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Early Participation in Cardiac Rehabilitation Exercise Programming Further Improves Aerobic Capacity Post Myocardial Infarction

2009; Lippincott Williams & Wilkins; Volume: 41; Issue: 5 Linguagem: Inglês

10.1249/01.mss.0000355543.73978.1c

1530-0315

Tyler G. Threlfall, Trina Hauer, Ross Arena, Karen Parker, Debra Lundberg, David Goodhart, Mouhieddin Traboulsi, Sandeep Aggarwal,

Cardiovascular and exercise physiology

Aerobic capacity is an important outcome of exercise based cardiac rehabilitation (CR) programs as it is a strong predictor of cardiac related death. Following a myocardial infarction (MI), engaging in aerobic exercise CR programming improves aerobic capacity, however, optimal timing of this programming remains controversial. PURPOSE: To determine if there are differences in aerobic capacity between subjects who engage in early compared to usual timing of aerobic exercise CR programming post MI. METHODS: One hundred and one patients diagnosed with a low risk (CADILLAC score 0-2) ST elevation MI participated in this analysis. Fifty three subjects (91% male, age: 56.1 ±9.1 years) were allocated to the Early Exercise arm, while forty eight subjects (81% male, age: 56.9 ±10.5 years), identified retrospectively and matched for Early Exercise criterion, served as the Usual Care comparison group. All subjects participated in a 12 week outpatient CR aerobic exercise program and underwent maximal exercise treadmill stress testing using BRUCE protocol, at baseline and at completion of their program. RESULTS: The following results are reported Early Exercise versus Usual Care group throughout. The time between MI event and baseline exercise testing was significantly shorter in the Early Exercise group (11.7 ±14.6 vs. 61.5 ±33.3 days, p<0.001). Baseline peak metabolic equivalent (MET) level was not significantly different (8.3 ±1.8 vs. 7.8 ±1.8 METs, p=0.25) between groups. While both groups experienced a significant improvement in post CR peak MET level (p<0.001) the mean change was significantly greater in the Early Exercise group (1.4 ±0.98 vs. 0.76 ±1.1 METs, p<0.005). CONCLUSION: The results of the present investigation are consistent with the vast body of previous literature demonstrating CR leads to a significant improvement in aerobic capacity. However, the mean improvement in aerobic capacity was significantly greater in the Early Exercise group compared to subjects entering Usual Care outpatient CR according to a more traditional initiation of exercise time-line. Hypotheses for this outcome include: 1) Less sedentary lifestyle-induced deconditioning following hospital discharge in the Early Exercise group and 2) Early cardiac follow-up care post MI leading to improved exercise compliance.