Cardiac rehabilitation improves survival in older patients with coronary disease.
Suaya JA, Stason WB, Ades PA et al: J Am Coll Cardiol 2009; 54: 25-33
Most of the data on the benefits of cardiac rehabilitation comes from randomised controlled trials and meta-analyses data that focussed on young to middle aged low risk men. A recent study provides evidence that an older American population who had been hospitalised for heart disease or revascularisation procedures benefitted from attendance at cardiac rehab. Just over 12% of the older population participated in an average of 24 sessions of cardiac rehab. Attendance at cardiac rehab appeared to reduce mortality by between 21-34%. This benefit did not differentiate between the different clinical subgroups involved in the study population – subjects recruited to the study were post MI, post revasc., or had a diagnosis of heart failure. Moreover, for the patients who attended 25 or more sessions of cardiac rehab, the risk of dying was 19% less over the following 5 years than matched users who completed less than 25 rehab sessions (p<0.001).
High-Calorie-Expenditure Exercise - A New Approach to Cardiac Rehabilitation for Overweight Coronary Patients.
Ades PA, Savage MS, Toth MJ et al: Circulation 2009, 119: 2671-2678
The majority of patients who join rehab programmes are overweight and more than half of these patients have metabolic syndrome. (Metabolic syndrome is a combination of medical problems that increase risk of developing heart disease and diabetes. People with metabolic syndrome have some or all of the following: high blood glucose, high blood pressure, abdominal obesity, low HDL elevated cholesterol and high triglycerides; Public Health Agency of Canada 2008). This study from the USA looked at the effect of two different exercise regimes on overweight patients whilst they attended 5 months of supervised cardiac rehabilitation. The high calorie expenditure group had an exercise expenditure goal of > 3000-3500 kcal/week and their exercise prescription consisted of longer duration exercise lasting 45-60 minutes and more frequent exercise – 5-7 times weekly. This compared with the ‘standard’ care group who exercised for a shorter duration of 25-40 minutes a session, and only 3 times each week. Walking was the preferred type of exercise. All patients completed homework exercise diaries to monitor exercise, aid compliance with the study, and to estimate calorific expenditure. By 5 months, most of the patients had progressed to performing the exercise prescription at home, with one session of supervised exercise a week.
Results from this study showed that there was a 28% reduction in the prevalence of metabolic syndrome in the patients who had undergone the high calorie expenditure exercise regime. The high calorie expenditure group also lost more weight than those who had received standard care.
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