Published Online
on April 21, 2003

A more recent version of this article appeared on May 6, 2003

This Article Full Text (PDF) All Versions of this Article: 107/17/2201    most recent 01.CIR.0000066322.21016.4Av1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Marchionni, N. Articles by Masotti, G. Search for Related Content PubMed PubMed Citation Articles by Marchionni, N. Articles by Masotti, G. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Related Collections Behavioral/psychosocial - treatment Secondary prevention Exercise/exercise testing/rehabilitation

Submitted on November 1, 2002
Revised on February 13, 2003
Accepted on February 18, 2003

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, and 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.

^* To whom correspondence should be addressed. 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

This article has been cited by other articles:

				F. Giallauria, R. Lucci, A. De Lorenzo, M. D'Agostino, D. Del Forno, and C. Vigorito Favourable effects of exercise training on N-terminal pro-brain natriuretic peptide plasma levels in elderly patients after acute myocardial infarction Age Ageing, November 1, 2006; 35(6): 601 - 607. [Abstract] [Full Text] [PDF]

				F. Giallauria, R. Lucci, M. Pietrosante, G. Gargiulo, A. De Lorenzo, M. D'Agostino, G. Gerundo, P. Abete, F. Rengo, and C. Vigorito Exercise-based cardiac rehabilitation improves heart rate recovery in elderly patients after acute myocardial infarction. J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2006; 61(7): 713 - 717. [Abstract] [Full Text] [PDF]

				A. M. Clark, L. Hartling, B. Vandermeer, and F. A. McAlister Meta-Analysis: Secondary Prevention Programs for Patients with Coronary Artery Disease Ann Intern Med, November 1, 2005; 143(9): 659 - 672. [Abstract] [Full Text] [PDF]

				A. Arya, M. Maleki, F. Noohi, E. Kassaian, and F. Roshanali Myocardial Oxygen Consumption Index in Patients with Coronary Artery Disease Asian Cardiovasc Thorac Ann, March 1, 2005; 13(1): 34 - 37. [Abstract] [Full Text] [PDF]

				C. J. Lavie and R. Milani Benefits of Cardiac Rehabilitation in the Elderly Chest, October 1, 2004; 126(4): 1010 - 1012. [Full Text] [PDF]

				H. Dalal, P. H Evans, and J. L Campbell Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction BMJ, March 20, 2004; 328(7441): 693 - 697. [Full Text] [PDF]

				E. Rideout Cardiac rehabilitation improved exercise tolerance after a myocardial infarction in older patients Evid. Based Nurs., January 1, 2004; 7(1): 20 - 20. [Full Text] [PDF]