Exercise dose and all-cause mortality within extended cardiac rehabilitation: a cohort study

Claire Taylor, Costas Tsakirides, James Moxon, James W Moxon, Michael Dudfield, Klaus Witte, Lee Ingle, Sean Carroll, Claire Taylor, Costas Tsakirides, James Moxon, James W Moxon, Michael Dudfield, Klaus Witte, Lee Ingle, Sean Carroll

Abstract

Aims: To investigate the relationship between exercise participation, exercise 'dose' expressed as metabolic equivalent (MET) hours (h) per week, and prognosis in individuals attending an extended, community-based exercise rehabilitation programme.

Methods: Cohort study of 435 participants undertaking exercise-based cardiac rehabilitation (CR) in Leeds, West Yorkshire, UK between 1994 and 2006, followed up to 1 November 2013. MET intensity of supervised exercise was estimated utilising serial submaximal exercise test results and corresponding exercise prescriptions. Programme participation was routinely monitored. Cox regression analysis including time-varying and propensity score adjustment was applied to identify predictors of long-term, all-cause mortality across exercise dose and programme duration groups.

Results: There were 133 events (31%) during a median follow-up of 14 years (range, 1.2 to 18.9 years). The significant univariate association between exercise dose and all-cause mortality was attenuated following multivariable adjustment for other predictors, including duration in the programme. Longer-term adherence to supervised exercise training (>36 months) was associated with a 33% lower mortality risk (multivariate-adjusted HR: 0.67; 95% CI: 0.47 to 0.97; p=0.033) compared with all lesser durations of CR (3, 12, 36 months), even after adjustment for baseline fitness, comorbidities and survivor bias.

Conclusion: Exercise dose (MET-h per week) appears less important than long-term adherence to supervised exercise for the reduction of long-term mortality risk. Extended, supervised CR programmes within the community may play a key role in promoting long-term exercise maintenance and other secondary prevention therapies for survival benefit.

Keywords: exercise volume; fitness; submaximal exercise testing; survival.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Unadjusted Kaplan-Meier plot comparing CR participants dichotomised on the basis of CR exercise dose undertaken (MET-h per week).
Figure 2
Figure 2
Unadjusted Kaplan-Meier plot comparing CR participants stratified by duration in the programme (3,12 and 36 month cutpoints).

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Source: PubMed

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