title: Exercise adherence in the elderly: Experience with abdominal aortic aneurysm simple treatment and prevention.
abstract: Poor adherence to health-related behaviors can have serious health consequences. Cardiac rehabilitation has been documented to have physiological and psychosocial benefits; however, optimizing adherence to exercise in patients with cardiovascular disease is a particular challenge. We recently completed a large, 6-year randomized trial of exercise training in elderly patients with abdominal aortic aneurysm (AAA) disease (50-85 years), which provided an opportunity to describe adherence strategies in this unique group of elderly individuals. Patients were randomized to exercise therapy or usual care. Using a case-management approach, a combination of center and home-based training was used during which patients trained for up to 3 years. We observed that overall, 84% of subjects in the exercise group completed ≥1 year in the study, achieving a mean energy expenditure of 1,999 ± 1,030 kcals per week. Subjects in the exercise group were more likely to drop out of the study as compared with usual care, though none of the reasons for dropping out were associated with exercise participation (eg, exercise-related injury). Reasons for withdrawal included orthopedic problems, lost physician coverage, time constraints, and AAA repair. Although the groups were matched for AAA size at baseline, there was a trend for more AAA repairs among usual care subjects versus those in the exercise group (12 [17.6%] vs 5 [6.9%], P = 0.09). The case-managed approach to optimizing adherence used was reasonably successful in achieving a training response (ie, improvement in exercise capacity) in elderly patients with AAA, a group for whom little is previously known regarding the effects of rehabilitation.
authors.affiliation: Cardiology Division, Veterans Affairs Palo Alto Health Care System; Stanford University, Stanford, CA. Electronic address: Mary.McElrath@va.gov.
authors.forename: Mary
authors.initials: M
authors.lastname: McElrath
authors.affiliation: Cardiology Division, Veterans Affairs Palo Alto Health Care System; Stanford University, Stanford, CA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.affiliation: Cardiology Division, Veterans Affairs Palo Alto Health Care System; Stanford University, Stanford, CA.
authors.forename: Khin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Cardiology Division, Veterans Affairs Palo Alto Health Care System; Stanford University, Stanford, CA.
authors.forename: Holly
authors.initials: H
authors.lastname: Fonda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000517:prevention & control / Q000601:surgery*; D000072038:Cardiac Rehabilitation / Q000379:methods / Q000523:psychology*; D005081:Exercise Therapy / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome