Regular exercise is good for your heart, no matter how old you are!

A new study in the Canadian Journal of Cardiology showed that older individuals have the most to gain and may gain the most from rehabilitation programs, but this need is often ignored


Philadelphia, October 8, 2019

Regular exercise is highly beneficial for all patients with cardiovascular disease regardless of age, report investigators in the Canadian Journal of Cardiology, published by Elsevier. Their results showed that the patients who benefited most from cardiac rehabilitation were those who started out with the greatest physical impairment.

Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event, yet older patients are largely underrepresented in rehabilitation programs. Studies have shown that this might be due to a lack of referral and encouragement to attend cardiac rehabilitation in older patients.

“Aging is associated with several factors such as increased inflammation or oxidative stress that predispose people to cardiovascular diseases. As a result, elderly patients are usually less fit than their younger counterparts, and deconditioning is accelerated once cardiovascular disease is established,” explained lead investigator Gaëlle Deley, PhD, INSERM UMR1093 – CAPS, Faculty of Sports Sciences, University of Burgundy Franche-Comté, Dijon, France. “However, there are few data about the impact of patient age on the physical and psychological effectiveness of cardiac rehabilitation.”

Several studies have looked at the effects of cardiac rehabilitation in older adults. However, these data often focus on patients above the age of 65 with no distinction between old and very old patients and examine either physical or psychological outcomes but not both.

The goal of this study was to compare the effects of an exercise‐based cardiac rehabilitation program on physical and psychological parameters in young, old, and very old patients. It also aimed to identify the features that best predicted cardiac rehabilitation outcome.

All patients referred to Cardiac Rehabilitation at the Clinique Les Rosiers, Dijon, France from January 2015 to September 2017 were included in this single-center prospective study. Investigators examined 733 patients who completed a 25-session cardiac rehabilitation program. They were divided into three subgroups: less than 65 years old; between 65 and 80 years old; and 80 years or older. Physical and psychological variables such as scores of anxiety and depression were evaluated for all patients before and after cardiac rehabilitation.

Following the intervention, all patients experienced improvements. “We found a few weeks of exercise training not only significantly improved exercise capacity, but also decreased anxiety and depression. Patients with the greatest physical impairments at baseline benefited the most from exercise,” commented Dr. Deley. “Another interesting result was that patients younger than 65 who were very anxious before rehabilitation benefited the most from exercise training. A similar result was found for depressed patients older than 65. These improvements will surely have a great positive impact on patients’ independence and quality of life and might help both clinicians and patients to realize how beneficial exercise rehabilitation can be.”

In an accompanying editorial, Codie R. Rouleau, PhD, RPsych, Clinical Psychologist, Adjunct Assistant Professor in Psychology, and James A. Stone, MD, PhD, Clinical Professor of Medicine, both at the University of Calgary and TotalCardiology Research Network in Calgary, AB, Canada, point out that the study’s conclusion that age does not limit physical performance outcomes is inconsistent with some previous research showing that advancing age, especially for patients 60 years and older, is associated with smaller cardiorespiratory fitness gains during cardiac rehabilitation. The reasons may relate to different program characteristics, different methods of physical performance measurement, or the exceptional adherence rate reported in the study (average 98.6 per cent prescribed sessions attended).

“Older adults who are eligible for cardiac rehabilitation have a decreased likelihood of receiving a referral compared to their younger counterparts and the present report may serve as a catalyst for clinicians to recognize that older adults with coronary artery disease stand to benefit only if referred and given the opportunity to participate,” commented Dr. Rouleau.

“A strength of this work is the examination of changes in psychosocial well-being during cardiac rehabilitation—an understudied outcome that is often highly valued by patients,” added Dr. Stone. “The work of Deley et al. may help inform strategies to augment the effects of rehabilitation, reach more patients with a greater likelihood of achieving clinical benefit, and derive improved outcomes from higher value healthcare.”

Cardiovascular diseases are the main cause of death globally. Nearly 18 million people died from cardiovascular diseases in 2016, representing over 30 per cent of all global deaths according to the World Health Organization. While cardiovascular diseases increasingly affect young people, the number of people above the age of 65 years, and even more above the age of 80 years, dying from cardiovascular diseases is also increasing.

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Notes for editors
The articles are “Physical and Psychological Effectiveness of Cardiac Rehabilitation: Age Is Not a Limiting Factor!” by Gaëlle Deley, PhD, Cécile Culas, MS, Marie-Cécile Blonde, MD, France Mourey, PhD, and Bénédicte Vergès, MD (https://doi.org/10.1016/j.cjca.2019.05.038) and “Editorial: Sorting the Wheat from the Chaff in Cardiac Rehabilitation: Who Gets Better and Why?” by Codie R. Rouleau, PhD, RPsych, and James A. Stone, MD, PhD (https://doi.org/10.1016/j.cjca.2019.07.003). They appear in the Canadian Journal of Cardiology, volume 35, issue 10 (October 2019) published by Elsevier.

Full text of the articles is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628 or cjcmedia@elsevier.com to obtain copies. Journalists wishing to speak to the study’s authors should contact Gaëlle Deley, PhD, at gaelle.deley@u-bourgogne.fr. To reach the editorial’s authors for comment contact Codie R. Rouleau, PhD, RPsych, at crroulea@ucalgary.ca or James A. Stone, MD, PhD, at jastone@shaw.ca.

About the Canadian Journal of Cardiology
The Canadian Journal of Cardiology is the official journal of the Canadian Cardiovascular Society. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca

About the Editor-in-Chief
Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
Eileen Leahy
Elsevier
+1 732 238 3628
cjcmedia@elsevier.com