SPC365

Cardiac Rehabilitation in obese patients: a population at increased risk

Session: SESSÃO DE POSTERS 09 - OBESIDADE E HIPERTENSÃO: VELHOS CONHECIDOS, NOVAS FERRAMENTAS
Speaker: João Pedro Dantas Martins Neves

Congress: CPC 2025
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Cartazes
FP Number: ---
Authors: João Martins Neves; Miguel Azaredo Raposo; Ana Abrantes; Catarina Gregório; João Fernandes Pedro; Gisela Afonso; Graça Araújo; Sandra Miguel Correia; Nelson Cunha; Inês Aguiar-Ricardo; Fausto J. Pinto; Ana Abreu
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Cardiac rehabilitation (CR) is a cornerstone in cardiovascular patients&#39;&nbsp;treatment. Patients 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.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To evaluate adherence and efficacy of CR program in obese patients when compared to non-obese patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Single center retrospective study of consecutive patients 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 &ge;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.</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> We included 446 patients, 23% obese, of these 6% had BMI &gt;35 kg/m2 and 5 patients BMI &gt;40 kg/m2. In obese patients 73% were male, mean age 50</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> years,</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> 72% had dyslipidemia, 56% had smoking habits. Obese patients had an 80% increased odd of hypertension and 90% odd of diabetes when compared to non-obese patients (81% vs 71%, OR 1.8 CI 1.1-3.2; 36% vs 23%, OR 1.9 CI 1.2-3; respectively). Most&nbsp;patients completed the program with 98%</span></span></span><span style="font-size:8pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">adherence, with median number of exercise sessions completed of 12&plusmn;4, with no differences between groups. After completing the CR program obese paients presented a significant improvement in NYHA functional class (p&lt;0.001), cardiovascular risk factors (weight:95&plusmn;12 kg vs 94&plusmn;12 kg p=0.035, abdominal perimeter: 113vs108 p=0.009, cLDL75 &plusmn; 69vs 56&plusmn;33 p=0.002, HgA1C 6.5&plusmn;1.2vs6&plusmn;0.5 p=0.04)&nbsp; 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 patients showed a significantly higher weight, abdominal perimeter and BMI reduction when compared to control (1.4&plusmn;4vs0.5&plusmn;3kg p&lt;0.001, 2&plusmn;4vs0.5&plusmn;4 cm, p=0.02, 1&plusmn;2 vs0.1&plusmn;1 points, p=&lt;0.001 respectively</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">). In obese patients both METs and percentage of predicted peak O2 positively correlated with distance in 6MWT, with a strongest correlation for METs (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">r</span></span></span><span style="font-size:7pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">s</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">44%, p&lt;0.001, </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">r</span></span></span><span style="font-size:7pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">s</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">57%, p&lt;0.001, respectively). Regarding phase 3, 46% of obese patients joined a supervised program, 12% enrolled in a fitness center and 42% failed to maintain an activity regime.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> 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.</span></span></span></p>