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Exercise program improved recovery of patients with heart disease

Jolly M. Circulation. 2011;doi:10.1161/CIRCULATIONAHA.110.005009.

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Heart rate recovery in patients with heart disease improved after phase 2 cardiac rehabilitation, improving all-cause mortality, according to researchers.

Patients included in the study underwent exercise stress testing before and after a phase 2 cardiac rehabilitation program and exercised under physician supervision for 12 weeks. Exercise included a 10- to 15-minute warm-up, 30 to 50 minutes of aerobic exercise and a 15- to 20-minute cool-down. Researchers defined the primary endpoints as heart rate recovery and mortality. Heart rate recovery was the difference between heart rate at peak exercise and exactly 1 minute into the recovery period, according to researchers.

There were 1,070 patients who underwent exercise stress testing, and 544 of the patients had abnormal heart rate recovery at baseline. At baseline, the average value of heart rate recovery during stress testing was 13.2 ± 8.6 beats/minute vs. 16.6 ± 9.4 beats/minute after cardiac rehabilitation. After rehabilitation, 41% of patients with abnormal heart rate recovery had normal heart rate recovery, and patients who could not normalize heart rate recovery had a higher predicted mortality rate (P<.001).

When looking at a multivariable model, researchers found predictors that failed to improve heart rate recovery included older age (OR=1.47; 95% CI, 1.23-1.75), lack of improvement in exercise capacity (OR=0.70; 95% CI, 0.59-0.83), peripheral arterial disease (OR=3.02; 95% CI, 1.37-6.68) and prior congestive HF (OR=1.93; 95% CI, 1.12-3.32). After cardiac rehabilitation, 89% of patients who had normal heart rate recovery at baseline continued to have normal heart rate recovery vs. 41% of patients who achieved normal heart rate recovery. Eleven percent of patients with normal heart rate recovery developed abnormal heart rate recovery vs. 59% who maintained abnormal heart rate recovery. Overall, 18% of patients died.

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