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Background: Transcatheter aortic valve implantation plays a leading role in the management of aortic stenosis in patients with comorbidities but no data are available about cardiac rehabilitation in these subjects. This study aimed to compare safety and efficacy of an early, exercise-based, cardiac rehabilitation programme in octogenarians after a traditional surgical aortic valve replacement versus transcatheter aortic valve implantation., Methods: Seventy-eight consecutive transcatheter aortic valve implantation patients were studied in order to evaluate the effect of an exercise-based cardiac rehabilitation programme in comparison to 80 of a similar age having surgical aortic valve replacement. Functional capacity was assessed by a 6 min walking test on admission and at the end of the programme. When possible, a cardiopulmonary exercise test was also performed before discharge., Results: The two groups were similar in terms of gender and length of stay in cardiac rehabilitation; as expected, the transcatheter aortic valve implantation group had more comorbidities but no major complications occurred in either group during rehabilitation. All patients enhanced autonomy and mobility and were able to walk at least with the assistance of a stick. In those patients who were able to perform the 6 min walking test, the distance walked at discharge did not significantly differ between the groups (272.7 ± 108 vs. 294.2 ± 101 m, p = 0.42), neither did the exercise capacity assessed by cardiopulmonary exercise test (peak-VO2 12.5 ± 3.6 vs. 13.9 ± 2.7 ml/kg/min, p = 0.16)., Conclusions: Cardiac rehabilitation is feasible, safe and effective in octogenarian patients after transcatheter aortic valve implantation as well as after traditional surgery. An early cardiac rehabilitation programme enhances independence, mobility and functional capacity and should be highly encouraged., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: An abnormal glucose tolerance (AGT) in coronary artery disease (CAD) patients could negatively influence recovery after an acute event but the question, relevant in the field of cardiac rehabilitation (CR), is still controversial., Design: Prospective study, aiming to establish the prevalence of AGT and its possible influence on functional recovery in CAD patients without a previous diagnosis of diabetes mellitus (DM)., Methods: An oral glucose tolerance test was performed on 230 CAD patients without known DM, submitted to a 2-week period of intensive exercise-based CR after a recent acute myocardial infarction or coronary artery bypass graft. Functional capacity was assessed by a cardiopulmonary exercise test (CPET) and by 6-minute walking tests (6MWT) performed both on admission and at discharge., Results: The prevalence of AGT in our population was 53%. Exercise capacity was lower in AGT patients (maximum workload achieved at CPET 79.3 ± 29.9 vs. 91.8 ± 36.9 W, p = 0.01; peak-VO(2) 17.8 ± 4.7 vs. 19.8 ± 5.6 ml/kg/min, p = 0.01). In the subgroup of AGT patients characterized by an inferior walking capacity at baseline, the increment in the distance walked was less than in the controls (Δ6MWT: 81.9 ± 60.1 vs. 109.1 ± 72.1, p = 0.04). An independent, negative, association was observed between AGT and Δ6MWT in patients with lower baseline test, and between maximum workload and peak-VO(2) in the whole population., Conclusions: A high prevalence of AGT was observed in a population of CAD patients without known DM after an acute coronary event. AGT is associated to a lower functional recovery, and to a reduced exercise capacity at the end of CR.

Background and Aims: Anemia seems to be rather common in cardiac rehabilitation patients but it is not known whether it could influence cardiovascular performance indexes and prognosis immediately after an acute cardiac event. The purposes of this study were to define its prevalence and to investigate the safety and efficacy of an intensive exercise-based cardiac rehabilitation in patients with and without anemia., Methods: 436 participants (77% males; mean age 64 ± 13 years) were submitted to a two-week cardiac rehabilitation program consisting of low to medium intensity, individualized training with respiratory, aerobic and calisthenic exercises (three sessions daily, six times per week). A six-minute walking test was performed at enrolment and repeated at discharge together with a cardiopulmonary test., Results: Anemia, as defined according to World Health Organization criteria, was detected in 328 patients (75.2% of the entire population). The distance walked increased from 381 ± 117 m at baseline to 457 ± 110 m (p < 0.001) after a mean period of 12.4 ± 4 days. A direct correlation was found between hemoglobin concentrations and both the absolute distance walked (r = 0.48; p < 0.001) and peak VO(2) (r = 0.39; p < 0.001). Anemic patients walked a significantly shorter distance at baseline and at discharge (p < 0.001); however, both groups showed the same increment in the distance walked: 76.0 ± 61 m vs 76.0 ± 60 m (p = 0.99)., Conclusions: Our data indicate: 1) a high prevalence of anemia in the study population and 2) that, in spite of a clear reduction in exercise capacity, a moderate anemia does not preclude increments in cardiac performance during a short period of intensive, exercise-based cardiac rehabilitation.