Cardiac rehabilitation in obese patients: a population at increased risk
Authors: Raposo M , Abrantes A , Cravo J , Afonso G , Araujo G , Correia S , Costa J , Oliveira C , Garcia A , Martins M , Gregorio C , Cunha N , Ricardo I , Pinto F J , Abreu A 
Published: June 2024

Abstract

Introduction
Cardiac rehabilitation (CR) is a cornerstone in cardiovascular patient’s (pts) treatment. Pts with obesity face elevated cardiovascular risk and warrant meticulous integration into these programs. Moreover, it has been suggested that standard CR guidelines may not be optimal for obese patients and further studies are needed to better understand obese patients adherence and CR efficacy.

Purpose
To evaluate adherence and efficacy of CR program in obese pts when compared to non-obese pts.

Methods
Single center retrospective study of consecutive pts referred to a center-based CR program from 2015 to April 2023. The CR program was conducted 2 or 3 times per week, the exercise training session lasts 60 mins (aerobic and resistance training) plus 60 minutes of respiratory session. Obesity was defined as BMI ≥ 30 kg/m2 and control as BMI &lt;30 kg/m2. Adherence was evaluated as percentage of programmed sessions attended and efficacy as reduction in cardiovascular risk factors or improvement of cardiopulmonary exercise test (CPET) parameters after the CR program. Parametric and non-parametric tests were applied as adequate.

Results
We included 446 pts, 23% obese, of these 6% had BMI &gt;35 kg/m2 and 5 pts BMI &gt;40 kg/m2. In obese pts 73% were male, mean age 50 years, 72% had dyslipidemia, 56% had smoking habits. Obese pts presented an 80% increased odd of hypertension and 90% odd of diabetes when compared to non-obese pts (81% vs 71%, OR 1.8 CI 1.1-3.2; 36% vs 23%, OR 1.9 CI 1.2-3; respectively). The majority of pts completed the program with 98% [MP1] adherence, with median number of exercise sessions completed of 12±4, with no differences between groups. After completing the CR program obese pts presented a significant improvement in NYHA functional class (p&lt;0.001), cardiovascular risk factors (weight:95±12 kg vs 94±12 kg p=0.035, abdominal perimeter: 113vs108 p=0.009, cLDL75 ± 69vs 56±33 p=0.002, HgA1C 6.5±1.2vs6±0.5 p=0.04) and improvement of functional capacity (peak VO2 14.6 vs 16.5ml/kg/min, p=0.008; %of predicted VO2peak 59 vs 65% p=0.009; O2pulse 11vs12.4 p=0.003; CPET time 8vs10 min, p=&lt;0.00). Obese pts showed a significantly higher weight, abdominal perimeter and BMI reduction when compared to control (1.4±4vs0.5±3kg p&lt;0.001, 2±4vs0.5±4 cm, p=0.02, 1±2 vs0.1±1 points, p=&lt;0.001 respectively[MP4] ). In obese pts both METs and percentage of predicted peak O2 positively correlated with distance in 6MWT, with a strongest correlation for METs (rs44%, p&lt;0.001, rs57%, p&lt;0.001, respectively). Regarding phase 3, 46% of obese pts joined a supervised program, 12% enrolled in a fitness center and 42% failed to maintain an activity regime.

Conclusion
Obese patients demonstrated comparable adherence to the program and exhibited equivalent, or in some cases, superior efficacy in terms of cardiovascular risk control compared to those without obesity.