Exercise intervention speeds up recovery of frail older adults after acute MI

Older adult patients participating in a physical programme exhibit improvement in frailty status at 3 months, but such benefit is attenuated following a shift to a home-based programme, according to a study. Recruitment and retention to this intervention has also been challenging.

“A physical exercise programme was associated with a directionally favourable effect on frailty status at 3 months, which reached statistical significance in the subgroup of patients who participated,” the researchers said. “A better frailty trajectory might influence midterm prognosis.”

One hundred fifty survivors of acute myocardial infarction (MI), aged ≥70 years and with prefrailty or frailty (Fried scale ≥1 points), were randomly assigned to either intervention (n=73) or control (n=77) groups. Participants in the intervention group underwent a 3-month exercise programme, with physiotherapist supervision, followed by an independent home-based programme.

Forty-four (60 percent) of 73 patients in the intervention group participated in the programme, and 23 (32 percent) completed it. At 3 months, a reduction in the Fried score was observed in these individuals, with no effect at 1 year. [Am J Med 2021;134:383-390.E2]

However, intention-to-treat analysis revealed no statistical significance in such change (p=0.110). Only treatment comparisons made among subgroups participating in (p=0.033) and completing (p=0.018) the programme achieved statistical significance. No differences were seen in clinical events.

During follow-up, a worse Fried score trajectory correlated with higher mortality risk (hazard ratio, 2.38, 95 percent confidence interval, 1.24–4.55; p=0.009).

Patients with frailty and heart disease are not usually considered for physical rehabilitation programmes due to several factors, including lack of fitness, difficulties with transportation to attend sessions, or a hypothetical lack of benefit due to poor prognosis conferred by the frailty status itself. [Clin Geriatr Med 2019;35:445-457; J Am Heart Assoc 2018;7e008296]

“Our study confirms that programme participation is difficult for these patients because only 60 percent of the allocated participants actually took part in the programme and 32 percent completed ≥80 percent of the sessions,” the researchers said, noting both clinical worsening and voluntary refusal as causes.

This finding was consistent with that of previous cohort studies, which reported failure to complete rehabilitation programmes among patients with frailty, with a programme adherence rate between 58 percent and 68 percent. [J Am Heart Assoc 2018;7e008296; J Cardiopulm Rehabil Prev 2017;37:175-181; J Clin Med 2018;7:560; Can J Cardiol 2020;36:482-489]

“Frailty is a dynamic condition with frequent transitions between frailty states over time, yet acute illness and the hospitalization process itself might impair frailty,” the researchers said. [Arch Intern Med 2006;166:418-423; Ann Epidemiol 2019;34:65-70; Circ Cardiovasc Qual Outcomes 2016;9:230-238; N Engl J Med 2013;368:100-102]

In the current study, frailty status improved from discharge to 12 months regardless of allocation to a physical programme, but those who participated in the intervention had faster recovery.

This short-term beneficial effect has been reported in randomized trials of older adults without overt heart disease and study cohorts of several heart diseases. [PLoS One 2015;10e0116256; Am J Med 2015;128:1225-1236; J Am Geriatr Soc 2016;64:1640-1645; Eur J Prev Cardiol 2017;24:257-264]

“The Fried score domains of gait speed and exhaustion improved significantly with the intervention. Indeed, gait speed is directly addressed in exercise programmes. The improvement in this domain might translate into feeling less exhausted,” the researchers said.

“Unfortunately, the exercise programme failed to modify lifetime habits, explaining its lack of effect on other domains,” they added.