Responder Analysis of Adaptive Postural Balance Cardiac Rehabilitation Exercise in Patients with Coronary Artery Disease and Type 2 Diabetes: Secondary Analysis of a Randomized Trial

Background Patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) show variable responses to exercise-based cardiac rehabilitation. We compared metabolic and exercise responder rates after adaptive postural balance cardiac rehabilitation exercise (APBCRE) versus aerobic exercise (AE) and explored baseline factors associated with responder status.Methods This pre-specified secondary analysis included 167 patients with CAD and T2DM from a randomized trial who completed an 8-week intervention (APBCRE, n = 87; AE, n = 80). Metabolic response was defined as an HbA1c reduction of ≥0.5%, and exercise response as a VO2max increase of ≥3.5 mL·kg−1·min−1. Multivariable logistic regression evaluated associated factors.Results APBCRE was associated with higher metabolic (48.3% vs 32.5%, P < 0.05) and exercise responder rates (31.0% vs 11.3%, P < 0.01) than AE. APBCRE was independently associated with metabolic response (OR 2.09, 95% CI 1.03-4.25; P = 0.043) and exercise response (OR 3.66, 95% CI 1.55-8.65; P = 0.003). Higher baseline HbA1c was associated with metabolic response (OR 5.04, 95% CI 2.14-11.86; P < 0.001), whereas insulin therapy was inversely associated (OR 0.25, 95% CI 0.07-0.90; P = 0.034). Lower baseline VO2max was associated with exercise response (OR 0.84, 95% CI 0.72-0.97; P = 0.016).Conclusions APBCRE was associated with higher rates of clinically meaningful metabolic and exercise responses than AE. Responder analysis complements conventional outcome assessment and may support individualized cardiac rehabilitation.