title: Reduced executive functioning is associated with poorer outcome in cardiac rehabilitation.
abstract: Patients with cardiovascular disease and cognitive impairment show reduced adherence to treatment. No study has examined whether cognitive impairment may also predict reduced benefit from cardiac rehabilitation (CR). It appears that cognitively impaired patients may exhibit poorer adherence to CR and limited gains in cardiovascular fitness and/or quality of life (QOL). Forty-four older adults who enrolled in a CR program and completed measures at enrollment and discharge were included. Cognitive functioning was assessed using the Trail Making Test B. Estimated metabolic equivalents (METs) were derived from a treadmill stress test to provide a measure of cardiovascular fitness. QOL was measured with the Short Form-36 (SF-36) physical and mental component scales (PCS and MCS, respectively). Repeated measures analysis of variance showed improvements in METs [METs; F(1,36)=77.6, P<.001] and physical [SF-36 PCS; F(1,36)=14.14, P=.001)] and mental QOL [SF-36 MCS; F(1,36)=11.55, P=.002)]. Partial correlations indicated that poorer Trail Making Test B performance was associated with lower METs at discharge (r=-0.30, P<.05), but not PCS or MCS. Mini-Mental State Examination scores were not related to outcome variables. Current findings suggest that patients with poorer executive functioning derive reduced benefit from CR. CR programs may consider screening patients at baseline for low cognitive functioning to help identify those patients at greatest risk for poor outcome.
authors.affiliation: Department of Psychology, Kent State University, Kent, OH 44242, USA. lreese3@kent.edu
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Kakos
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Szabo
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Stanek
authors.forename: Donna
authors.initials: D
authors.lastname: Waechter
authors.forename: Joel
authors.initials: J
authors.lastname: Hughes
authors.forename: Faith
authors.initials: F
authors.lastname: Luyster
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.forename: Jim
authors.initials: J
authors.lastname: Rosneck
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers; D003071:Cognition; D003072:Cognition Disorders / Q000523:psychology*; D003324:Coronary Artery Disease / Q000523:psychology / Q000534:rehabilitation*; D005080:Exercise Test; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D011932:Reading; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers