Physical fitness and quality of life in elderly patients recovering from an acute coronary event : a randomised controlled study on the effects of aerobic group training

Abstract: An active lifestyle into old age has been shown to reduce the risk for chronic disease, and conserve functional capacity. Caediac rehabilitation including exercise training is of proven value in ischemic heart disease. Despite this, elderly patients with coronary heart disease are frequently not referred or encouraged to pursue cardiac rehabilitation and training programmes, a shortcoming that possibly may limit their performance of activities in everyday life. This investigation evaluates the feasibility of an aerobic group training programme early after an acute coronary event in elderly patients and the physiological effects and health-related self-reported quality of life of such a programme over twelve months. The study-population consisted of a consecutive series of 101 patients (males 80%) aged 65-84 (mean 71) years admitted to the Coronary Care Unit at the Karolinska Hospital, Stockholm due to an acute coronary event. All patients were instructed about physical activity after a coronary event and were encouraged to take a daily walk according to energy and to re-start their prior physical activity as soon as they felt fit for this. The patients were stratified according to diagnosis, acute myocardial infarction or unstable angina pectoris, and randomised into an intervention group or a control group. Patients in the intervention group participated in an aerobic group training programme three times a week during three months, with a voluntary step down period once a week for another three months. All patients were assessed as regards exercise capacity, health-related quality of life and wellbeing, heart rate variability, and muscular endurance and recovery of the knee extensor muscle. Factors of importance for physical activity one year after the acute event were assessed from interviews. The two groups were well balanced as regards clinical characteristics. The compliance in the training group was 87%. Exercise tolerance increased in the trained group from 104 to 122 and 111 watts after three and twelve months, respectively. The corresponding values were 102, 105 and 105 watts among controls. Parameters such as quality of life, self-estimated level of physical activity, fitness and wellbeing were graded higher by the trained patients than those who served as controls at the two follow-up occasions. The programme was also successful in modifying heart rate variability in a prognostic favourable direction, and to change exercise habits positively. The programme itself was not associated with a further improvement in muscular endurance and recovery of the knee extensor muscle, as measured by an isokinetic fatigue-test, than regular walking was. Aerobic group training of elderly patients recovering from an acute coronary event beneficially influences physical fitness and several parameters expressing quality of life, and can safely be performed in this age-cohort. Elderly coronary patients without earlier experience of physical activity seem to require participation in training programmes to be able to change exercise habits in a favourable way. It is therefore of great importance that also elderly patients with coronary heart disease have access to caediac rehabilitation programmes with exercise training. The improvement in health-related quality of life and exercise capacity does, however, not persist over time. Great care has to be taken to preserve initial effects by continued training.