IMPROVED EXERCISE TOLERANCE BY CARDIAC REHABILITATION ALTER MYOCARDIAL-INFARCTION IN THE ELDERLY - RESULTS OF A PRELIMINARY, CONTROLLED-STUDY

Elderly patients are commonly excluded from cardiac rehabilitation after myocardial infarction (MI). The present controlled, non-randomized trial was undertaken as a preliminary study to compare some effects of cardiac rehabilitation between patients younger and older than 65 years without contraindications to physical exercise. Baseline total work capacity (TWC) was assessed by a maximal ergometric stress testing 4 weeks after MI. Patients were then prospectively enrolled into an 8-week ambulatory rehabilitation program (R-group: age less than or equal to 65 N=16; age >65 N=16). Those who refused or who could not participate in the program because of logistic difficulties served as controls (NR-group: age less than or equal to 65 N=16; age >65 N=14). In spite of non-randomized allocation, clinical characteristics did not differ between either treatment groups or age groups. TWC was re-assessed at 8 weeks from baseline evaluation in all patients. The number of completed training sessions in the R-group, and the proportion of sessions which were suspended for physiological or pathological (adverse events during exercise) causes were similar under and over 65 years. TWC increased (p<0.001) in the R-group, the improvement being similar in the two age cohorts (less than or equal to 65: +55% vs >65: +65%, NS). A spontaneous enhancement of TWC (+37%, p<0.001) occurred among younger controls as well. Only older controls did not improve their TWC; moreover, their +16% change was significantly (p<0.05) less than the +65% increase obtained by the R-group of the same age. Though non-randomized allocation must be acknowledged as a major limitation of the present study, these results suggest that cardiac rehabilitation may be more cost-effective in those patients who are usually excluded because of their advanced age.