Functional improvement of older outpatients with acute coronary syndrome after one year of exercise-based secondary prevention program

INTRODUCTION: Among cardiovascular diseases, acute coronary syndrome (ACS) remains the leading cause of morbidity and mortality. Cardiac rehabilitation and secondary prevention programs make significant contributions to the continuum of care in patients, and physical activity has been recognized as core part of such interventions. However, despite the documented benefits, older patients diagnosed with acute coronary syndrome (ACS) are less likely to attend traditional center-based programs limiting the efficacy of the intervention. This situation has emphasized the importance of more comprehensive and sustainable intervention strategies. Thus, the aim of the study was to examine functional changes of older patients with ACS involved in a center- and home-based secondary prevention program after one year of intervention. METHODS: A subsample of 254 consecutive patients (mean age 75 years) with ACS extracted from the ITER registry (NCT05817305) was analyzed. The proposed intervention program consisted of 6 individual on-site sessions including functional evaluation along with continuous motivational reinforcement to reach exercise goals and stably maintain an active lifestyle. The home-based exercise prescription was based on the results of the validated 1km-Treadmill Walking Test. Functional variables were assessed during each visit. Main outcomes were changes in self-reported weekly physical activity, average walking speed (WS) registered during the test and estimated cardiorespiratory fitness (VO2peak). RESULTS: Physical activity levels significantly increased and were maintained during the follow-up period (median METh/week 3.0, 12.0, and 9.0 at baseline, 6-, and 12 months, respectively; p<0.0001). These results were associated with increasing mean WS (2.9, 3.9, 4.1 km/h, respectively, p<0.0001), and VO2peak (16.9, 20.0, 20.5 mL/kg/min, respectively, p<0.0001). CONCLUSION: The proposed intervention demonstrated a stable adherence to physically active lifestyle, along with improved walking capacity and estimated VO2peak in older patients with ACS. Results therefore highlight the importance of exercise testing and training in older patients and the effectiveness of the program. This may provide valuable insights for the development of more efficient and patient-centered exercise-based secondary prevention programs.