Cardiorespiratory Fitness Benefits of Long-Term Maintenance-Phase Cardiac Rehabilitation in Males and Females: A Retrospective Cohort Study.

Purpose: This study investigated if associations exist between enrolment delay and VO2peak over five years of maintenance-phase cardiac rehabilitation (CR) in males and females. Method: Data were extracted from the records of participants who had enrolled for ≥ 1 year in CR and completed ≥ 2 cardiopulmonary exercise tests. Mixed model analyses examined VO2peak trajectories for up to five years of enrolment. Interactions between enrolment delay × enrolment duration, baseline age × enrolment duration, and baseline VO2peak × enrolment duration were explored for inclusion in the model. Results: The charts of 151 males (aged 63.9 ± 9.4 y) and 32 females (aged 65.3 ± 9.0 y) were included in the analyses. The enrolment delay following a cardiovascular event was 1.8 ± 3.0 years for males and 1.3 ± 1.7 years for females. No associations were found between enrolment delay × enrolment duration on VO2peak in males (ß[SEj, 0.07[0.05]; 95% CI -0.02, 0.16, p = 0.12) or in females (ß[SE], 0.07[0.13j; 95% CI -0.18, 0.33, p = 0.57), but predicted trajectories suggest clinically significantly improvements in VO2 peak (range, 1.3 to 1.6 mL/kg/min). Conclusions: Early enrolment in CR is recommended and encouraged, but the benefits of long-term CR are possible despite delays.

Objectif: étudier les associations éventuelles entre le retard d'inscription et la consommation maximale d'oxygène (VO2 max) pendant une phase d'entretien de cinq ans de la réadaptation cardiaque (RC) chez des hommes et des femmes. Méthodologie: données extraites des dossiers des participants inscrits en RC pendant au moins un an et qui ont effectué au moins deux épreuves d'effort cardiorespiratoire. Par des analyses en modèle mixte, les chercheurs ont examiné les trajectoires de VO2 max pendant une période d'inscription maximale de cinq ans. Ils ont exploré les interactions entre le retard d'inscription × la durée d'inscription, entre l'âge au départ × la durée d'inscription et entre la VO2 max au départ × la durée d'inscription pour les inclure dans le modèle. Résultats: les dossiers de 151 hommes (de 63,9 ± 9,4 ans) et de 32 femmes (de 65,3 ± 9,0 ans) ont été inclus dans les analyses. Après un événement cardiovasculaire, les hommes présentaient un retard d'inscription de 1,8 ± 3,0 ans et les femmes, de 1,3 ± 1,7 an. Les chercheurs n'ont constaté aucune association entre le retard d'inscription × la durée d'inscription et la VO2 max chez les hommes (ß[ET], 0,7[0,05]; IC à 95 % −0,02, 0,16, p = 0,12) ni chez les femmes (ß[ET], 0,07[0,13]; IC à 95 % −0,18, 0,33, p = 0,57), mais les trajectoires anticipées laissent supposer des améliorations cliniquement significatives de la VO2 max (plage de 1,3 à 1,6 mL/kg/min). Conclusions: il est recommandé et encouragé de s'inscrire rapidement en RC, mais la RC à long terme peut comporter des avantages malgré les retards d'inscription.

Long-Term Enrollment in Cardiac Rehabilitation Benefits of Cardiorespiratory Fitness and Skeletal Muscle Strength in Females with Cardiovascular Disease.

Background: The benefits of short-term cardiac rehabilitation (CR) for improving fitness are well known, but the effects of long-term maintenance-phase CR are less well established. Moreover, changes in cardiorespiratory fitness (CRF) and muscle strength with long-term CR have never been examined specifically in females, a population that is under-researched and under-represented in cardiovascular research. The objective of this retrospective pilot study was to estimate changes in CRF and muscle strength in females enrolled in a long-term CR program. Methods: Data from 39 females (mean ± standard deviation age 65 ± 9 years) enrolled for at least 1 year in a maintenance-phase CR program were analyzed. The program consisted of aerobic and resistance training, and data were collected annually for CRF (peak oxygen consumption [VO2peak, mL/kg/min]) and skeletal muscle strength (one-repetition maximum tests for chest press, seated row, and knee extension, kg). Mixed-model analyses were used to determine changes in CRF over the 5-year follow-up (203 observations) and muscle strength over 6 years (108 observations). Results: The CRF increased in females by 1.8%/year over 5 years of CR enrollment, and muscle strength increased by 0.6%-2.1%/year over 6 years. These findings are in contrast to the expected age-related declines in fitness over time. Conclusion: The positive long-term benefits on CRF and muscle strength in females provide initial preliminary support for maintenance-based CR, especially given that this population is commonly under-researched and under-represented in the CR literature.

A history of smoking does not reduce long-term benefits of cardiac rehabilitation on cardiorespiratory fitness in men and women with cardiovascular disease.

