Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients

Q: What are the key findings of this study?

Phase II cardiac rehabilitation in frail patients significantly improved 6-minute walking distance from 356m to 392m (P=0.01) but did not improve state (P=0.99) or trait (P=0.42) anxiety scores.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease undergoing Phase II cardiac rehabilitation (n=137). Intervention: Phase II cardiac rehabilitation in frail patients (KCL ≥8) vs. Non-frail (KCL ≤3) and pre-frail (KCL 4-7) patients undergoing Phase II cardiac rehabilitation. Primary outcome: 6-minute walking distance (6MWD) and State-Trait Anxiety Inventory (STAI) scores after Phase II cardiac rehabilitation in frail patients (p=0.01).

Q: What does this research mean for the field?

Phase II cardiac rehabilitation significantly improves physical function (6-minute walking distance) in frail cardiovascular patients but does not significantly reduce their state or trait anxiety levels. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Akio Honzawa; Miho Nishitani‐Yokoyama; Kazunori Shimada; Mitsuhiro Kunimoto; Tomomi Matsubara; Rie Matsumori; Kei Fujiwara; Mayumi Doi; Kana Takagi-Kawahara; Abidan Abulimiti; Jianying Xu; Akie Shimada; Taira Yamamoto; Atsushi Amano; Tohru Asai; Hiroyuki Daida; Tohru Minamino

doi:10.1253/circrep.cr-22-0008

June 7, 2022Circulation ReportsOpen Access

Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients

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Key result

Cardiac rehabilitation improves frail patients' 6-minute walk distance by ~36m without altering anxiety scores.

P=0.01
n=137

Why the study?

Frailty is an important prognostic factor in patients with CVD who also experience high rates of psycho-emotional stress and anxiety, yet few reports had examined the effects of Phase II cardiac rehabilitation on physical function and anxiety in frail patients.

Key Points

To examine the effects of Phase II cardiac rehabilitation on physical function and anxiety levels across frail, pre-frail, and non-frail patients with cardiovascular disease.
Included 137 patients (mean age 65.8±13.0 years; 71% male) who participated in Phase II cardiac rehabilitation and completed post-program assessments.
Categorized participants into non-frail (n=63, 46%), pre-frail (n=40, 29%), and frail (n=34, 25%) groups using baseline Kihon Checklist scores.
6-minute walking distance improved significantly across all groups: non-frail increased from 412±67 to 492±77 m (P<0.01), pre-frail from 349±78 to 402±103 m (P<0.01), and frail from 356±94 to 392±121 m (P=0.01).
State anxiety scores decreased significantly in non-frail (from 34±9 to 32±9; P=0.04) and pre-frail groups (from 40±9 to 36±9; P<0.01), but did not change in frail patients (from 42±9 to 42±12; P=0.99).
Trait anxiety scores improved only in the non-frail group (from 37±10 to 33±10; P<0.01), showing no significant changes in pre-frail (from 42±10 to 41±10; P=0.20) or frail patients (from 45±11 to 44±13; P=0.42).

Study Design

Type

Observational (n=137)

Multicenter

No

PICO

P

Population

137 patients with cardiovascular disease (mean age 65.8 years, 29% female) who completed a 150-day Phase II cardiac rehabilitation program in Japan, stratified by Kihon Checklist frailty scores.

E

Exposure / Comparator

Phase II cardiac rehabilitation in frail patients (KCL ≥8) vs Non-frail (KCL ≤3) and pre-frail (KCL 4-7) patients undergoing Phase II cardiac rehabilitation (60 min sessions scheduled once or twice weekly)

O

Primary Outcome

6-minute walking distance (6MWD) and State-Trait Anxiety Inventory (STAI) scores after Phase II cardiac rehabilitation in frail patients, p=0.01

Main Result

Absolute Event Rate: 392% vs 356%

p-value: p=0.01

Limitations

Small sample size from a single center
Only enrolled patients who completed Phase II cardiac rehabilitation, excluding dropouts
Did not survey physical activity, social activity, and lifestyle habits at home during rehabilitation
Low collection rate (51%) of STAI forms at the end of cardiac rehabilitation among completers
Baseline trait anxiety scores tended to be higher in women than in men
Physical impairment in the frailty group may have been relatively mild because frailty was defined by KCL rather than Fried criteria

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Implication

Improves walking distance but not anxiety in frail patients; extends physical function evidence while leaving anxiety benefits open.

Abstract

Background Frailty is an important prognostic factor in patients with cardiovascular diseases (CVD), and patients with CVD have a high rate of concurrent psycho-emotional stress, as well as depressive mood and anxiety symptoms. Despite this, few reports have examined the effects of the efficacy of Phase II cardiac rehabilitation (CR) in frail patients, including improvements in anxiety levels. Methods and Results In all, 137 patients (mean [±SD] age 65.8±13.0 years; 71% male) who participated in Phase II CR and were assessed after CR completion were included in this study. Patients were evaluated using the Kihon Checklist (KCL) form at the beginning of CR and were divided into the 3 groups according to KCL scores: frail (n=34, 25%), pre-frail (n=40, 29%), and non-frail (n=63, 46%). Physical function and anxiety levels were compared among the 3 groups. The pre-frail and frail groups had significantly higher state anxiety and trait anxiety than the non-frail group (P<0.01). At the end of Phase II CR, all 3 groups showed significant improvements in the 6-min walking distance (P<0.05). State anxiety improved significantly in the non-frail and pre-frail groups, whereas trait anxiety only improved in the non-frail group. Conclusions Physical function was improved in frail patients who participated in Phase II CR. However, there was no significant improvement in their level of anxiety.

Discussion

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Cite This Study

Honzawa et al. (2022) conducted an observational in Cardiovascular disease undergoing Phase II cardiac rehabilitation (n=137). Phase II cardiac rehabilitation in frail patients (KCL ≥8) vs. Non-frail (KCL ≤3) and pre-frail (KCL 4-7) patients undergoing Phase II cardiac rehabilitation was evaluated on 6-minute walking distance (6MWD) and State-Trait Anxiety Inventory (STAI) scores after Phase II cardiac rehabilitation in frail patients (p=0.01). Phase II cardiac rehabilitation in frail patients significantly improved 6-minute walking distance from 356m to 392m (P=0.01) but did not improve state (P=0.99) or trait (P=0.42) anxiety scores.

synapsesocial.com/papers/6aebd4a77978950fa0c77d01 https://doi.org/10.1253/circrep.cr-22-0008

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Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effects of Phase II Cardiac Rehabilitation on Physical Function and Anxiety Levels in Frail Patients

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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