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Maintenance of Exercise Capacity and Physical Activity Patterns 2 Years After Cardiac Rehabilitation

Boesch, Claudia MD; Myers, Jonathan PhD; Habersaat, Anita MD; Ilarraza, Hermes MD; Kottman, Wilhard MD; Dubach, Paul MD

Journal of Cardiopulmonary Rehabilitation: January-February 2005 - Volume 25 - Issue 1 - p 14–21

BACKGROUND The benefits of exercise training for postmyocardial infarction and postcoronary artery bypass surgery patients are well established, but little is known about the effects of rehabilitation in the months or years following the program. The purpose of this study was to assess exercise capacity, blood lipids, and physical activity patterns 2 years after completing a concentrated residential rehabilitation program in Switzerland.

METHODS Seventy-eight patients (86% males, mean age = 56 ± 10, mean ejection fraction = 64% ± 12%) were referred to a residential rehabilitation program after a myocardial infarction or coronary artery bypass surgery between January 2001 and June 2001. Patients lived at the center for 1 month, during which time they underwent educational sessions, consumed a low-fat diet, and exercised 2 hours daily. Two years after completing the program, patients returned to the hospital and underwent a maximal exercise test, an assessment of recent and adulthood physical activity patterns, and evaluation of blood lipids.

RESULTS During the 2-year follow-up period, there were 5 deaths, and 70 of the remaining 73 patients returned for repeat testing. Mean exercise capacity increased 27% during the rehabilitation program (P < .01). Gains in exercise capacity during rehabilitation were maintained after the follow-up period; mean exercise capacity after 2 years was 34% higher compared with that at baseline (P < .01). At the 2-year evaluation, patients were expending a mean of 3127 ± 1689 kcals/wk during recreational activities compared with 977 ± 842 kcals/wk during adulthood prior to their cardiac event (P < .001). Between the completion of rehabilitation and the 2-year follow-up, total cholesterol, total cholesterol/high-density lipoprotein ratio, and triglycerides increased significantly.

CONCLUSIONS Two years after a cardiac event and participation in a concentrated residential rehabilitation program, patients maintained their exercise capacity and engaged in physical activities that exceed the levels recommended by guidelines for cardiovascular health. These observations suggest that a relatively intensive rehabilitation program provided a catalyst to maintain physical activity patterns and exercise tolerance in the 2 years following a cardiac event.

Seventy-eight postmyocardial infarction or postbypass surgery patients were evaluated 2 years after completing a concentrated residential rehabilitation program. At follow-up, mean exercise capacity was similar to that after completing the program, 34% higher compared with prerehabilitation baseline. Patients were expending on average more than 3000 kcal/week in recreational activity at the 2-year follow-up compared with less than 1000 kcal/week during adulthood prior to their cardiac event and participation in the rehabilitation program. These findings suggest that the rehabilitation program had a favorable long-term effect on physical activity and maintenance of exercise capacity.

Rehabilitation Center, Seewis, Switzerland, and the Cardiology Division, Kantonsspital, Chur, Switzerland (Drs Boesch, Habersaat, Kottman, and Dubach); the Cardiology Division, Palo Alto Veterans Affairs Health Care System, and Stanford University, Palo Alto, Calif (Dr Myers); and the Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico (Dr Ilarraza).

Address correspondence to: Jonathan Myers, PhD, VA Palo Alto Health Care System, Cardiology Division – 111C, 3801 Miranda Ave, Palo Alto, CA 94304 (e-mail:

This study was supported in part by grants from RAHN-Medizinfonds, Zurich, Schweizerische Herzstiftung, Switzerland, the Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, and Bonizzi-Theler-Stiftung, Zurich, Switzerland.

The authors have no conflict of interest.

© 2005 Lippincott Williams & Wilkins, Inc.