Stone. “The work of Deley et al. may help inform strategies to augment the effects of rehabilitation, reach more patients with a greater likelihood of achieving clinical benefit, and derive improved outcomes from higher value healthcare.”
Cardiovascular diseases are the main cause of death globally. Nearly 18 million people died from cardiovascular diseases in 2016, representing over 30 percent of all global deaths according to the World Health Organization. While cardiovascular diseases increasingly affect young people, the number of people above the age of 65 years, and even more above the age of 80 years, dying from cardiovascular diseases is also increasing.
“Physical and Psychological Effectiveness of Cardiac Rehabilitation: Age Is Not a Limiting Factor!” by Gaëlle Deley, Cécile Culas, Marie-Cécile Blonde, France Mourey and Bénédicte Vergès, Canadian Journal of Cardiology, Volume 35, Issue 10, 1353 – 1358.
“Sorting the Wheat From the Chaff in Cardiac Rehabilitation: Who Gets Better and Why?” by Codie R. Rouleau and James A. Stone, Canadian Journal of Cardiology, Volume 35, Issue 10, 1272 – 1274.