One-year adherence to exercise in elderly patients receiving postacute inpatient rehabilitation after cardiac surgery

Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review

Objective

The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR).

Methods

A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted.

Results

The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices.

Conclusion

ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.

[Effects of a Phase III cardiac rehabilitation program on functional capacity and body composition for coronary heart disease]

INTRODUCTION AND OBJECTIVES

The effects of a phase III cardiac rehabilitation program (CRP) have been insufficiently studied in terms of training methods and administration. We studied the impact on functional capacity, body composition and physical activity engagement of interdisciplinary program based on aerobic and community strength therapeutic exercise after an acute coronary syndrome.

TRIAL DESIGN

Randomised clinical trial.

METHODS

Eighty consecutive patients with stable ischemic heart disease and preserved systolic function before phase II CRP were included. They were distributed into a control group (CG), with autonomous exercise, and an experimental group (EG), that follows supervised community program based on aerobic exercise and overload dynamic muscle strength, and an educational strategy through short messaging. Both groups underwent monthly inpatient group therapy. Results were compared after 12 months.

RESULTS

Functional capacity presented higher levels in the EG and measured by the 6-min walk test (26.0±27.4m; P<.001), and maximal exercise test (0.6±2.2METs; P=.021). Home physical activity measured in minutes by IPAQ questionnaire increased more in the EG (90±78min/week) (P=.047), and the sitting time during the week decreased (-50.25±94.48min/day) (P=.001). There were no differences in body mass index, although we found a higher percentage of adipose tissue in CG after 12 months (P=.039).

CONCLUSIONS

A multidisciplinary community phase III CRP based on aerobic and dynamic muscle strength therapeutic exercise combined with a short message service educational strategy was feasible. After 12 months, patients in the EG presented higher levels on functional capacity, reported higher physical activity engagement compared to the CG.

Assessing Relationships between Physically Demanding Work and Late-Life Disability in Italian Nonagenarian Women Living in a Rural Area

As more and more persons live into their 90s and beyond, investigating causes of disability in the oldest-old population is relevant for public health implications to plan preventive strategies and rehabilitation interventions. A negative association between physically demanding work and midlife physical function has been shown, but there is a paucity of longitudinal studies investigating possible work-related long-term effects in the oldest old. This study investigates the relationship between physically demanding work exposure and late-life physical performances, disability, general health status, and quality of life in a sample of women aged 90 years and over inside the Mugello Study. Sociodemographic data, cognitive and functional status, lifestyle, medical history, drug use, and work history were collected from 236 participants. Farmers had a lower percentage of individuals with preserved independence in basic activities of daily living compared to other occupations. However, in the multivariate analysis, only a higher cognitive function remained associated with functional independence. While confirming the well-known association between cognitive and functional decline in very old age, our results do not support the hypothesis that the negative effects of physical work exposure observed in midlife are relevant to predict disability in nonagenarian women.

Predictors of Mortality in 433 Nonagenarians Inside the Mugello Study: A 10 Years Follow-Up Study

OBJECTIVE

to identify the predictors of mortality in a cohort of nonagenarians inside the "Mugello study" after 10 years follow-up.

METHODS

Information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 non-selected participants aged 90-99 years, living in the Mugello area (Italy). Participants were followed over 10 years and their dates of death were retrieved from the municipal registers. Cox regression analysis was used to determine significant potential prognostic factors.

RESULTS

The mortality rate was 96.5%. Cox proportional hazards analysis showed that a lower cognitive status was significantly associated with higher mortality as well as a poorer functional status, a higher comorbidity, and a higher number of drugs consumption.

DISCUSSION

Impaired cognitive function, loss of functional independence, higher comorbidity, and higher drugs intake were the stronger predictors of mortality.

12-month survival in nonagenarians inside the Mugello study: on the way to live a century

Background

Life expectancy has increased over the last century and a growing number of people is reaching age 90 years and over. However, data on nonagenarians’ health trends are scarce due to difficulties in investigating this specific population. This study aims to identify risk factors for one-year mortality in nonagenarians using data collected within the “Mugello Study”.

Methods

Complete information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 nonagenarians, as well as information about survival after 1 year from the interview.