Smoking is an important risk factor for cardiovascular disease and all-cause mortality. Cardiac rehabilitation (CR) is effective for reducing the risk of recurrent cardiac events through improving cardiorespiratory fitness (CRF). Little is known about the influence of smoking on CRF throughout long-term CR. The purpose of this analysis was to compare CRF trajectories among individuals with positive and negative smoking history enrolled in long-term CR. Participants had a positive smoking history if they currently or formerly smoked (Smoke+, n = 55, mean age = 64.9 ± 9.0 years) and had a negative history if they never smoked (Smoke-, n = 34, mean age = 61.4 ± 9.0 years). CRF (peak oxygen uptake) was measured at baseline and annually thereafter for 6 years. The Smoke+ group had lower CRF compared with the Smoke- group over enrollment (ß = -3.29 (SE = 1.40), 95% confidence interval (CI) -6.04 to -0.54, p = 0.02), but there was no interaction of smoking history and enrollment (ß = 0.35 (SE = 0.21), 95% CI: -0.06 to 0.77, p = 0.10). Moreover, trajectories were not influenced by pack-years (ß = 0.01 (SE = 0.01), 95% CI: -0.01 to 0.04, p = 0.23) or time smoke-free (ß = -0.002 (SE = 0.01), 95% CI: -0.02 to 0.02, p = 0.80). Although the trajectories of CRF do not appear to be affected by smoking behaviour, individuals without a history of smoking maintained higher CRF throughout enrollment. Novelty: The benefits of long-term exercise-based cardiac rehabilitation on cardiorespiratory fitness are similar between those who have smoked and those who have never smoked. Neither the number of pack-years nor the length of time spent smoke-free influence cardiorespiratory fitness trajectories following long-term cardiac rehabilitation.

Long-term Enrollment in Cardiac Rehabilitation Benefits Cardiorespiratory Fitness and Skeletal Muscle Strength in Men With Cardiovascular Disease.

BACKGROUND: Despite known associations between fitness and recurrent cardiovascular events, changes in cardiorespiratory fitness (CRF) and muscle strength with long-term cardiac rehabilitation (CR) have not been extensively examined. The objectives of this study were to (1) examine changes in CRF and muscle strength associated with long-term CR program enrollment in men, and (2) compare these changes to previously published rates of decline (2.0% per year for CRF and 2.36% per year for muscle strength in healthy age-matched individuals). METHODS: Data were extracted from the program charts of 160 men (64 ± 9 years) who were enrolled ≥ 1 year in a maintenance-phase CR program and who completed ≥ 2 exercise tests. CRF was represented by peak oxygen consumption (VO2peak, mL/min/kg). The skeletal muscle strength was assessed using 1-repetition maximum tests for chest press, seated row, and knee extension. Mixed model analyses with polynomial functions were used to determine changes in CRF (up to 5.5 years) and muscle strength (up to 10 years). RESULTS: CRF increased nonlinearly up to 3 years (range, 0.33%-3.23% per year) and then declined nonlinearly to the 5.5-year endpoint (range, 1.03%-2.59% per year). Chest press and seated row strength declined at < 1% per year over 10 years, whereas knee extension increased nonlinearly by 0.18%-1.40% per year from baseline until 4 years and then declined nonlinearly at 1.00%-3.58% per year until the 10-year endpoint. All declines were similar to literature rates. CONCLUSIONS: The results indicate that significant health benefits are associated with maintenance-phase CR programs for men. Enrollment was associated with preserved CRF and lower body muscle strength for 3-4 years.

Exploring the Association Between Physical Activity, Sedentary Behavior, and High-Sensitivity C-Reactive Protein Among Stroke Survivors.

Stroke results in low physical activity, high sedentary behavior (SB), and elevated C-reactive protein (CRP), which are associated with stroke recurrence. This study examined the association between physical activity, SB, and CRP in stroke. CRP data from 185 stroke survivors (Mage = 65 years) from the National Health and Nutritional Examination Survey 2009-2010 were analyzed using weighted regression analysis. There was an interaction between physical activity and SB on CRP (estimated-ß = -0.079, 95% confidence interval [-0.14, -0.02], p = .011). SB was associated with CRP among those who did not engage in physical activity (estimated-ß = 0.068, 95% confidence interval [0.02, 0.11], p = .005), but not among those who did (estimated-ß = 0.0003, 95% confidence interval [-0.03, 0.03], p = .988). Physical activity and SB are important modifiable risk factors to lower the risk of recurrent stroke. These findings provide insight into the inflammatory consequences of SB after stroke, particularly among those who also do not engage in physical activity.

Association between upper leg length and metabolic syndrome among US elderly participants-results from the NHANES (2009-2010).

OBJECTIVE: To examine the relationship between upper leg length (ULL) and metabolic syndrome (MetS) in older adults. METHODS: Data was collected from National Health and Nutritional Examination Survey (NHANES, 2009-2010). 786 individuals (385 males and 401 females) who were 60 years of age or older were included in this analysis. MetS was defined as having at least three of following conditions, i.e., central obesity, dyslipidemia, insulin resistance, and hypertension based on National Cholesterol Education Program guidelines. ULL was grouped into gender-specific tertiles. RESULTS: 328 (41.7%) of participants were categorized as having MetS (38.7% in men and 49.1% in women, P = 0.002). Compared to individuals in the 1(st) tertile (T1) of ULL, those in the 3(rd) tertile (T3) had lower levels of triglycerides (120.8 vs. 153.1 mg/dL, P = 0.045), waist circumference (100.7 vs. 104.2 cm, P = 0.049), and systolic blood pressure (126.7 vs. 131.4 mmHg, P = 0.005), but higher levels of high-density-lipoprotein cholesterol (58.1 vs. 52.4 mg/dL, P = 0.024). The odds ratios (95% CI) of MetS from multivariate logistic regression were 0.57 (0.32-1.03) for individuals in the T2 of ULL and 0.39 (0.24-0.64) for individuals in the T3 of ULL, respectively (P-value for the trend 0.022). CONCLUSIONS: ULL was negatively associated with MetS in older adults. Further research is needed to identify potential mechanisms.