Download PDF
CC BY 4.0 · Int J Sports Med 2024; 45(01): 63-70
DOI: 10.1055/a-2161-4137
Clinical Sciences

Elective Cardiac Procedure Patients Have Low Preoperative Cardiorespiratory Fitness

Sini Vasankari 
1   Clinical Medicine, University of Turku Faculty of Medicine, Turku, Finland
,
Visa Mahlamäki
2   Heart Center, Kuopio University Hospital, Kuopio, Finland
,
Juha Hartikainen
2   Heart Center, Kuopio University Hospital, Kuopio, Finland
3   Clinical Medicine, University of Eastern Finland – Kuopio Campus, Kuopio, Finland
,
Ville Vasankari
4   Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
,
Kari Tokola
5   UKK Institute, UKK Institute, Tampere, Finland
,
Henri Vähä-Ypyä
5   UKK Institute, UKK Institute, Tampere, Finland
,
Vesa Anttila
6   Heart Center, TYKS Turku University Hospital, Turku, Finland
,
Pauliina Husu
5   UKK Institute, UKK Institute, Tampere, Finland
,
Harri Sievänen
5   UKK Institute, UKK Institute, Tampere, Finland
,
Tommi Vasankari  ‡
5   UKK Institute, UKK Institute, Tampere, Finland
7   Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
,
Jari Halonen‡
2   Heart Center, Kuopio University Hospital, Kuopio, Finland
3   Clinical Medicine, University of Eastern Finland – Kuopio Campus, Kuopio, Finland
› Author Affiliations Funding Information Sydäntutkimussäätiö — http://dx.doi.org/10.13039/501100005633; Research Foundation of North Savo Hospital District — Yrjö Jahnssonin Säätiö — http://dx.doi.org/10.13039/100010114; 6992 Opetus- ja Kulttuuriministeriö — http://dx.doi.org/10.13039/ 501100003126; Academy of Finland (decision nro 356156)
› Further Information
Also available at
   Permissions and Reprints

Abstract

Preoperative cardiorespiratory fitness may influence the recovery after cardiac procedure. The aim of this study was to investigate the cardiorespiratory fitness of patients scheduled for elective cardiac procedures, using a six-minute walk test, and compare the results with a population-based sample of Finnish adults. Patients (n=234) awaiting percutaneous coronary intervention or coronary angiography, coronary artery bypass grafting, aortic valve replacement or mitral valve surgery performed the six-minute walk test. VO2max was calculated based on the walk test. The patients were compared to a population-based sample of 60–69-year-old Finnish adults from the FinFit2017 study. The mean six-minute walk test distances (meters) and VO2max (ml/kg/min) of the patient groups were: 452±73 and 24.3±6.9 (coronary artery bypass grafting), 499±84 and 27.6±7.2 (aortic valve replacement), 496±85 and 27.4±7.3 (mitral valve surgery), and 519±90 and 27.3±6.9 (percutaneous coronary intervention or coronary angiography). The population-based sample had significantly greater walk test distance (623±81) and VO2max (31.7±6.1) than the four patient groups (all p-values<0.001). All patient groups had lower cardiorespiratory fitness than the reference population of 60–69-year-old Finnish adults. Particularly the coronary artery bypass grafting group had a low cardiorespiratory fitness, and therefore might be prone to complications and challenging rehabilitation after the operation.

Key words

aortic valve disease - coronary artery disease - mitral valve insufficiency - physical activity