Results

The sample included 314 women (72.5%) and 119 men (27.5%) with a median age of 92 years (range 90-99 years). The mortality rate was 20.3% (88 deaths). After adjustment for age and sex, a significantly higher risk of dying within 12 months was observed in individuals with more severe cognitive impairment (HR = 5.011, p < 0.001), more severe disability in basic activities of daily living (HR = 4.193, p < 0.001), sedentary lifestyle (HR = 3.367, p < 0.001), higher number of drugs assumed (HR = 1.118, p = 0.031), and kidney dysfunction (HR = 2.609, p = 0.004). When all the variables were included in the analysis, only older age (HR = 1.079, p = 0.048), lower cognitive function (HR = 2.859, p = 0.015), sedentary lifestyle (HR = 2.030, p = 0.026), and kidney dysfunction (HR = 2.322, p = 0.018) remained significantly associated with reduced survival.

Conclusions

Data from the Mugello study support the hypothesis that survival at 12 months in nonagenarians is not a stochastic process and that older age, reduced cognitive function, sedentary lifestyle, and the presence of kidney dysfunction are associated with mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02908-9.

Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review

With the aging of the world's population, a large proportion of patients seen in cardiovascular practice are older adults, but many patients also exhibit signs of physical frailty. Cardiovascular disease and frailty are interdependent and have the same physiological underpinning that predisposes to the progression of both disease processes. Frailty can be defined as a phenomenon of increased vulnerability to stressors due to decreased physiological reserves in older patients and thus leads to poor clinical outcomes after cardiovascular insults. There are various pathophysiologic mechanisms for the development of frailty: cognitive decline, physical inactivity, poor nutrition, and lack of social supports; these risk factors provide opportunity for various types of interventions that aim to prevent, improve, or reverse the development of frailty syndrome in the context of cardiovascular disease. There is no compelling study demonstrating a successful intervention to improve a global measure of frailty. Emerging data from patients admitted with heart failure indicate that interventions associated with positive outcomes on frailty and physical function are multidimensional and include tailored cardiac rehabilitation. Contemporary cardiovascular practice should actively identify patients with physical frailty who could benefit from frailty interventions and aim to deliver these therapies in a patient-centered model to optimize quality of life, particularly after cardiovascular interventions.

[Effects of home-based strength training during COVID-19 lockdown in acute coronary syndrome]

INTRODUCTION AND OBJECTIVE

Cardiac rehabilitation has the highest level of recognition in medical guideline references. The rise of COVID-19 pandemic, particularly during the first months of strict containment, cause to temporally stop most of the ongoing programs. We studied the effects of an interdisciplinary phase II secondary prevention in patients diagnosed with a recent acute coronary syndrome with the use of new technologies, home-exercise and telemedicine.

METHODS

Between the 2nd and 11th of March 2020, we included 37 patients with recent acute coronary syndrome (76.4%), low-risk and preserved systolic function and underwent a 12-week treatment. A dynamic muscle toning with overload domiciliary training program was applied, in addition to nutritional counselling, as well as psychological and educational therapy.

RESULTS

Of the initial cohort, 30 patients finished. At the end of the program, we observed and increased functional capacity over the 6-min walking test (+47.13m; 95% CI: 32.82-61.45, P<.001), and improvement to the subjective feeling of dyspnoea on the modified Borg scale (-0.5 units; 95% CI: -0.76 to -0.24, P=.001), and an improvement over both initial and final training systolic blood pressure (-6.67mmHg; 95% CI: -10.98 to -2.35, P=.004) (-7mmHg; 95% CI: -12.86 to -1.14, P=.021). We also observed an increase in the level of physical activity during leisure time in the IPAQ questionnaire (+1162.93min/week; 95% CI: 237.36-2088.5, P=.016), and in the Mediterranean eating habits on the PREDIMED test (+2.1units; 95% CI: 1.32-2.28, P<.001).

CONCLUSIONS

After three months of a domiciliary cardiac rehabilitation program, patients increased their functional capacity, feeling of dyspnoea, blood pressure and eating habits. Domiciliary telemedicine cardiac rehabilitation program produces an improvement in the patient after acute coronary syndrome.

In-hospital cardiac rehabilitation and clinical outcomes in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective cohort study

OBJECTIVES

To verify the associations between participation in an in-hospital cardiac rehabilitation (CR) programme and clinical outcomes among patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).

DESIGN

A retrospective cohort study using the Japanese administrative claims database.

SETTING

Japanese acute-care hospitals.

