Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial

Correspondence to Dr Gianluca Campo, Medical Sciences, Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona (FE), Italy; [email protected]

Introduction

The benefits of regular physical activity are well-recognised in the secondary prevention of cardiovascular disease.¹ However, the use of exercise as part of regular treatment in healthcare vary largely.¹ In recent years, the average age of patients admitted to the hospital for acute coronary syndromes (ACS) has significantly increased.² Older patients with ACS show the highest risk of mobility limitation, sedentary behaviour and physical inactivity, further worsening short-term and mid-term prognosis.^{2 3} Previous studies showed that traditional centre-based cardiac rehabilitation programmes effectively improve physical performance and outcomes after ACS. However, in most cases older patients with ACS are less likely to be referred to or to participate in such programmes. Therefore, the implementation and maintenance of physical activity in this high-risk subgroup of patients is still an unmet clinical need.⁴ To fill this gap, we designed the Physical Activity Intervention for Elderly Patients with Reduced Physical Performance after ACS (HULK) trial.⁵ In this study, an early, individualised and progressive, low-cost exercise intervention including few supervised sessions and home-based exercises was assessed and compared with a health education strategy.⁵ We found that the proposed exercise intervention was associated with a high attendance rate and with significant increase in the time engaged in PA and the values of short physical performance battery (SPPB).⁶

The purpose of the present analysis from the HULK study was to assess additional differences in terms of physical performance, activities of daily living, anxiety, depression, quality of life and adverse events in the study groups.

Methods

Study design

The HULK study was a multicentre, investigator-driven, randomised clinical trial conducted at three sites across the Emilia-Romagna region (Italy).⁵ A detailed study outline, a list of the criteria used for inclusion or exclusion in the study and definitions of end points have been previously published.⁵

Study population

The main inclusion criteria were: i) age ≥70 years; ii) hospital admission for ACS and iii) SPPB score from 4 to 9 at the inclusion visit (30±5 days after hospital discharge). In agreement with previous studies, we excluded patients with values ≥10 because they were considered to have exceptional...