Course and effects of exercise training in the rehabilitation after myocardial infarction in different groups of patients

Exercise training is the most important part of the cardiac rehabilitation in patients after myocardial infarction (MI). Despite the well proved benefits of cardiac rehabilitation and exercise training, only limited data are available for the elderly patients on the benefits of cardiac rehabilitation. We performed the retrospective analysis of all patients having completed an out-patient rehabilitation program in convalescence after myocardial infarction at the University Department of Angiology during the period between 1988 and 1997. We gathered the data of 475 patients (360 younger than 65 years and 115 elderly, aged 65 years or more) and compared the course of the rehabilitation program, the results of exercise stress testing and serum lipids before and after rehabilitation. The elderly patients were included in the rehabilitation program significantly later than younger ones (3,9±6,1 vs. 2,8 ±4,5 months, p < 0.05). More complications occurred during the rehabilitation in elderly patients, there were more cases of heart failure and cardiac arrhytmias. After rehabilitation, the elderly demonstrated significant improvement in symptom-limited aerobic capacity at exercise stress testing, the increase being the same as in younger patients (elderly patients: from 4,42±1,70 to 5,90±2,10METs; younger patients: from 5,43±2,00 to 7,21±2,30METs). As in younger patients, the mean left ventricular ejection fraction did not change after rehabilitation either in elderly patients with normal left ventricular systolic function or in those with significant systolic dysfunction. In those patients being not treated with lipid-lowering drugs after rehabilitation, more atherogenic serum lipid profile was observed in elderly patients, while in younger ones the observed changes were favorable. These data showed that an out-patient rehabilitation program in convalescence after myocardial infarction is useful and safe also for elderly patients. Therefore, its more intensive application should be encouraged in this population.