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Cardiac Rehabilitation Update 2008—Biological, Psychological, and Clinical Benefits
Table 1: The Benefits of Formal Phase II Cardiac Rehabilitation and Figure 1: Changes in High-sensitivity C-reactive Protein Following
Exercise Training Programs Cardiac Rehabilitation and Exercise Training in Patients who
Achieved Weight Loss (n=121) versus Patients who Gained
Improvements in exercise capacity
Weight (n=106)
Estimated METs +35%
4
Peak anaerobic threshold +10–15%
p=0.003 p=0.004
Peak VO
3.40
2
+15–20%
3.36
Before
Improvements in lipids
After
Total cholesterol -5%
3
Triglycerides -15% (higher in hypertriglyceridemia)
HDL-C +5–10% (higher in low HDL-C)
LDL-C -3%
2
1.90
2.00
LDL/HDL -8%
HSCRP (mg/l)
Reduction in obesity indices
BMI -1.5% 1
% fat -5%
Metabolic syndrome -37%
Reduction in inflammation (HSCRP -40%)
0
Improvements in blood rheology Weight loss Weight gain
Plasma viscosity
Adapted with permission from Milani RV, et al., 2004.
14
Increased RBC transport efficiency
Improvements in autonomic function
Improvement in heart rate variability
Figure 2: Improvements in Median Levels of High-sensitivity
Improvement in heart rate recovery
C-reactive Protein Before and After Cardiac Rehabilitation and
Exercise Training in Patients with and without Metabolic Syndrome
Reduction in homocysteine (-10%)
Improvements in psychological risk factors
p=0.01
Depression
Hostility
5
4.6
p=0.03
MS
Anxiety
No MS
Total stress scores 4
Improvements in quality of life (and many components) p=0.01
Reduction in hospitalization costs
3
Reductions in fatal MI, sudden cardiac death, and total mortality
2.6
p=0.01
2.5
METs = metabolic equivalents; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density
HSCRP (mg/l)
2
lipoprotein cholesterol; BMI = body mass index; HSCRP = high-sensitivity C-reactive protein;
1.5
RBC = red blood cell; MI = myocardial infarction.
1
We recently studied a large cohort of 635 consecutive patients and
specifically compared 104 patients <55 years of age (mean 48±6 years)
0
and 260 patients ≥70 years (mean 75±3 years) to determine the Before After
prevalence of psychological risk factors and response to CRET.
26
We
Reproduced from Milani RV, Lavie CJ, 2003.
15
demonstrated that depression was slightly more prevalent in the younger
cohort (23 versus 19%; see Figure 3),
26,27
and that both groups, depression as well as mortality risk, whereas those patients who had
particularly the younger patients, experienced marked improvements either a small or a large increase in exercise capacity significantly reduced
following CRET. In addition, younger patients had a much higher both their risk for depression and its high accompanying mortality risk
prevalence of hostility (13 versus 5%; p<0.01) and anxiety (28 versus (see Figure 8).
14%; p<0.01), and both groups showed dramatic improvements in both
psychological factors following formal CRET (see Figures 4 and 5).
26,27
Importantly, these data suggest that only a small increase in levels of
physical fitness is needed to reduce depression and depression-related
Most recently, we compared 522 consecutive patients who took part in increased mortality. Additionally, although our study was specifically
CRET with 179 patients who did not participate in CRET and served as performed in a CHD cohort following major CHD events, we believe that
controls.
28
Most importantly, patients who remained depressed following these data can probably be extrapolated to those in the general
CRET had a four-fold higher mortality (22 versus 5%; p<0.001) than population who are at risk for depression, supporting the potential
those who were not depressed following CRET (see Figure 6). Moreover, benefits of regular exercise training and increased levels of physical
the control depressed group had a 30% mortality during a mean 3.5-year fitness to reduce depression and its increased risk.
follow-up compared with only 8% (p<0.001) in the CRET depressed
group (see Figure 7). Finally, we noted that patients who did not Clinical Events and Mortality Data
significantly improve their exercise capacity, as assessed by peak oxygen There have been no randomized controlled trials (RCTs) of CRET that have
consumption (or peak VO
2
), maintained a high prevalence of been large enough to assess major CHD morbidity and mortality, causing
US CARDIOLOGY 73
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