Unlocking physical potential: the crucial role of cardiac rehabilitation in enhancing physical capacity

Abstract Introduction Cardiac rehabilitation (CR) is a structured program that combines exercise and education to help patients (pts) recover from cardiac conditions, in order to improve their cardiovascular health and enhance overall well-being and quality of life. Purpose To compare cardiopulmonary exercise test (CPET) parameters and 6 minute walking test (6MWT) performance before and after CR program completion. Methods Single center prospective study of consecutive pts that completed a center-based CR program from 2015 to April 2023. The CR program included evaluation by a cardiologist physician, nutritionist and psychologist, 2 weekly supervised exercise sessions, and educational sessions. CPET and 6MWT were performed at baseline and after program conclusion. Student T and Pearson correlation tests were used for statistical analysis. Results We included 446 pts, 81% males, mean age 60±11 years. Ischemic cardiomyopathy was the main reason for CR referral, followed by dilated and valvular cardiomyopathy in 84%, 6% and 6% of pts, respectively. Most pts had hypertension, 72% had dyslipidemia, 60% of pts were current or former smokers and 20% were diabetic. Most pts were overweight (median BMI 27 kg/m2), mean ejection fraction was 49% and median NTproBNP was 478 pg/mL. Overall, pts completed on average 14 CR sessions, which corresponds to 92% of scheduled sessions. After CR program, pts experienced a significant improvement on CPET parameters with an increase in VO2 peak (17±5 vs 19±5 ml/kg/min, p0.001), percentage of predicted VO2 peak (66±17 vs 68±17ml/kg/min, p0.001), O2 pulse (mean 11.7±3 vs 13±5, p0.001), maximum workload (12±3 vs 135±41 W, p0.001), duration of CPET (8.5±2 vs 9±3, p0.001) and total distance on 6MWT (443±105 vs 558±113m, p0.001), as well as a decrease in optimal cardiorespiratory point (OCP) (27±6 vs 26±6, p=0.001), reflecting physical capacity improvement. This improvement was consistent when performing subgroup analysis for gender, people older than 70 years, obese pts (defined as BMI30kg/m2), ischemic and non-ischemic cardiomyopathy. We found a positive correlation between program adherence and improvement in VO2 peak, VO2 pulse and OCP (rs 16%, p=0.045; rs 16% p=0.042 and rs 26% p=0.001, respectively). Conclusion In our population, CR program significantly improved CPET and 6MWT performance and enhanced physical fitness and well-being, especially in patients with higher program adherence rates.