Physical Activity, Physical Function and Quality of Life in Community-Based Maintenance Cardiac Rehabilitation

Abstract

Cardiac rehabilitation (CR) is a comprehensive approach to recovery developed to help overcome the complications associated with cardiovascular disease. However, despite the reported advantages of CR, little is known of the benefits associated with long-term, maintenance CR, as many previous studies have focused on short-term CR. Furthermore, there remains a significant gap in evidence regarding the effects of CR in specific demographics, specifically women and elderly, due in part to the significant disparity in referral to CR and consequently, representation in CR research. Therefore, this study aimed to examine the physical activity (PA) habits, physical function as well as quality of life (QOL) perceptions of those elderly individuals participating in community-based, maintenance CR.

Thirty-nine elderly (71.8% female; age 70.5±5.5 years) individuals participating in community-based, maintenance CR were recruited from two local CR clubs in Dunedin, New Zealand. Participants were assigned to either the CAD group (defined as history of MI, coronary angioplasty or stent insertion, valve surgery or coronary artery bypass graft surgery, n=13) or the non-CAD group (no history of CAD, n=26) based on the history of cardiovascular disease. Self-report questionnaires on demographics, medical history, PA habits and QOL were completed. Participant physical function was assessed through a Short Physical Performance Battery (SPPB), 30-second chair-to-stand test, handgrip strength test, Six-Minute Walk Test and Ten-Meter Incremental Shuttle Walk Test. Objective PA was measured by seven-day accelerometer wear.

Overall, the CAD group performed significantly more moderate-to-vigorous physical activity (MVPA) per week (329.7±233.3 mins versus 160.6±149.5 mins, p=0.013). However, only 26.3% of all participants in the present study were categorised as being physically active by current PA guidelines (≥30 mins, ≥5 days/week). No differences were seen in self-reported PA habits except for moderate intensity PA, which was statistically significantly higher in the CAD group. Body composition was the only significantly different anthropometric measure between the two groups, with the CAD group having less body fat percentage (27.5±8.4 versus 36.5±8.7, p=0.004) and higher muscle mass percentage (72.5±8.4 versus 63.0±9.8, p=0.022) compared to the non-CAD group. Significantly more of the CAD group was on various prescribed medications compared to the non-CAD group and self-reported significantly higher presence of chest pain with exertion (61.5% versus 3.8%, p=0.000) and shortness of breath (38.5% versus 7.7%, p=0.018). No significant differences were observed for any measures of physical function or Quality of life.

Elderly CAD patients who participate in community-based maintenance CR could perform enough PA to meet current PA guidelines, however, are not currently regularly active throughout the week. Furthermore, the CAD patients in the present study had similar physical function and QOL perceptions as their non-CAD peers. Therefore, it may be suggested continued participation in community-based, maintenance CR is effective in preserving the PA habits of elderly CAD patients and subsequently slowing the decline in physical function, and QOL saw with older age. The limitations of this study warrant further investigation to confirm these findings. Furthermore, the results of this present study highlight the need for increased referral of elderly CAD patients to CR.