Key result
Lower baseline predicted peak VO2 (OR 0.91, p<0.001) and higher Karvonen training heart rate range (OR 1.03, p=0.004) independently predicted Δ peak VO2 ≥2 ml/min/kg after cardiac rehabilitation.
Why the study?
Patients undergoing cardiac rehabilitation achieve variable improvements in peak VO2 despite following recommended programs. Predictors of achieving a clinically meaningful increase in peak VO2 of at least 2 ml/min/kg needed to be identified.
Does baseline clinical, exercise, and hemodynamic assessment predict an improvement in peak VO2 ≥2 ml/min/kg in patients undergoing cardiac rehabilitation?
Observational (n=271)
No
Does baseline clinical, exercise, and hemodynamic assessment predict an improvement in peak VO2 ≥2 ml/min/kg in patients undergoing cardiac rehabilitation?
Lower baseline exercise capacity (% predicted peak VO2) and higher training heart rate intensity independently predict clinically meaningful improvement in peak VO2 (≥2 ml/min/kg) during outpatient cardiac rehabilitation.
Higher baseline peak VO2 % predicted may limit post-rehabilitation gains; leaves open targeted program design for lower-baseline patients.
Introduction Cardiac rehabilitation (CR) focuses on improving exercise capacity, that could be assessed as oxygen uptake at peak exercise (peak VO2). Despite CR being performed according to the recommended program, patients achieve different degrees of improvement in peak VO2. A change in peak VO2 (Δ peak VO2) from baseline to post-CR of at least 2 ml/min/kg is associated with better long-term prognosis. Aim The aim of this study was to identify predictors of improvement in VO2 ≥2 ml/min/kg in patients undergoing CR. Methods A single-center, retrospective registry of 518 patients who underwent CR was conducted. Exclusion criteria included history of cardiac surgery, inpatient rehabilitation, and the absence of cardiopulmonary exercise testing performed twice during CR. The clinical reasons for CR, demographic data, comorbidities, and hemodynamic parameters at rest (assessed via impedance cardiography (ICG)) were analyzed. The analysis included 271 patients who were divided into two subgroups according to Δ peak VO2: Δ peak VO2 ≥ 2ml/min/kg (95 patients, 76 men, median age 60 years) and Δ peak VO2 < 2ml/min/kg (176 patients, 133 men, median age 63 years). Variables that significantly differed between the two subgroups with a p-value < 0.1 were selected for the logistic regression analysis. Results In the univariate logistic regression, the following parameters were identified as predictors of Δ peak VO2 ≥ 2ml/min/kg: age (OR 0.96, p=0.007), number of previous percutaneous coronary intervention (OR 1.25, p=0.039), total fluid content (TFC) (OR 1.08, p=0.032), and Karvonen upper training heart rate range (OR 1.02, p=0.042). In multivariate regression analysis as independent predictors revealed: baseline predicted value of peak VO2 (baseline peak VO2 % pred. - OR 0.91, p<0.001) and Karvonen upper training heart rate range (OR 1.03, p=0.004). Other variables, including comorbidities, left ventricular ejection fraction, reason of CR, other than TFC parameters via ICG were not associated with improvement in peak VO2 during CR. Conclusions The improvement of Δ peak VO2 ≥ 2ml/min/kg after CR has complex background. Lower exercise capacity before CR and higher training intensity revealed independent predictors of this positive effect. Individual comprehensive assessment is crucial for the qualification to CR, planning of intervention and prediction of the effects regarding exercise performance.
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Kurpaska et al. (2026) conducted an observational in Cardiovascular conditions requiring cardiac rehabilitation (n=271). Baseline predicted value of peak VO2 and Karvonen upper training heart rate range vs. Δ peak VO2 < 2 ml/min/kg was evaluated on Improvement in peak VO2 (Δ peak VO2) ≥ 2 ml/min/kg (OR 0.91, p=<0.001). Lower baseline predicted peak VO2 (OR 0.91, p<0.001) and higher Karvonen training heart rate range (OR 1.03, p=0.004) independently predicted Δ peak VO2 ≥2 ml/min/kg after cardiac rehabilitation.
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