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Cardiac rehab may benefit oldest patients

By Kerry Grens

NEW YORK (Reuters Health) - Exercise-based rehabilitation programs for heart patients are tied to health benefits even among the most elderly, according to a new study.

"Unfortunately, there are some people even now who believe (some patients are) too old to go into such programs. We don't believe so. It's quite the reverse. You do get a benefit from this," said Dr. Killian Robinson, one of the study authors from Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina.

So-called cardiac rehabilitation is often prescribed for patients who have had heart surgery or a major cardiac problem, such as a heart attack.

It usually involves returning to the hospital several times a week for a few months for monitored exercise, taking medication to control heart-related risk factors and making lifestyle improvements.

Numerous studies have found that cardiac rehabilitation can improve patients' health and reduce their chances of dying early (see Reuters Health report of June 10, 2011 here: http://reut.rs/kbcoAn).

"Cardiac rehabilitation is probably the best kept secret in cardiovascular medicine today. It's underutilized for those who are eligible for the program, and especially underutilized for older adults," said Dr. Randal Thomas, director of the Cardiovascular Health Clinic at the Mayo Clinic in Rochester, Minnesota, who was not part of the study.

It's estimated that only about 30 percent of eligible patients attend a cardiac rehab program.

Doctors are expected to refer patients to cardiac rehab, but very few people take advantage of it for a number of reasons, including difficulty traveling to the hospital regularly, a lack of insurance coverage or not understanding its benefits, Thomas told Reuters Health.

To see whether cardiac rehab can help older patients as much as younger people, Robinson and his colleagues collected information on patients' weight, quality of life, exercise abilities, blood pressure and cholesterol before and after a rehab program.

Out of 1,112 heart patients in the study, 79 were over 80 years old.

Both younger and older patients improved on nearly all measures by the end of 36 rehab sessions, the researchers report in The American Journal of Cardiology.

For example, systolic blood pressure - the top number in a blood pressure reading - dropped by 3.8 mm Hg in the younger group from a starting point of 122 mm Hg and by 5.5 mm Hg among older patients, from 129 mm Hg.

Healthy levels are considered below 120 mm Hg.

Patients' exercise capacity, measured by the highest level of exertion they could achieve, also improved in both groups.

A metabolic equivalent (MET) score of three represents low or moderate intensity exercise, such as walking, while a score of five requires more exertion, such as with dancing.

The younger patients increased their exercise capacity to 5.1 points, on average, up from 2.7 at the beginning of the study.

The elderly patients went from a peak exertion of 2.2 points up to 3.2.

MEANINGFUL IMPROVEMENTS

Dr. Carl Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute at the University of Queensland School of Medicine in New Orleans, said fitness is a crucial component of health and longevity.

Although the improvements in exercise capacity among the very old were not as large as the gains seen among younger patients, they are still meaningful, said Lavie, who wasn't involved in the research.

"The elderly are more debilitated, so this very small improvement could make a real significant improvement in their quality of life and allow them to do things they wouldn't ordinarily be able to do from a functional standpoint," he told Reuters Health.

Robinson said the study shows that cardiac rehabilitation works for the oldest patients, and that doctors should be more assertive in getting their patients on board.

He told Reuters Health cardiac rehab is considered safe for the vast majority of patients well enough to undergo heart surgery.

It would not be recommended for patients with crippling arthritis, orthopedic issues or debilitating cancers or those having other surgeries or facing the end of life.

The new study did not randomly assign patients to receive cardiac rehab or not, so the researchers can't say how patients would have fared without the program.

It's also possible that patients in the study were a healthier bunch than the average person who might be referred for cardiac rehabilitation.

Lavie said there are plenty of other studies, however, showing that patients in cardiac rehab have better outcomes than those who don't attend.

"It's a therapy that's been absolutely proven to decrease mortality and to improve quality of life and improve functional capacity," he said.

SOURCE: http://bit.ly/1bgS71a The American Journal of Cardiology, online July 8, 2013.

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