by Jeff Bendix

Even patients recovering from heart attacks and other serious cardiovascular problems have trouble maintaining a regular exercise program, according to researchers at Case Western Reserve University's Frances Payne Bolton School of Nursing.

Shirley M. Moore

In a study of 83 patients who had heart attacks, bypass surgery or angioplasty (a technique to clear clogged blood vessels), researchers found that after completing a formal cardiac rehabilitation program 12 patients (14 percent) did not exercise at all over the next year. In addition, the number of people exercising, and their exercise frequency and intensity, all decreased in the 12 months following cardiac rehabilitation.

"It is critical that we work with these people to find out why there is such a drop-off," said Shirley M. Moore, lead author of the study and associate dean for research at the Bolton School. "Either they don't understand what is considered aerobic exercise, or we've designed a program for them that's so uncomfortable that they're not doing it."

Moore and colleagues followed 28 women and 55 men of an average age of 62. After completing a standard 12-week cardiac rehabilitation program, patients were given heart rate monitors and instructed to wear them during exercise sessions over the next 12 months. Researchers asked them to exercise most days of the week for 35 to 45 minutes per session, recording their activity in a diary.

Though the duration of an exercise session remained constant at 48 minutes over the year, there were drop-offs in other exercise patterns measured:

• The number of people not exercising in a given month increased from 15 people (18 percent) in the first month to 46 people (55 percent) in the 12th month.

• The frequency of exercise per month decreased from 10.4 sessions in Month 1 to 5.7 sessions in Month 12.

• The amount of exercise decreased from 8.7 hours in the first month to 5.3 hours in the last month.

• The average percent of time that a participant spent in the targeted heart rate zone
(a sign of a good workout for the heart) decreased from 34.3 percent to 28.2 percent over the year.

Moore said she is familiar with patients' usual reasons for not exercising, and older women generally are not big exercisers to begin with.

"They're not used to sweating. To them it's not equated to health," she said.

For men, time can be an issue. Others think they're "macho" enough that they will overcome the health issues on their own or they may be in denial that there is a problem at all, according to Moore. Generally, when men stop participating in organized sports teams, they tend to not exercise.

"Still," she said, considering the severity of their illness, "the group that didn't exercise at all is a bit of a shock to us."

Moore is looking into establishing a program of "booster doses" of cardiac rehabilitation, where patients can return every two months for follow-up.

The research findings were presented recently at the annual meeting of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) in Kansas City.

Study co-authors from the Bolton School are Jacqueline M. Charvat, Beverly L. Roberts and Mary A. Dolansky. They were joined by Paul M. Ribisl from Wake Forest University.

Return to the online edition of the 11-6-03 Campus News.

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