Predictive factors of cardiac rehabilitation's failure in patients undergoing a continuous endurance training program.A retrospective study

Abstract

Cardiac rehabilitation is one of the most important parts for the management of cardiovascular patients. It includes endurance and resistance training, therapeutic optimization and a structured therapeutic education program. The aim of this study was to determine predictive factors associated with failure of continuous endurance training program. From December 2015 to November 2016, 235 patients entered a cardiac rehabilitation program in Reims hospital. They all practiced the same continuous endurance training program on bicycles and participated to at least 10 of the 20 sessions prescribed. Continuous endurance training program failure was defined by a progression inferior to 1 metabolic equivalent (1 MET) between initial and final exercise stress tests. For this period, 169 patients were included. In total, 41.4% patients improved their functional capacities of 1 MET at least and mean improvement was 0.88 ± 0,74 MET. In univariate analysis, the fifth training session was associated with program failure ( P = 0.005) and was also the best one to discriminate a failure at the end of the program Area Under ROC Curve: 0.635 ± 0.043 [ P = 0.003; CI95% (0.551; 0.720)]. Failure was also associated with diabetes ( P = 0.02) and chronic obstructive pulmonary disease (COPD) ( P = 0.001). In multivariate analysis, each 10 watts step improvement between the first and the fifth session reduced the risk of failure of 20% [ P = 0.033; OR 0.807; CI95% (0.663; 0.983)]. As well, diabetes multiplied the risk of failure by two [ P = 0.046; OR 2.084; CI95% (1.012; 4.293)]. The fifth training session, diabetes and COPD were associated with continuous endurance training program failure. Moreover, it could exist an inverse proportional relationship between functional capacity improvement from the first to the fifth session and the risk of failure. According to these results, we could provide a more adjusted endurance training program for these patients.