A gift that keeps on giving: long-term benefits of cardiac rehab

E xercise is one of the best things most people can do for their health, and that holds true for heart patients as well. People who complete a supervised, exercise-based cardiovascular rehabilitation program after treatment for a heart condition or an event such as a heart attack or bypass fare better than those who do not – including having lower mortality rates. Those immediate benefits of cardiac rehab are well known, but longer-term benefits are not as well defined. “We know about those improvements over the six months of the program: if you complete cardiac rehab, you will have a better cardiovascular risk profile than before rehab, mostly driven by improvements in fitness,” says Mireille Landry, physiotherapist and exercise coordinator with the Women’s Cardiovascular Health Initiative (WCHI) at Women’s College Hospital. “But how long do you maintain it?” For Landry and her fellow clinicians and researchers at the WCHI, that question is particularly important for women. As a program designed specifically and exclusively for women, WCHI has achieved excellent results in improving uptake and completion rates for women patients. “We know that women are typically less likely to attend cardiac rehab, and when they do enroll they’re also more likely to drop out compared to men,” Landry says, explaining that although women face more barriers to rehab, men and women get the same benefits when they do go. With fewer women attending and completing cardiac rehab than men, less is known about their long-term results. Landry and her fellow researchers at WCHI carried out a study that looked at cardiovascular risk factors in women who had already completed the WCHI cardiac rehab program. Women in the WCHI program have supervised exercise sessions twice per week for about six months, and also work with an interdisciplinary team to learn skills to manage their health conditions and their cardiovascular risk factors. Women are offered followup appointments six months after completing the program, and again after one year. The researchers used information from these appointments to look at longterm results. Of the 422 women who completed the WCHI cardiac rehab program from 2007 to 2013, 252 attended a followup appointment six months later, and 183 attended a 12-month followup. “The outcomes that we were specifically looking to monitor related to cardiovascular risk factors,” Landry says. These included systolic blood pressure, cholesterol and lipid profile, blood sugar, and body mass in- dex, and particularly exercise capacity. “Exercise capacity is a big one. We know that exercise-based cardiac rehab improves aerobic fitness or capacity,” Landry says. “We strongly believe that exercise is medicine, and we know that even small changes to your aerobic capacity confer big protective changes. Aerobic capacity can protect your heart and your risk of having a heart attack, as successfully as some of the medication typically prescribed for heart disease or having a procedure done. So we were really interested in following up on that.” They also looked at depression, and physical and mental quality of life scores. Immediately after finishing the cardiac rehab program, women had made significant gains in exercise capacity and in physical quality of life, and their depression scores had improved compared to when they began the program. Six months later, they had maintained all of those gains. One year after finishing the program, exercise capacity remained significantly higher than when they began. “Specifically we were interested in looking at aerobic capacity, and that was significantly improved,” Landry says. “At the sixmonth followup point, and at the 12-month followup, they had maintained those gains in aerobic capacity, which is what we were hoping to see.” The study results are very encouraging, reflectingfl ti ongoingi benefitsb fit forf women whoh complete cardiac rehab. The WCHI program has a very high completion rate: 85 per cent of women who begin the program stick with it, and reap the immediate and ongoing benefits. “We were very happy to see that the women who attended our followup program were successful at maintaining the improvements that we saw when they completed rehab,” Landry says.