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Response to Cardiac Rehabilitation

Philip A. Ades, MD; Anne Maloney, MD; Patrick Savage, MS; Robert L. Carhart, Jr, MD

Arch Intern Med. 1999;159:2357-2360.

Background  Coronary heart disease is a major cause of disability. There has been little study of the effect of cardiac rehabilitation on measures of self-reported physical functioning.

Methods  Physical functioning was measured using the Medical Outcomes Study–Short-Form Questionnaire. Determinants of physical function were analyzed in 303 patients with coronary heart disease. Response of physical function to a 3-month exercise rehabilitation program was then determined.

Results  At baseline, women had lower physical function scores than men, despite similar age and diagnostic distribution. Older patients had lower physical function than younger patients. Aerobic exercise capacity, leg and arm strength, and comorbidity and depression scores were all significant predictors of baseline physical function (r range, 0.46 to -0.22). Physical function score increased significantly after exercise conditioning, with a mean (±SD) overall score increase from 66 ± 23 to 80 ± 20 on a scale of 0 to 100. The best baseline determinant of a favorable physical function improvement after rehabilitation was a low baseline physical function score. The best training-related correlate of improved physical function score was a decrease in mental depression score.

Conclusions  Self-reported physical function in coronary patients is related to age, sex, fitness, and mood state. Physical functioning improves after cardiac rehabilitation in all age, sex, and diagnostic groups, but particularly in patients with low baseline values. These data support the concept that cardiac rehabilitation effectively prevents and treats cardiac disability.

From the Division of Cardiology, Department of Medicine, University of Vermont College of Medicine, Burlington. Dr Carhart is now affiliated with the Division of Cardiology, Department of Medicine, State University of New York Health Science Center, Syracuse.

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