Adherence level and efficacy of a one-year exercisebased intervention program in patients with myocardial infarction

Purpose: Statistics demonstrate that elderly patients with myocardial infarction (MI) exhibit higher levels of sedentary behavior and lower adherence to traditional cardiovascular rehabilitation and secondary prevention programs. This observational study aims to analyze adherence to an exercise-based intervention program in patients hospitalized for MI, while also evaluating the effectiveness of the intervention at the end of the one-year follow-up period. Methods: Data from 65 patients who completed the one-year cycle of visits were analyzed. Participants underwent functional assessments through a submaximal 1-kilometer treadmill walking test, based on which a home-based physical activity program was prescribed, evaluated, and potentially adjusted at the end of each assessment session. The level of physical activity carried out at home was assessed using the 7-day Physical Activity Recall, which analyzes the type of exercise performed, intensity, and frequency, and then provides estimates of energy expenditure (kcal/week) and the amount of physical activity calculated, indicated in MET-hours/week. Results: Throughout the sessions, a positive maintenance of program adherence percentage (63.1%) was observed. The higher risk of dropout was observed in the early stages of the program, specifically between the first and second visit. This dropout is primarily attributed to logistical challenges and skepticism towards the proposed intervention. Weekly physical activity significantly increased from baseline to the end of the follow-up period (from 7.5 to 13.2 MET/h-week; p<0.001). Moreover, both average speed (from 3.0 to 4.4 km/h; p<0.0001) and oxygen consumption (from 16.8 to 21.2 ml/kg/min; p<0.0001) significantly improved. When comparing male and female participants, a comparable increase in values was observed between the two groups. Specifically, regarding physical activity, it is notable that women, who started from a lower level at the baseline, increased their activity progressively, eventually reaching the levels of men. Conclusions: The adherence rate to the 1-year program (63.1%) is high, considering that prescribed programs typically last up to 12 weeks and considering the higher risk of drop-out among older patients. This, coupled with the sustained maintenance of a significant level of weekly physical activity, underscores the effectiveness of the proposed intervention, indicating that it can improve physical performance and functional abilities.