Efficacy of a Community-Based Phase III Cardiac Rehabilitation Program in Improving Function in Older Adults

Abstract

Purpose and Hypothesis: The purpose of this investigation was to analyze objective measures of endurance, balance, and strength following 4 and 12 weeks of participation in a combined volunteer and student run Phase III cardiovascular wellness program at a public university. It was hypothesized that improvements in objective tests of balance, strength, and endurance will be noted following completion of one month and three months of the program. 

Methods: A prospective observational longitudinal design explored changes in function in 51 ambulatory patients attending a Phase III community-based cardiac rehabilitation clinic. Functional measures assessed including 3 minutes of stepping, 6-minute walk test, gait speed test, Timed Up and Go test, 30 second chair rise test, along with assessment of absolute and relative quadricep strength using a handheld dynamometer. Measurements were collected by two designated data collectors at enrollment into the study (data visit 1), after 4-weeks (data visit 2) and after 12-weeks (data visit 3). All subjects received routine Phase III cardiac rehabilitation that combined monitored aerobic exercise and strengthening exercises during the 12-week participation period. Subjects voluntarily participated in the program and attended on average 2 sessions per week.

Results: 33 females and 18 males with mean age 74 + 9 years, mean weight 76 + 14 kg. who were registered participants in the community clinic, participated in this study. A repeated measures ANOVA revealed statistically significant differences over the course of 12 weeks in 6-minute walk scores (F=10.98, p<0.01); absolute strength scores (F=4.07, p=0.02) and relative strength scores (F=3.15, p=0.04). Changes in 30 second chair rise scores neared significance (F=2.80, p=0.06). No statistically significant differences were noted from baseline to 12 weeks for gait speed, timed up and go test, and 3-minute step test scores. (p> 0.05) 

Conclusion: With the growing number of patients in the community with heart disease, it is imperative to investigate new delivery models including the use of a community-based wellness program that may be effective in improving patient outcomes. This investigation reports meaningful improvements in 6-minute walk test and quadricep strength scores in individuals receiving Phase III cardiac rehabilitation within a community-based clinic. Standardized care was not provided during the course of the intervention. Future studies should examine the use of a standardized intervention to further validate the effectiveness of community-based programs in improving functional outcomes in older individuals with heart disease.