PARTICIPANTS

Patients aged ≥18 years who underwent PCI due to AMI and survived to discharge.

PRIMARY AND SECONDARY OUTCOME MEASURE

The primary outcomes were revascularisation, all-cause readmission and cardiac readmission (median follow-up period: 324 days, 236 days and 263 days, respectively). The secondary outcomes were all-cause mortality and cardiac mortality (median follow-up period: both were 460 days).

RESULT

The data of 13 697 patients were extracted from the database, and 65.4% of them participated in an in-hospital CR. The risks of revascularisation, all-cause readmission and cardiac readmission among CR participants were compared with those of non-participants using two statistical techniques: matched-pair analysis based on propensity score and a 30-day landmark analysis. The results of those analysis were consistent and showed that the CR participants had lower risk of revascularisation (adjusted HR: 0.74; 95% CI: 0.65 to 0.84), all-cause readmission (HR: 0.81; 95% CI: 0.74 to 0.88) and cardiac readmission (HR: 0.77; 95% CI: 0.70 to 0.85). However, all-cause mortality and cardiac mortality were not associated with participation in the CR.

CONCLUSIONS

It was suggested that in-hospital CR participation may reduce the risk of revascularisation, all-cause readmission and cardiac readmission among patients with AMI after PCI. In-hospital CR may expand the potential benefits of CR in addition to outpatient CR.

Early exercise training feasibility after aortic valve repair: A multicentre prospective French survey on behalf of the Aortic Valve repair International Registry (AVIATOR)

BACKGROUND

Standardization of aortic valve repair by the external ring annuloplasty approach is an alternative to valve replacement to avoid prosthetic valve-related events. Although the benefit of exercise training to improve postoperative exercise tolerance has been demonstrated in many conditions after cardiac surgery, it has never been described after aortic valve repair.

OBJECTIVES

To evaluate the feasibility of an early exercise training programme after aortic valve repair.

METHODS

Consecutive patients were prospectively included in 13 postoperative centres. Patients underwent an exercise training programme for approximately 3-5 weeks. Transthoracic echocardiography and a cardiopulmonary exercise test were performed before and after the exercise training programme.

RESULTS

Fifty patients (mean±standard deviation [SD] age: 50±13 years) were included a mean of 13.6±12.0 days after aortic valve repair. The preoperative degree of aortic insufficiency was moderate to severe in 35 patients (70%) and the aortic valve was bicuspid in 24 patients (48%). Valve-sparing root replacement and isolated aortic valve repair (including 10% supracoronary aorta replacement) were performed in 64% and 36% of patients, respectively. We found no aortic insufficiency occurrence or worsening and no adverse clinical events after the exercise training programme. Mean left ventricular ejection fraction increased significantly (from 54%±8% to 57%±9%; P=0.0007). Mean peak oxygen consumption and first ventilatory threshold increased from 17.0±5.3 to 22.5±7.8mL/kg/min (32% increase) and from 12.0±3.9 to 14.3±5.2mL/kg/min (19% increase), respectively (both P<0.05).

CONCLUSION

Exercise training early after aortic valve repair is safe and seems to significantly improve exercise capacity.

A Standard Form of Cardiac Rehabilitation Can Improve Self-Reported Positive Behavior Changes in the Short- to Medium-Term

PURPOSE

Little is known about the impact of standard cardiac rehabilitation (CR), consisting of health education and exercise, on self-reported behavior change among people who have completed rehabilitation. This qualitative study aimed to explore the lived experiences of participants' behaviors toward exercise and diet in the short- to medium-term after CR program completion.

METHODS

Using a phenomenological framework, we interviewed participants who had completed a 4-wk CR program and then 6 mo later. The program included education and exercise in a private outpatient facility. A thematic analysis was conducted to explore changes in self-reported behavior. These themes were triangulated with Bandura's self-efficacy scales and Stages of Readiness for Change questionnaires to identify any convergence of themes.

RESULTS

A total of 21 participants were recruited to the study. One main theme and 4 subthemes emerged from analysis of the data. Most participants reported that they had either maintained or initiated positive lifestyle changes in both exercise and diet in the short- and medium-term. Fear of having another myocardial infarction, seeing the benefits of adhering with recommendations, and family involvements were motivating factors along with the involvement of the multidisciplinary staff in the program. The themes converged with the results from the questionnaires.

