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

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

Authors

Claire Taylor c.l.taylor@leedsbeckett.ac.uk

Costas Tsakirides

James Moxon

James W. Moxon

Michael Dudfield

Klaus Witte

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 1993 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 hazard ratio: 0.67; 95% confidence interval: 0.47 to 0.97; p=0.033) compared to 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.

Journal Article Type Article
Publication Date Jul 1, 2017
Journal Open heart
Electronic ISSN 2053-3624
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 4
Issue 2
Pages e000623
Institution Citation Taylor, C., Tsakirides, C., Moxon, J., Moxon, J. W., Dudfield, M., Witte, K., …Carroll, S. (2017). Exercise dose and all-cause mortality within extended cardiac rehabilitation: a cohort study. Open heart, 4(2), e000623. https://doi.org/10.1136/openhrt-2017-000623
DOI https://doi.org/10.1136/openhrt-2017-000623
Keywords Survival, Submaximal exercise testing, Fitness, Exercise volume
Publisher URL http://openheart.bmj.com/content/4/2/e000623
Copyright Statement © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Additional Information Copy of article first published in: Open heart, v.4, issue 2

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Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/




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