Effects of a contemporary, exercise-based rehabilitation and cardiovascular risk-reduction program on coronary patients with abnormal baseline risk factors

Abstract

Phase II cardiac rehabilitation programs are associated with improvements in exercise tolerance, coronary risk factors, and psychosocial well-being. Nevertheless, previous reports have generally evaluated the global effectiveness of these programs (ie, on all subjects, collectively), which may serve to camouflage or attenuate the impact of these interventions on specific patient subsets. In this study, we investigated the effectiveness of a contemporary, exercise-based cardiac rehabilitation program that included a cardiovascular risk-reduction intervention, using a computerized database on 117 patients (average age, 66.5 years; 68% men; 96% white) who completed pre-phase II and post-phase II evaluations. Exercise training involved three 45- to 60-min sessions per week at minimum of 40 to 50% to a maximum of 75% oxygen uptake for 6 to 8 weeks. The effectiveness of the exercise training program was substantiated by significant (p <or= 0.05) reductions in heart rate (- 8 beats/min), systolic BP (- 11 mm Hg), and rating of perceived exertion (- 2, 6 to 20 scale) at a standard submaximal workload. Initial and follow-up ratings of overall health were improved: excellent (2.6 to 4.3%) and very good (20.7 to 35.7%). Average changes (p <or= 0.05 unless otherwise indicated) for all participants and those with abnormal baseline risk factors were as follows: systolic BP (- 4 mm Hg and - 16 mm Hg); diastolic BP (- 5 mm Hg and - 18 mm Hg); total cholesterol (- 19 mg/dL and - 75 mg/dL); low-density lipoprotein cholesterol (- 17 mg/dL and - 61 mg/dL); high-density lipoprotein cholesterol (- 1 mg/dL [not significant] and + 11 mg/dL); and triglycerides (- 5 mg/dL [not significant] and - 82 mg/dL), respectively. The present findings suggest that a positive correlation generally characterizes the change in coronary risk factors subsequent to a contemporary phase II cardiac rehabilitation program. Patients with the worst coronary risk factor profiles at baseline demonstrated the greatest improvements.