CONCLUSIONS

A standard form of CR can result in positive self-reported behavior change in the short- to medium-term. Further trials are needed to determine whether a standard form of rehabilitation is sufficient to change health behaviors at sufficient levels to result in long-term health benefits.

Association of Body Fat With Health-Related Quality of Life and Depression in Nonagenarians: The Mugello Study

OBJECTIVES

The association of body fat with health status and depression in the oldest old is still debated. The aim of this cross-sectional study is to investigate the association of body fat with health-related quality of life and depression in a sample of nonagenarians.

DESIGN

Data are from the Mugello study, a community-based project conducted in Italian older adults aged 90 years.

SETTING AND PARTICIPANTS

Total body fat was assessed by body impedance assessment. Participants were divided into 3 groups according to gender-specific tertiles of body fat percentage (BF%). Self-perceived mental and physical health status were assessed by the Mental Component Summary (MCS) and the Physical Component Summary (PCS) subscales derived from the 12-item Short Form Health Survey. Lower scores of MCS and PCS indicated poorer mental health and physical health status, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, and a score ≥5 was used to identify participants with depression.

RESULTS

The mean age of 251 study participants was 92.5 years, and 173 (68.9%) were women. Participants were included in the low (n = 83), medium (n = 83), and high (n = 85) BF% groups. In the whole sample, mean scores at PCS progressively declined with the increasing BF% group (P = .004). This association was stronger in women, although no significant interaction was observed between the gender and BF% group (P = .63). No significant association between BF% and MCS was documented. Medium and high BF% were associated with a significantly higher probability of depression as compared with low BF% [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.04-4.44, and OR 2.15, 95% CI 1.06-4.34, respectively]. This association was stronger in women, although no significant interaction was observed between gender and BF% group (P = .70).

CONCLUSIONS AND IMPLICATIONS

High BF% is significantly positively associated with poor health-related quality of life and depression, underpinning the clinical relevance to test BF% in older adults. These associations appear to be stronger in women than in men, highlighting the need to investigate deep inside this gender discrepancy.

Systematic review of preoperative physical activity and its impact on postcardiac surgical outcomes

OBJECTIVES

The objective of this systematic review was to study the impact of preoperative physical activity levels on adult cardiac surgical patients' postoperative: (1) major adverse cardiac and cerebrovascular events (MACCEs), (2) adverse events within 30 days, (3) hospital length of stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5) activities of daily living (ADLs), (6) quality of life, (7) cardiac rehabilitation attendance and (8) physical activity behaviour.

METHODS

A systematic search of MEDLINE, Embase, AgeLine and Cochrane library for cohort studies was conducted.

RESULTS

Eleven studies (n=5733 patients) met the inclusion criteria. Only self-reported physical activity tools were used. Few studies used multivariate analyses to compare active versus inactive patients prior to surgery. When comparing patients who were active versus inactive preoperatively, there were mixed findings for MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that adjusted for confounding variables, five studies found a protective, independent association between physical activity and MACCE (n=1), 30-day postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies found no protective association for 30-day postoperative events (n=1) and postoperative ADLs (n=1). No studies investigated if activity status before surgery impacted quality of life or cardiac rehabilitation attendance postoperatively. Three studies found that active patients prior to surgery were more likely to be inactive postoperatively.

CONCLUSION

Due to the mixed findings, the literature does not presently support that self-reported preoperative physical activity behaviour is associated with postoperative cardiac surgical outcomes. Future studies should objectively measure physical activity, clearly define outcomes and adjust for clinically relevant variables.

REGISTRATION

Trial registration number NCT02219815. PROSPERO number CRD42015023606.

Efficacy of treadmill exercises on arterial blood oxygenation, oxygen consumption and walking distance in healthy elderly people: a controlled trial

Background

Regular physical exercise and healthy lifestyle can improve aerobic power of the elderly, although lung capacity gradually deteriorates with age. The aims of the study are: a) to evaluate the therapeutic effect of a treadmill exercise program on arterial blood oxygenation (SaO₂), maximum oxygen consumption (VO_2max) and maximum walking distance (MWD) in healthy elderly people; b) to examine the outcome of the program at a supervised short-term and at an unsupervised long-term.

