[Factors determining the improvement of effort capacity in aged patients with coronary disease during the 1st month following coronary surgery].

UNLABELLED

In order to determine the predictive factors of improvement of the physical capacity of elderly coronary patients following coronary surgery, we retrospectively analysed the data of 204 consecutive patients over the age of 65 years (181 men, 23 women, mean age: 70 +/- 4.4 years), admitted for a phase II active training programme.

METHODS

The patients were divided into two groups as a function of the rate of improvement of the duration of the stress test: group A (improvement greater than or equal to 25%; n = 108) and group B (less than 25%; n = 96). Comparison of these 2 groups by multivariate analysis identified predictive factors of improvement among seven variables: age, sex, excess weight, haemoglobin, number of training sessions, duration of baseline stress test, interval between bypass graft and start of training.

RESULTS

After training, the duration of the stress test and the maximal power were improved by 26.5% and 24%, respectively: 7.1 +/- 1.7 vs 8.9 +/- 2.3 minutes (p = 0.0001); 79 +/- 18.4 vs 97.8 +/- 23.7 watts (p = 0.0001). 34 (1.4%) of the 2,396 training sessions were temporarily interrupted, because of muscle fatigue in 47% of cases. Patients who had readapted before the 15th postoperative day presented fewer incidents: 4.3% vs 13.1%; NS. Only three variables appeared to be predictive of improvement of physical capacity: a duration less than 6 minutes on the baseline stress test (p = 0.0003), more than 12 training sessions (p = 0.0029) and age less than or equal to 70 years (p = 0.014).

CONCLUSION

In elderly subjects undergoing coronary surgery, the improvement of physical capacity is greater the lower the baseline effort, the lower the age-group and the greater the number of training sessions. In the absence of contraindication, it appears justified to include elderly coronary patients in training programmes, even when their baseline effort level appears to be low. This training can be started by the 15th postoperative day.