Abstract 4125: Beyond Functional Capacity: Exercise Training Improves Adverse Prognostic Markers from the Exercise Tolerance Test
Meta analyses have shown that exercise training decreases mortality in post MI patients, but no single cohort study has shown this benefit. To evaluate whether risk score - predicted mortality and adverse prognostic markers derived from exercise tolerance tests (ETT) are modifiable with exercise training, we analyzed 210 consecutive patients (age 58±10 yrs/ 59% male) who completed a 12 week cardiac rehabilitation (CR) program without change in medications. The Duke Prognostic Score (DUKE), Cleveland Clinic Foundation Risk Score (CCFRS), chronotropic Index (CI), and the one-minute post exercise heart rate recovery (HRR) were compared from symptom-limited ETT’s done upon entry and exit from CR. All prognostic variables and risk scores improved significantly with CR (see table⇓ below). Data are also shown below for those with abnormal CI <80% and HRR < 12 bpm. Based on risk score data, the group DUKE 5-year predicted cardiovascular mortality fell from 5% to 1%. The group 5-year CCFRS predicted total mortality fell from 5% to 3% (p< 0.0001), while that in the highest risk CCFRS subgroup ( n=70) fell from 9% to 6% (p<0.0001). When controlled for age, gender, diabetes, ejection fraction, and beta blocker use, the observed improvements in each outcome measure remained significant. Therefore, exercise training in patients with cardiovascular disease significantly improves ETT- derived prognostic markers and risk scores translating into a significant reduction in predicted mortality, with an even greater benefit derived in those with abnormal entry markers.