Methods

A prospective, not-randomized controlled intervention trial (NRCT) was conducted. Eighty participants were allocated into two homogeneous groups (training group, TG, n = 40; control group, CG, n = 40). Each group consisted of 20 men and 20 women. Pre-intervention measures of SaO₂, VO_2max and MWD were taken of each participant 1-week before the training program to establish the baseline. Also, during the training program, the participants were followed up at the 12, 30 and 48th week. The exercise program consisted of walking on a treadmill with fixed 0 % grade of inclination 3 times weekly for 48 weeks; the first 12 weeks were supervised and the remaining 36 weeks of the program were unsupervised. Participants in the control group were encouraged to walk twice a week during 45 min, and received standard recommendations for proper health.

Results

Related to the baseline, the SaO_2, VO_2max, and MWD is greater in the intervention group at the 12^th (p <.001), 30^th (p <.001) and 48^th week (p <.001). Compared with the control group, there was also a significant improvement of SaO_2, VO_2max, and MWD valuesin the intervention group (p <.001) at the 12^th (p <.001), 30^th (p <.001) and 48^th week (p <.001). Supervised intervention shows greater improvement of SaO_2, VO_2max, and MWD values than in the unsupervised one.

Conclusion

These results show that performing moderate exercise, specifically walking 3 days a week, is highly recommended for healthy older people, improving aerobic power.

Trial registration

Current Controlled Trials ISRCTN12621097.

Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review

QUESTION

How has adherence been measured in recent prospective studies focusing on adherence to exercise programs among older people? What is the range of adherence rates? Which factors are associated with better adherence?

DESIGN

Systematic review of prospective studies that had a primary aim of assessing adherence to exercise programs.

PARTICIPANTS

Older people undertaking exercise programs.

INTERVENTION

Exercise programs.

OUTCOME MEASURES

Measures of adherence, adherence rates and factors associated with adherence.

RESULTS

Nine eligible papers were identified. The most common adherence measures were the proportion of participants completing exercise programs (ie, did not cease participation, four studies, range 65 to 86%), proportion of available sessions attended (five studies, range 58 to 77%) and average number of home exercise sessions completed per week (two studies, range 1.5 to 3 times per week). Adherence rates were generally higher in supervised programs. The person-level factors associated with better adherence included: demographic factors (higher socioeconomic status, living alone); health status (fewer health conditions, better self-rated health, taking fewer medications); physical factors (better physical abilities); and psychological factors (better cognitive ability, fewer depressive symptoms).

CONCLUSION

Older people's adherence to exercise programs is most commonly measured with dropout and attendance rates and is associated with a range of program and personal factors.

Adherence of older women with strength training and aerobic exercise

Background

Participation of older people in a program of regular exercise is an effective strategy to minimize the physical decline associated with age. The purpose of this study was to assess adherence rates in older women enrolled in two different exercise programs (one aerobic exercise and one strength training) and identify any associated clinical or functional factors.

Methods

This was an exploratory observational study in a sample of 231 elderly women of mean age 70.5 years. We used a structured questionnaire with standardized tests to evaluate the relevant clinical and functional measures. A specific adherence questionnaire was developed by the researchers to determine motivators and barriers to exercise adherence.

Results

The adherence rate was 49.70% in the aerobic exercise group and 56.20% in the strength training group. Multiple logistic regression models for motivation were significant (P=0.003) for the muscle strengthening group (R²=0.310) and also significant (P=0.008) for the aerobic exercise group (R²=0.154). A third regression model for barriers to exercise was significant (P=0.003) only for the muscle strengthening group (R²=0.236). The present study shows no direct relationship between worsening health status and poor adherence.

Conclusion

Factors related to adherence with exercise in the elderly are multifactorial.

Higher uric acid levels are associated with better functional recovery in elderly patients receiving cardiac rehabilitation

BACKGROUND AND AIMS

Whether uric acid (UA) serves as risk factor for cardiovascular diseases or as antioxidant defense has not yet been completely clarified. In this study we investigated the effects of UA on functional recovery in patients receiving cardiac rehabilitation.

METHODS AND RESULTS

306 patients, 209 men and 97 women, age range 25-87 years (mean 68 ± 11), performed the 6-min walk test (6mWT) before and after the rehabilitation, and the increase in walking distance was considered as the outcome measure of the study. Baseline UA serum levels ranged from 1.0 to 10.9 mg/dL (mean 5.2 ± 1.7). As there was a significant (p = 0.005) age*UA levels interaction, patients were divided into two subgroups, less then 65 years (n. 103, 68 men and 35 women, mean age 56 ± 9) and 65 years or more (n. 203, 141 men and 62 women, mean age 74 ± 5). After adjusting for relevant confounders, higher UA levels remained independent positive predictors of the increase in walking distance in older (p < 0.001) but not in younger patients (p = 0.807).