Supplementary Material



Publication History

Received: 17 December 2023

Accepted: 28 August 2023

Accepted Manuscript online:
28 August 2023

Article published online:
06 October 2023

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Roth GA, Abate D, Abate KH. et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736-1788
    CrossrefPubMedGoogle Scholar
  • 2 Roth GA, Johnson C, Abajobir A. et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70: 1-25
    CrossrefPubMedGoogle Scholar
  • 3 James SL, Abate D, Abate KH. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global burden of disease study 2017. Lancet 2018; 392: 1789-1858
    CrossrefPubMedGoogle Scholar
  • 4 Yadgir S, Johnson CO, Aboyans V. et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation 2020; 141: 1670-1680
    CrossrefPubMedGoogle Scholar
  • 5 Ferket BS, Oxman JM, Iribarne A. et al. Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies. J Thorac Cardiovasc Surg 2018; 155: 1671-1681.e11.
    CrossrefPubMedGoogle Scholar
  • 6 Ekblom-Bak E, Hellénius ML, Ekblom Ö. et al. Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults. Eur J Cardiovasc Prev Rehabil 2010; 17: 175-180
    CrossrefPubMedGoogle Scholar
  • 7 DeFina LF, Haskell WL, Willis BL. et al. Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health?. Prog Cardiovasc Dis 2015; 57: 324-329
    CrossrefPubMedGoogle Scholar
  • 8 Blair SN, Kampert JB, Kohl HW. et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276: 205-210
    CrossrefPubMedGoogle Scholar
  • 9 Kodama S, Saito K, Tanaka S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA 2009; 301: 2024-2035
    CrossrefPubMedGoogle Scholar
  • 10 Smith JL, Verrill TA, Boura JA. et al. Effect of cardiorespiratory fitness on short-term morbidity and mortality after coronary artery bypass grafting. Am J Cardiol 2013; 112: 1104-1109
    CrossrefPubMedGoogle Scholar
  • 11 Bittner V, Weiner DH, Yusuf S. et al. Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. JAMA 1993; 270: 1702-1707
    CrossrefPubMedGoogle Scholar
  • 12 Rostagno C, Gensini GF. Six minute walk test: A simple and useful test to evaluate functional capacity in patients with heart failure. Intern Emerg Med 2008; 3: 205-212
    CrossrefPubMedGoogle Scholar
  • 13 de Arenaza DP, Pepper J, Lees B. et al. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart 2010; 96: 113-117
    CrossrefPubMedGoogle Scholar
  • 14 Mänttäri A, Suni J, Sievänen H. et al. Six-minute walk test: a tool for predicting maximal aerobic power (VO2max) in healthy adults. Clin Physiol Funct Imaging 2018; 38: 1038-1045
    CrossrefPubMedGoogle Scholar
  • 15 Chen YC, Chen KC, Lu LH. et al. Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery: A prospective cohort study. Medicine (Baltimore) 2018; 97: e12925
    CrossrefPubMedGoogle Scholar
  • 16 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: Developed with the special contribution of the European association for cardiovascular prevention & rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23: NP1-NP96
    PubMedGoogle Scholar
  • 17 Chomistek AK, Manson JE, Stefanick ML. et al. Relationship of sedentary behaviour and physical activity to incident cardiovascular disease: Results from the women’s health initiative. J Am Coll Cardiol 2013; 61: 2346-2354
    CrossrefPubMedGoogle Scholar
  • 18 van Laar C, TImman ST, Noyez L. Decreased physical activity is a predictor for a complicated recovery post cardiac surgery. Health Qual Life Outcomes 2017; 15: 5
    CrossrefPubMedGoogle Scholar
  • 19 Noyez L, Biemans I, Verkroost M. et al. Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?. Neth Heart J 2013; 21: 439-445
    CrossrefPubMedGoogle Scholar
  • 20 Laukkanen JA, Kurl S, Salonen R. et al. The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: A prospective population-based cohort study. Eur Heart J 2004; 25: 1428-1437
    CrossrefPubMedGoogle Scholar
  • 21 Dibben GO, Faulkner J, Oldridge N. et al. Exercise-based cardiac rehabilitation for coronary heart disease: A meta-analysis. Eur Heart J 2023; 44: 452-469
    CrossrefPubMedGoogle Scholar
