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(Circulation. 2003;107:2201.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Improved Exercise Tolerance and Quality of Life With Cardiac Rehabilitation of Older Patients After Myocardial Infarction

Results of a Randomized, Controlled Trial

Niccolò Marchionni, MD; Francesco Fattirolli, MD; Stefano Fumagalli, MD; Neil Oldridge, PhD; Francesco Del Lungo, MD; Linda Morosi, MD; Costanza Burgisser, MD; Giulio Masotti, MD

From the Department of Critical Care Medicine and Surgery (N.M., F.F., S.F., F.D.L., L.M., C.B., G.M.), Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy, and the Center for Aging Research (N.O.), Schools of Allied Health Sciences and Medicine, Indiana University, Regenstrief Institute for Health Care, Indianapolis, Ind, and the Center for Urban Population Health, University of Wisconsin-Milwaukee, Wis.

Correspondence to Niccolò Marchionni, MD, Department of Critical Care Medicine and Surgery, University of Florence, Via delle Oblate, 4. 50141 Florence, Italy. E-mail nmarchionni{at}unifi.it

Background— Whether cardiac rehabilitation (CR) is effective in patients older than 75 years, who have been excluded from most trials, remains unclear. We enrolled patients 46 to 86 years old in a randomized trial and assessed the effects of 2 months of post-myocardial infarction (MI) CR on total work capacity (TWC, in kilograms per meter) and health-related quality of life (HRQL).

Methods and Results— Of 773 screened patients, 270 without cardiac failure, dementia, disability, or contraindications to exercise were randomized to outpatient, hospital-based CR (Hosp-CR), home-based CR (Home-CR), or no CR within 3 predefined age groups (middle-aged, 45 to 65 years; old, 66 to 75 years; and very old, >75 years) of 90 patients each. TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline, after CR, and 6 and 12 months later. Within each age group, TWC improved with Hosp-CR and Home-CR and was unchanged with no CR. The improvement was similar in middle-aged and old persons but smaller, although still significant, in very old patients. TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR. HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients. Complications were similar across treatment and age groups. Costs were lower for Home-CR than for Hosp-CR.

Conclusions— Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group. However, with lower costs and more prolonged positive effects, Home-CR may be the treatment of choice in low-risk older patients.

Key Words: aging • coronary disease • exercise • myocardial infarction • quality of life

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