CONCLUSIONS

Our findings show an independent association of higher UA levels with better functional recovery after cardiac rehabilitation selectively in elderly patients, suggesting that higher UA levels might reflect the decline in antioxidant defenses that occurs with advancing age. Future studies aimed at understanding the several contradictions concerning UA should, probably, address the issue within this perspective.

The Mugello study, a survey of nonagenarians living in Tuscany: design, methods and participants' general characteristics

BACKGROUND

Previous studies on nonagenarians have widely investigated functional and cognitive decline, falls, predictors of mortality, inflammation and aging genetics. However, some intriguing domains, such as body composition, daily energy expenditure, sleep quality and physical activity, as well as endothelial progenitor cells and "omics" fields, such as proteomics or metabolomics, have been poorly explored. In this preliminary paper we report design, methods and characteristics of participants in the Mugello Study, a survey of nonagenarians aimed at filling these gaps.

METHODS

475 non selected nonagenarians, 130 men and 345 women, mean age 92.6 years ± SD 2.6, received a visit by a trained physician at their residence. Along with the assessment of social, functional and cognitive status, reported in this paper, participants also underwent instrumental examinations, including body impedance assessment and continuous direct calorimetry, and were administered a series of validated questionnaires. Further, 385 participants accepted to undergo blood withdrawal.

RESULTS

In 52 cases the visit was conducted in nursing homes. Among the 423 home-living participants, 91 lived alone and 77 were not looked after by any caregiver. Altogether, 154 participants over 475 were free from disabilities and 266 showed Mini Mental State Examination raw scores ≥ 21. Men showed less disability and cognitive impairment (p<0.001, for both).

CONCLUSIONS

As a whole, our findings are comparable to those reported in other surveys. Future studies, by using the Mugello Study database and biologic bank, that will be available to all researchers, will shed some more light on the aging process in nonagenarians.

Effects of a structured physical activity intervention on measures of physical performance in frail elderly patients after cardiac rehabilitation: a pilot study with 1-year follow-up

The objective of this prospective randomized controlled study was to compare the long-term effects of a structured physical activity intervention with those of aerobic exercises alone, in a cohort of elderly patients who had undergone elective cardiac surgery, and who were classified as frail at the end of rehabilitation based on their Short Physical Performance Battery (SPPB) score. At the end of rehabilitation, 140 frail elderly patients were randomly allocated either to the intervention group (IG) or to the control group (CG). CG participants received the usual aerobic exercise prescription, while IG participants were also taught additional exercises for strength, flexibility, balance and coordination. The improvement in SPPB score after 1 year was the outcome of the study. IG showed a significant improvement in SPPB score (9.0 ± 1.1 vs. 7.7 ± 1.4, p < 0.001), while no significant change was found in CG (7.7 ± 1.6 vs. 7.6 ± 1.5, p = 0.252). IG also showed a significantly higher proportion of participants who improved their SPPB score of at least 1 point (70 vs. 37%, p < 0.001). In conclusions, our structured physical activity intervention significantly improves the SPPB score in frail elderly patients who have undergone elective cardiac surgery. An intervention that improves the SPPB score might delay the occurrence of mobility disability.

The improvement of walking speed after cardiac rehabilitation is associated with the reduction in the metabolic cost of walking in older persons

BACKGROUND

To walk a given distance older persons consume more metabolic energy than younger adults across all speeds. As physical activity interventions improve a variety of physical performance measures in older persons, including walking speed, in this study we hypothesized that the improvement of walking speed might be associated with the reduction of the metabolic cost of walking and we tested our hypothesis in a selected sample of older patients receiving cardiac rehabilitation.

METHODS

In 120 patients (88 men and 32 women, mean age 74.1 years±SD 5.0) we assessed energy expenditure during the 6-min Walk Test (6mWT) before and after the rehabilitation using a portable system for direct calorimetry.