  • 22 Vasankari S, Hartikainen J, Vasankari V. et al. Objectively measured preoperative physical activity and sedentary behaviour among Finnish patients scheduled for elective cardiac procedures: baseline results from randomized controlled trial. BMC Sports Sci Med Rehabil 2022; 14: 130
    CrossrefPubMedGoogle Scholar
  • 23 Vasankari V, Halonen J, Husu P. et al. Personalised eHealth intervention to increase physical activity and reduce sedentary behaviour in rehabilitation after cardiac operations: study protocol for the PACO randomised controlled trial (NCT03470246). BMJ Open Sport Exerc Med 2019; 5: e000539
    CrossrefPubMedGoogle Scholar
  • 24 Husu P, Tokola K, Vähä-Ypyä H. et al. Physical activity, sedentary behavior and time in bed among Finnish adults measured 24/7 by tri-axial accelerometry. J Meas Phys Behav 2021; 4: 163-173
    CrossrefPubMedGoogle Scholar
  • 25 ATS committee on proficiency standards for clinical pulmonary function laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111-117
    CrossrefPubMedGoogle Scholar
  • 26 Vähä-Ypyä H, Vasankari T, Husu P. et al. A universal, accurate intensity-based classification of different physical activities using raw data of accelerometer. Clin Physiol Funct Imaging 2015; 35: 64-70
    CrossrefPubMedGoogle Scholar
  • 27 Vähä-Ypyä H, Vasankari T, Husu P. et al. Validation of cut-points for evaluating the intensity of physical activity with accelerometry-based mean amplitude deviation (MAD). PLoS One 2015; 10: e0134813
    CrossrefPubMedGoogle Scholar
  • 28 Strath SJ, Kaminsky LA, Ainsworth BE. et al. Guide to the assessment of physical activity: Clinical and research applications: A scientific statement from the American heart association. Circulation 2013; 128: 2259-2279
    CrossrefPubMedGoogle Scholar
  • 29 Tremblay MS, Aubert S, Barnes JD. et al. Sedentary behavior research network (SBRN) – Terminology consensus project process and outcome. Int J Behav Nutr Phys Act 2017; 14: 75
    CrossrefPubMedGoogle Scholar
  • 30 Vähä-Ypyä H, Husu P, Suni J. et al. Reliable recognition of lying, sitting, and standing with a hip-worn accelerometer. Scand J Med Sci Sports 2018; 28: 1092-1102
    CrossrefPubMedGoogle Scholar
  • 31 Vasankari V, Husu P, Vähä-Ypyä H. et al. Association of objectively measured sedentary behaviour and physical activity with cardiovascular disease risk. Eur J Prev Cardiol 2017; 24: 1311-1318
    CrossrefPubMedGoogle Scholar
  • 32 Steinmetz C, Bjarnason-Wehrens B, Baumgarten H. et al. Prehabilitation in patients awaiting elective coronary artery bypass graft surgery - effects on functional capacity and quality of life: a randomized controlled trial. Clin Rehabil 2020; 34: 1256-1267
    CrossrefPubMedGoogle Scholar
  • 33 Waite I, Deshpande R, Baghai M. et al. Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery. J Cardiothorac Surg 2017; 12: 91
    CrossrefPubMedGoogle Scholar
  • 34 Marcin T, Eser P, Prescott E. et al. Predictors of pre-rehabilitation exercise capacity in elderly European cardiac patients - The EU-CaRE study. . Eur J Prev Cardiol 2020; 27: 1702-1712
    CrossrefPubMedGoogle Scholar
  • 35 Vaara JP, Vasankari T, Wyss T. et al. Device-based measures of sedentary time and physical activity are associated with physical fitness and body fat content. Front Sports Act Living 2020; 2: 587789
    CrossrefPubMedGoogle Scholar
  • 36 Vähä-Ypyä H, Sievänen H, Husu P. et al. Intensity paradox-low-fit people are physically most active in terms of their fitness. Sensors (Basel) 2021; 21: 2063
    CrossrefPubMedGoogle Scholar
  • 37 Piercy KL, Troiano RP, Ballard RM. et al. The physical activity guidelines for Americans. JAMA 2018; 320: 2020-2028
    CrossrefPubMedGoogle Scholar
  • 38 US department of health and human services. 2008 physical activity guidelines for Americans. https://health.gov/our-work/physical-activity/previous-guidelines/2008-physical-activity-guidelines; Accessed: 8 July 2022
    PubMed
  • 39 Hukkanen H, Husu P, Sievänen H. et al. Aerobic physical activity assessed with accelerometer, diary, questionnaire, and interview in a Finnish population sample. Scand J Med Sci Sports 2018; 28: 2196-2206
    CrossrefPubMedGoogle Scholar