Men At Highest Risk Least Likely to Comply with Post-Heart-Attack Exercise Program, UB Study Finds

By Lois Baker

Release Date: June 4, 1999 This content is archived.

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SEATTLE -- Men recovering from a heart attack who are at the highest risk of a second attack and thus would benefit most from conscientious participation in an exercise program are the least likely to do so, a University at Buffalo study has found.

Results of the study, presented here today (June 4, 1999) at the annual meeting of the American College of Sports Medicine, showed that heart attack survivors who were least likely to take part in a prescribed exercise rehabilitation program tended to be overweight, have high cholesterol and triglyceride levels and smoke tobacco.

"The dropout rate in cardiac rehabilitation is a huge problem," said Joan Dorn, Ph.D., assistant professor of social and preventive medicine in the UB School of Medicine and Biomedical Sciences and lead author on the study. "It is important to find out who is likely to drop out and how we can target them, so we can find ways to keep them involved.

"We found that the people who were at the most risk were the ones who attended least. Not only were these men in trouble already because of their cardiac risk factors, they compounded the risk by not participating regularly in the exercise program."

The research involved 308 of the 651 participants in the National Exercise and Heart Disease Project (NEHDP), a three-year, multicenter, randomized, clinical trial conducted in the U.S. from 1976-79. John P. Naughton, M.D., UB professor of medicine and former dean of the UB medical school, directed the trial.

Prescribing exercise after a heart attack was considered revolutionary 25 years ago. The NEHDP trial was designed to determine if a structured exercise program could improve long-term survival.

Participants in this study, all men between the ages of 30 and 64, were randomly assigned to take part in a structured cardiac-rehabilitation exercise program. This "treatment" group first exercised for eight weeks in a laboratory setting and then began the full rehabilitation program, involving jogging, cycling or swimming at a targeted heart rate three times a week.

Before being enrolled, and at every six months in the three-year trial, participants received a physical examination, performed an exercise test on a treadmill, and answered questions about their lifestyle.

Dorn found that men with a higher work capacity, higher peak heart rate, and higher HDL were more likely to stay with the exercise program. They also tended to be older than those who dropped out of the program.

Those who stopped exercising were more likely to be overweight, have higher total cholesterol and triglycerides and a higher depression score. Smokers were significantly less compliant than non-smokers.

Dorn said the findings may indicate that this program asked too much, too soon.

"The preliminary sessions were low intensity, but the actual program was based on getting the heart rate up to a predetermined target at each grade," she noted. "Maybe we should consider easing people into a cardiac-rehabilitation program more slowly."

Also participating in this research were Naughton; Dai Imamura, a Ph.D. candidate, and Maurizio Trevisan, M.D., professor and chair in the Department of Social and Preventive Medicine.

The research was funded by grants from the National Institutes of Health and the Rehabilitation Services Administration of the former Department of Health, Education and Welfare.