RESULTS

On the 6mWT performed after the rehabilitation patients significantly increased total energy expenditure (28.0 kcal±SD 8.3 vs. 25.7 kcal±SD 7.6, p<0.001), the distance walked (398 m±SD 93 vs. 343 m±SD 95, p<0.001) and, consequently, walking speed (1.11 m/s±SD 0.26 vs. 0.95m/s±SD 0.26, p<0.001) while the metabolic cost of walking, i.e. the amount of energy used to move a body mass of 1 kg for a distance of 1m, was significantly reduced (1.00 cal/kg/m±SD 0.19 vs. 1.11 cal/kg/m±SD 0.32, p<0.001).

CONCLUSIONS

In older patients receiving cardiac rehabilitation the improvement of walking speed is associated with the improvement of walking economy. This might be a contributory factor to the favourable effects of physical activity interventions on physical performance measures.

Cardiac rehabilitation in skilled nursing facilities: a missed opportunity

BACKGROUND

After hospitalization for a cardiac event, older adults are frequently discharged to a skilled nursing facility (SNF) for postacute care. The American Association of Cardiopulmonary Rehabilitation recommends that cardiac care be integrated into procedures at SNFs.

OBJECTIVE

We undertook this research to describe the characteristics of patients in SNFs after a cardiac event and the cardiac care delivered at SNFs.

METHODS

A dual approach included (1) a retrospective medical record review of consecutive patients admitted to 2 hospital-based SNFs after a cardiac event (n = 80), and (2) surveys from healthcare professionals (n = 21) working in these facilities.

RESULTS

Thirty-two percent of patients were not candidates for cardiac rehabilitative interventions because they had been rehospitalized, discharged to long-term care facilities, or manifested contraindications to exercise. No standard assessment of exercise tolerance was evident, and although 70% of patients were discharged home, cardiac-specific discharge education was seldom evident. Healthcare professionals in SNFs reported that standard procedures for cardiac care services were lacking.

CONCLUSION

The integration of cardiac care into SNFs is important to ensure the safety of therapy and improve the transition of patients from SNFs to outpatient cardiac rehabilitation programs.

Postacute rehabilitation after coronary surgery: the effect of preoperative physical activity on the incidence of paroxysmal atrial fibrillation

OBJECTIVE

Postoperative atrial fibrillation (AF) is a frequent complication after cardiac surgery. AF may also occur after hospital discharge during postacute rehabilitation. Several studies have addressed the AF that occurs in the hospital after surgery, and predictors have already been identified. Postoperative AF that occurs after hospital discharge has not been investigated thoroughly, and predictors are still unknown. In this study, we hypothesized that moderate-intensity physical activity in the year before surgery might favorably affect the incidence of AF during postacute rehabilitation.

DESIGN

We tested our hypothesis in a cohort of 158 older patients admitted to a medical rehabilitation facility for postacute inpatient rehabilitation after coronary surgery and continuously monitored by telemetry for the duration of the rehabilitation.

RESULTS

Independent of potential confounders, patients who reported low-intensity physical activity in the year before surgery showed a significantly higher incidence of AF during postacute rehabilitation when compared with those who reported moderate-intensity physical activity (32.1% vs. 8.1%; P = 0.029). Other independent predictors of AF during postacute rehabilitation were the occurrence of AF during the patients' stay in hospital, larger left atrial volume, and lower left atrial emptying fraction.

CONCLUSIONS

These findings confirm our hypothesis that physical activity in the year before surgery affects the incidence of postoperative AF during postacute rehabilitation. The results also provide information regarding possible predictors that may assist in identifying patients who could benefit from preventive treatments.

Music, Exercise Performance, and Adherence in Clinical Populations and in the Elderly: A Review

The purpose of this study was to review a series of studies (n = 20) examining the effects of adding music to exercise programs in clinical populations and in the elderly. We found that the addition of music can (a) improve exercise capacity and increase patients’ motivation to participate in cardiac and pulmonary exercise rehabilitation programs; (b) lead to improved balance, greater ability to perform activities of daily living, and improved life satisfaction in elderly individuals; (c) enhance adherence and function of individuals suffering from neurological diseases such as Alzheimer’s and Parkinson’s; and (d) sustain these benefits if continued on a long-term basis. Based on the reviewed studies, a number of methodological concerns were presented, among them the choice of music style. One of the practical implications suggested for clinicians and practitioners was that the type of music should be individualized based on each patient’s musical preferences.