title: Supervised versus non-supervised exercise in patients with recent myocardial infarction: A propensity analysis.
abstract: BACKGROUND
  The influence of supervised versus non-supervised exercise training on outcome in patients with a recent myocardial infarction (MI) is controversial.
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  FRENA is an ongoing registry of stable outpatients with symptomatic coronary, cerebrovascular or peripheral artery disease. We compared the rate of subsequent ischaemic events (MI, ischaemic stroke or lower limb amputation) and the mortality rate in patients with recent MI, according to the use of supervised versus non-supervised exercise training. The influence of physical activity on outcomes was estimated by using propensity score method in multivariate analysis.
  
  
  RESULTS
  As of February 2014, 1124 outpatients with recent MI were recruited, of whom 593 (53%) participated in a supervised exercise training programme. Over a mean follow-up of 15 months, 25 patients (3.3%) developed 26 subsequent ischaemic events - 24 MI, one stroke, one lower-limb amputation - and 12 (1.6%) died. The mortality rate (0.15 vs. 2.89 deaths per 100 patient-years; rate ratio = 0.05; 95% confidence interval, 0.01-0.39) was significantly lower in supervised exercise than in non-supervised exercise patients. On propensity score analysis, the rate of the composite outcome was significantly lower in supervised exercise patients (1.80 vs. 6.51 events per 100 patient-years; rate ratio = 0.28; 95% confidence interval, 0.12-0.64).
  
  
  CONCLUSIONS
  The use of supervised exercise training in patients with recent MI was associated with a significant decrease in the composite outcome of subsequent ischaemic events and death.
authors: Department of Physical Medicine and Rehabilitation, Hospital Universitari Parc Taulí Sabadell, Spain Universitat Autònoma de Barcelona, Spain coll.roser@gmail.com.
authors: Roser
authors: R
authors: Coll-Fernández
authors: Department of Physical Medicine and Rehabilitation, Hospital Universitari Germans Trias i Pujol, Spain.
authors: Ramon
authors: R
authors: Coll
authors: Department of Internal Medicine, Hospital San Pedro de Alcántara, Spain.
authors: Juan F Sánchez
authors: JF
authors: Muñoz-Torrero
authors: Department of Internal Medicine, Hospital de Alcañiz, Spain.
authors: Eduardo
authors: E
authors: Aguilar
authors: Universitat Autònoma de Barcelona, Spain Department of Angiology and Vascular Surgery, Hospital de Terrassa, Spain.
authors: Lorenzo
authors: L
authors: Ramón Álvarez
authors: Department of Internal Medicine, Hospital Municipal de Badalona, Spain.
authors: Joan Carles
authors: JC
authors: Sahuquillo
authors: Department of Angiology and Vascular Surgery, Hospital de Terrassa, Spain.
authors: Montserrat
authors: M
authors: Yeste
authors: Department of Neurology, Hospital San Pedro de Alcántara, Spain.
authors: Pedro Enrique
authors: PE
authors: Jiménez
authors: Department of Internal Medicine, Hospital Universitari Parc Taulí Sabadell, Spain.
authors: Abel
authors: A
authors: Mujal
authors: Universitat Autònoma de Barcelona, Spain Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Spain.
authors: Manuel
authors: M
authors: Monreal
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000534:rehabilitation*; D016017:Odds Ratio; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
keywords: Myocardial infarction; exercise; mortality; propensity score; rehabilitation