Key result
Exercise training yields ~24% non-responders in CAD, predicted by older age, COPD, and low education.
Why the study?
Some CAD patients do not increase peak oxygen uptake after exercise training, and identifying them could help tailor exercise programmes.
What baseline clinical and socioeconomic characteristics predict non-response to an 8-week supervised exercise intervention in patients with coronary artery disease?
Observational (n=1,443)
What baseline clinical and socioeconomic characteristics predict non-response to an 8-week supervised exercise intervention in patients with coronary artery disease?
Approximately 24% of CAD patients do not improve their aerobic capacity after an 8-week exercise program, with non-response predicted by older age, higher baseline fitness, COPD, and lower socioeconomic status.
Baseline characteristics may identify CAD exercise non-responders; leaves open whether tailoring training improves outcomes.
The impact of baseline characteristics on response to exercise training in patients with ischemic heart disease. Background Exercise training improves peak oxygen uptake, an important predictor of mortality in patients with coronary artery disease (CAD). Unfortunately, some patients do not response with an increase in peak oxygen uptake after exercise training. If it is possible to identify these patients it would be possible to tailor their exercise training. Purpose To investigate if baseline characteristics can predict response to exercise training in patients with heart disease. Methods A retrospective analysis of 1443 CAD patients (age 64±11 y (mean (±SD)), 74% male, participated and completed an eight-week supervised outpatient exercise intervention with two weekly training sessions of 1.5 hours with high intensity interval- (>80% of VO2peak) and resistance training. Patient characteristics were entered in the local database as the patients entered cardiac rehabilitation (CR). VO2peak was assessed before and after CR using a cardiopulmonary exercise test (CPET) with a maximal symptom limited bicycle ergometer test. Breathing gases were collected and analysed breath-by-breath. Each test aimed at physical exhaustion and a respiratory exchange ratio of more than 1.1 to ensure the validity of the CPET test. Patients were divided into responders defined as an improvement in aerobic capacity (change in VO2peak) after CR and non-responders if no improvement (change in VO2peak of 0.0ml/kg/min or less) post CR. We performed a multivariable logistic regression analysis using responders vs. non-responders as the endpoint. Explanatory variables were identified according to previous literature and comprised the following variables; age, sex, baseline VO2peak, tobacco use, diabetes, COPD, revascularization, working status, educational attainment, ethnicity and hypercholesteremia. Results 1097 patients were responders and 346 (24%) non-responders to the exercise training despite no difference in attendance. Logistic regression analysis of responders vs. non-responders in relation to baseline characteristics are shown in the table. Conclusion In summarize, 24% of these heart patients were exercise non-responders. High baseline VO2peak, older age, having COPD, being on disability pension, low educational attainment and non-western ethnicity were predictors of training non-response. Identification of patients with a large likelihood of non-response is a beginning towards patient tailored exercise programmes. Baseline characteristics in responders. CABG: coronary artery bypass graft; COPD: chronic obstructive pulmonary disease; PCI: percutaneous coronary intervention; SD: standard deviation; VO2peak: change in peak oxygen uptake. P-values of <0.05 are considered significant and shown in bold. 95% confidence intervals are shown in last column. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Helsefonden
No takes yet. Share an insight, caveat, or question.
Rasmusen et al. (2020) conducted an observational in Coronary artery disease (n=1,443). Baseline clinical and socioeconomic characteristics vs. Patients without these characteristics was evaluated on Response to exercise training (improvement in aerobic capacity / change in VO2peak > 0.0ml/kg/min). Among 1,443 patients with coronary artery disease completing an 8-week exercise program, 24% were non-responders; older age, COPD, and low education predicted training non-response.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: