Early and late rehabilitation and physical training in elderly patients after cardiac surgery.
OBJECTIVE
Few randomized trials have enrolled patients who have undergone cardiac surgery, and even fewer have included patients aged 75 yrs or more. Furthermore, the optimal timing of cardiac rehabilitation for postsurgical patients has not yet been codified. The aim of this study was to verify whether rehabilitation outcomes are also favorable in postsurgical patients aged 75 yrs or more and whether an early rehabilitation program is as effective and safe as a late one.


METHODS
Three hundred patients who underwent cardiac surgery, 27.7% of whom were at least 75 yrs old, were randomly assigned to a rehabilitation program starting within the second week after operation or within the fourth week. All events occurring during the rehabilitation program or in the following year were recorded.


RESULTS
During the rehabilitation program, new-onset atrial fibrillation was significantly more frequent in the early rehabilitation group, independent of age class, and anemia was significantly more frequent in older patients, independent of rehabilitation timing. At the end of the rehabilitation program, more than 90% of patients showed significant increases in walking distance, and during the follow-up, no significant difference was found with regard to mortality, nonfatal events, functional ability, or control of cardiovascular risk factors, independent of rehabilitation timing and age class.


CONCLUSIONS
This study provides evidence that in selected patients who have undergone cardiac surgery, rehabilitation outcomes are also favorable in patients aged 75 yrs or more, and an early rehabilitation program is as effective and safe as a traditionally late one.
Macchi
Claudio
C
Cardiac Rehabilitation Unit, Don Gnocchi Foundation, Florence, Italy.
Fattirolli
Francesco
F
Lova
Raffaele Molino
RM
Conti
Andrea A
AA
Luisi
Maria Luisa Eliana
ML
Intini
Rosanna
R
Zipoli
Renato
R
Burgisser
Costanza
C
Guarducci
Lorenzo
L
Masotti
Giulio
G
Gensini
Gian Franco
GF
D000367:Age Factors; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000534:rehabilitation*; D004434:Early Ambulation / Q000009:adverse effects; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology