Gender and age-dependent differences in body composition changes in response to cardiac rehabilitation exercise training in patients after coronary artery bypass grafting

Małgorzata Socha 1  ,  
Department of Human Biology, Faculty of Physiotherapy, University School of Physical Education, Wroclaw, Poland
Faculty of Physical Education and Physiotherapy, University of Technology, Opole, Poland
Ann Agric Environ Med 2017;24(3):517–521
Cardiac rehabilitation (CR) is the standard procedure in persons after coronary artery bypass grafting (CABG). Its basic aim is to combat coronary heart disease (CHD) risk factors through physical activity and normalization of body mass. Many authors highlight the differences in response to training in CR as dependent on gender, age and occurrence of accompanying disease. The aim of this study is to assess the effectiveness of a three-week early CR in reference to changing body composition parameters in patients over 50 years of age. The study involved a random group of 65 patients (44 men and 21 women) between the ages of 50–76 (average: 62.6 ± 7.2) years with CHD following CABG. Anthropometric and body composition (bioelectrical impedance method) measurements were taken at the commencement of CR and after the training programme. After CR, body mass and body mass index were reduced in men < 65 and ≥ 65 years, and in women <65 years. A reduction % body fat and increase % fat free mass and % total body water was observed only in patients <65. years. Furthermore, in men < 65 years, an increase in % body cell mass was observed. In women ≥ 65 years, no statistically significant changes were observed in body fat indices and body composition features between initial and final study. Patients ≥ 65 years of age following surgery over a period of hospital cardiac rehabilitation do not experience the same significant improvement in body composition parameters associated with risk of CHD as middle-aged adults. Older women post-cardiac surgery are characterized by a higher disability index in relation to tolerance to physical stress in comparison with men of the same age and persons < 65 years of age.
Małgorzata Socha   
Department of Human Biology, Faculty of Physiotherapy, University School of Physical Education, Wroclaw, Poland
1. Banasiak W, Pociupany R, Wilkins A, Ponikowski P. Characteristics of patients with coronary artery disease managed on an outpatient basis in the population of Poland. Results of the multicentre RECENT trial. Kardiol Pol. 2007; 65: 132–140.
2. Abramov D, Tamariz MG, Sever JY, Christakis GT, Bhatnagar G, Heenan AL et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg. 2000; 70: 800–805.
3. Rea TD, Heckbert SR, Kaplan RC, Psaty BM, Smith NL, Lemaitre RN et al. Body mass index and the risk of recurrent coronary events following acute myocardial infarction. Am J Cardiol. 2001; 88(5): 467–472.
4. Spies C, Farzaneh-Far R, Na B, Kanaya A, Schiller NB, Whooley MA. Relation of obesity to heart failure hospitalization and cardiovascular events in persons with stable coronary heart disease (from the Heart and Soul Study). Am J Cardiol. 2009;104(7): 883–889.
5. Nicklas BJ, Penninx BW, Cesari M, Kritchevsky SB, Newman AB, Kanaya AM et al. Association of visceral adipose tissue with incident myocardial infarction in older men and women. The health, aging and body composition study. Am J Epidemiol. 2004; 160(8): 741–749. doi: 10.1093/aje/kwh281.
6. Wise FM, Patrick JM. Cardiac rehabilitation outcomes in women with chronic heart failure: mood, fitness, and exercise safety. J Cardiopulm Rehabil Prev. 2012; 32(2): 78–84.
7. Martin BJ, Hauer T, Arena R, Austford LD, Galbraith PD, Lewin AM et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation. 2012; 126(6): 677–687.
8. Evans J, Bethell H, Turner S, Yadegarfar G. Characteristics of patients entering cardiac rehabilitation in the United Kingdom 1993–2006: implications for the future. J Cardiopulm Rehabil Prev. 2012; 31(3): 181–187.
9. Grace SL, Racco C, Chessex C, Rivera T, Oh P. A narrative review on women and cardiac rehabilitation: program adherence and preferences for alternative models of care. Maturitas. 2010; 67(3): 203–208.
10. Daniels KM, Arena R, Lavie CJ, Forman DE. Cardiac rehabilitation for women across the lifespan. Am J Med. 2012; 125(9): 937.e1–7.
11. Herlitz J, Brandrup-Wognsen G, Karlson BW, Sjoland H, Karlsson T, Caidahl K et al. Mortality, risk indicators of death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in men and women. J Intern Med. 2000; 247: 500–506.
12. Rexrode KM, Buring JE, Manson JE. Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obes Relat Metab Disord. 2001; 25(7): 1047–1056.
13. Dobson LE, Lewin RJ, Doherty P, Batin PD, Megarry S, Gale CP. Is cardiac rehabilitation still relevant in the new millennium? J Cardiovasc Med (Hagerstown). 2012; 13(1): 32–37.
14. Listerman J, Bittner V, Sanderson BK, Brown TM. Cardiac rehabilitation outcomes: impact of comorbidities and age. J Cardiopulm Rehabil Prev. 2011; 31(6): 342–348.
15. Hsu CJ, Chen SY, Su S, Yang MC, Lan C, Chou NK et al. The effect of early cardiac rehabilitation on health-related quality of life among heart transplant recipients and patients with coronary artery bypass graft surgery. Transplant Proc. 2012; 43(7): 2714–2717.
16. Oerkild B, Frederiksen M, Hansen JF, Simonsen L, Skovgaard LT, Prescott E. Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial. Age Ageing. 2012; 40(1): 78–85.
17. Frengley JD, Sansone GR, Alba A, Uppal K, Kleinfeld J. Influence of age on rehabilitation outcomes and survival in post-acute inpatient cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2011; 31(4): 230–238.
18. Hausenloy DJ, Boston-Griffiths E, Yellon DM. Cardioprotection during cardiac burgery. Cardiovasc Res. 2012; doi: 10.1093/cvr/cvs131. Epub 2012 Mar 22.
19. Wittmer M, Volpatti M, Piazzalonga S, Hoffmann A. Expectation, satisfaction, and predictors of dropout in cardiac rehabilitation. Eur J Prev Kardiol. 2012; 19(5): 1082–1088.
20. Jegier B, Pietka I, Wojtczak-Soska K, Jaszewski R, Lelonek M. Cardiac rehabilitation after cardiac surgery is limited by gender and length of hospitalisation. Kardiol Pol. 2011; 69(1): 42–46.
21. Grace SL, Gravely-Witte S, Kayaniyil S, Brual J, Suskin N, Stewart DE. A multisite examination of sex differences in cardiac rehabilitation barriers by participation status. J Womens Health (Larchmt). 2009; 18(2): 209–216.
22. Sarrafzadegan N, Rabiei K, Shirani S, Kabir A, Mohammadifard N, Roohafza H. Drop-out predictors in cardiac rehabilitation programmes and the impact of sex differences among coronary heart disease patients in an Iranian sample: a cohort study. Clin Rehabil. 2007; 21(4): 362–372.
23. Czech B, Kucewicz-Czech E, Pacholewicz J, Wojarski J, Puzio J, Przybylski R et al. Early results of coronary artery bypass graft surgery in women. Kardiol Pol. 2007; 65:627–633.
24. Szczepanska-Gieracha J, Morka J, Kowalska J, Kustrzycki W, Rymaszewska. The role of depressive and anxiety symptoms in the evaluation of cardiac rehabilitation efficacy after coronary artery bypass grafting surgery. Eur J Cardiothorac Surg. 2012; 42(5): e108–114.
25. De Feo S, Tramarin R, Ambrosetti M, Riccio C, Temporelli PL, Favretto G et al. Gender differences in cardiac rehabilitation programs from the Italian survey on cardiac rehabilitation (ISYDE-2008). Int J Cardiol. 2012; 160(2): 133–139.