Key result
Cardiac rehabilitation yields similar peak oxygen uptake improvements regardless of baseline musculoskeletal comorbidities.
Why the study?
Musculoskeletal comorbidities may be escalating in the older and more obese population entering cardiac rehabilitation, potentially affecting exercise and outcomes.
Does cardiac rehabilitation improve peak oxygen uptake similarly in patients with and without musculoskeletal comorbidities?
Cohort (n=322)
Does cardiac rehabilitation improve peak oxygen uptake similarly in patients with and without musculoskeletal comorbidities?
Absolute Event Rate: 16.3% vs 18.8%
p-value: p=0.28
Despite a high prevalence of musculoskeletal comorbidities at entry to cardiac rehabilitation, patients can achieve significant improvements in cardiovascular fitness with appropriate exercise modifications without compromising compliance.
Supports adapted cardiac rehabilitation for musculoskeletal comorbidities; leaves open whether randomized trials would confirm equivalent gains.
In Brief BACKGROUND: With the demographic of patients entering cardiac rehabilitation (CR) indicating an older and more obese population, musculoskeletal comorbidities (MSKCS) may be escalating. METHODS: Musculoskeletal comorbidities affecting exercise were ascertained in 322 patients (233 men and 89 women) by a questionnaire and then an interview before and after 3 months of CR. Outcome variables were measured at baseline and 6 months. RESULTS: Musculoskeletal comorbidities perceived to affect exercise were reported by 50% of subjects at CR entry (48.1% of males, 55.1% of females; P = .26); most commonly occurring in the knee(s) (25%) and back (19%) due predominantly to arthritis (36.6%) and strains/sprains (28.6%). Multivariate regression revealed that greater body mass, older age, and lower peak oxygen uptake ( ) were predictors of baseline MSKCs. At entry, patients with MSKCs were less likely to be exercising 30 minutes or more, 5 times per week than those without MSKCs (17.4% vs 28%, respectively, P = .03). Exercise modifications were required for 33.5% of patients with MSKC. By 3 months, 15.2% of patients developed 62 new MSKCs (26.5% strains/sprains). Six months of CR yielded significant (P < .001) and similar improvements in for patients with and without baseline MSKCs (16.3% and 18.8%, respectively, P = .28). The improvement was mitigated in those with arthritic conditions compared with others (7.8% vs 20%, respectively, P = .01). By 6 months, 31.1% and 29.8% of patients with and without baseline MSKCs respectively, discontinued CR (P = .81). CONCLUSIONS: At entry to CR, patients reporting MSKCs had a poorer health profile than those without mskcs, including lower levels of physical activity and cardiovascular fitness, and unfavorable anthropometric measures. With exercise modifications, significant benefits were achievable without affecting compliance. Musculoskeletal comorbidities affecting exercise were reported by 50% of subjects at entry to cardiac rehabilitation. Multivariate regression revealed that greater body mass, older age, and lower peak oxygen uptake were associated with baseline musculoskeletal comorbidities. With exercise modifications, significant benefits in outcomes were achieved without affecting exercise compliance.
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Marzolini et al. (2010) conducted a cohort in Cardiac rehabilitation (n=322). Musculoskeletal comorbidities vs. No baseline musculoskeletal comorbidities was evaluated on Improvement in peak oxygen uptake at 6 months (p=0.28). Patients with baseline musculoskeletal comorbidities achieved similar improvements in peak oxygen uptake after 6 months of cardiac rehabilitation compared to those without (16.3% vs 18.8%; P=0.28).
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