BENEFITS OF CARDIAC REHABILITATION AND EXERCISE TRAINING IN SECONDARYCORONARY PREVENTION IN THE ELDERLY

Objectives. The aim of this study was to determine the effects of card iac rehabilitation and exercise training on plasma lipids, indexes of obesity and exercise capacity in the elderly and to compare the benefi ts in elderly patients with coronary heart disease with benefits in a younger cohort. Background. Despite the well proved benefits of cardia c rehabilitation and exercise training, elderly patients with coronary heart disease are frequently not referred or vigorously encouraged to pursue this therapy. In addition, only limited data are available for these elderly patients on the benefits of cardiac rehabilitation on p lasma lipids, indexes of obesity and exercise capacity. Methods. At tw o large multispecialty teaching institutions, baseline and post-rehabi litation data including plasma lipids, indexes of obesity and exercise capacity were compared in 92 elderly patients (greater-than-or-equal- to 65 years, mean age 70.1 +/- 4.1 years) and 182 younger patients (<6 5 years, mean 53.9 +/- 7.4 years) enrolled in phase II cardiac rehabil itation and exercise programs after a major cardiac event. Results. At baseline, body mass index (26.0 +/- 3.9 vs. 27.8 +/- 4.2 kg/M2, p < 0 .001), triglycerides (141 +/- 55 vs. 178 +/- 105 mg/dl, p < 0.01) and estimated metabolic equivalents (METs) (5.6 +/- 1.6 vs. 7.7 +/- 3.0, p < 0.0001) were lower and high density lipoprotein cholesterol was gre ater (40.4 +/- 12.1 vs. 37.5 +/- 10.4 mg/dl, p < 0.05) in the elderly than in younger patients. After rehabilitation, the elderly demonstrat ed significant improvements in METs (5.6 +/- 1.6 vs. 7.5 +/- 2.3, p < 0.0001), body mass index (26.0 +/- 3.9 vs. 25.6 +/- 3.8 kg/m2, p < 0.0 1), percent body fat (24.4 +/- 7.0 vs. 22.9 +/- 7.2%, p < 0.0001), hig h density lipoprotein cholesterol (40.4 +/- 12.1 vs. 43.0 +/- 11.4 mg/ dl, p < 0.001) and the ratio of low density to high density lipoprotei n, cholesterol (3.6 +/- 1.3 vs. 3.3 +/- 1.0, p < 0.01) and a decrease in triglycerides that approached statistical significance (141 +/- 55 vs. 130 +/- 76 mg/dl, p = 0.14) but not in total cholesterol or low de nsity lipoprotein cholesterol. Improvements in functional capacity, pe rcent body fat and body mass index, as well as lipids, were statistica lly similar in the older and younger patients. Conclusions. Despite ba seline differences, improvements in exercise capacity, obesity indexes and lipids were very similar in older and younger patients enrolled i n cardiac rehabilitation and exercise training. These data emphasize t hat elderly patients should not be categorically denied the psychosoci al, physical and risk factor benefits of secondary coronary prevention including formal cardiac rehabilitation and supervised exercise train ing.