The downward spiral of weakness and inactivity among elderly heart patients can be reversed with carefully monitored, regular workouts on stationary bikes and treadmills, researchers at the University of Maryland Medical Center say.
In a study that challenges a long-accepted medical standard opposing strenuous exercise for patients with congestive heart failure, 10 elderly patients finished three months of aerobic training able to walk more than twice as fast and 120 percent farther.
Some were able to resume driving, shopping and other normal day-to-day activities.
"We pushed them probably harder than they wanted to go, initially," said Dr. Peter Vaitkevicius, (pronounced "Vy-KAV-a-chiss").
"But once they realized they could see the improvement, and feel how dramatic it can be, we had to pull in the reins," he said. Dr. Vaitkevicius, a geriatric cardiologist, directed the study.
None of the men suffered a heart attack as a result of the workouts, according to the study, reported yesterday to the 67th Scientific Sessions of the American Heart Association, meeting in Dallas.
Nicholas Passarella, a 73-year-old retired watchmaker from Rodgers Forge, said he had been making only slow recovery after surgery last winter, in which doctors bypassed three clogged arteries in his heart with three healthy ones.
His surgery cured the increasing heart pain he had suffered after a heart attack 30 years ago. But he remained hospitalized six weeks later and still felt tired. He was diagnosed with congestive heart failure, a progressive weakening of the heart muscle.
"I was only walking along the [hospital] corridors a little bit," he said. His doctor enrolled him in the exercise study hoping it might help. It did.
Since starting his thrice-weekly workouts in March, Mr. Passarella has quadrupled his endurance on a stationary bicycle to 40 minutes. He has also worked his way up to 10 or 20 minutes on the treadmill, depending on how badly a World War II shrapnel wound in his ankle acts up.
"I feel much stronger now," he said. "I think the exercise program is wonderful." His doctors tell him his heart's pumping efficiency has doubled.
Until now, Dr. Vaitkevicius said, the nation's 3 million elderly with congestive heart failure seemed locked into a progressive decline, where inactivity led to increased weakness and more inactivity before eventual death.
"We don't have a lot of good drugs" to address the problem, he said, and physical training was taboo. "All the textbooks said that for congestive heart failure, you don't push patients. . . . That's been the 'gold standard' for years and years."
"We have . . . investigated, and found no real data to support this recommendation to do nothing," Dr. Vaitkevicius said.
Participants in the study were men ages 61 to 85. Tests found their hearts to be, on average, less than half as efficient as those of healthy men of their years.
Dr. Vaitkevicius said one 74-year-old man was so weak one day that he could not walk from his bed to his closet to get his shoes. He finally crawled into the closet, but was then too weak to get out again.
"He spent four hours in the closet waiting for his wife to come home," Dr. Vaitkevicius said. On the treadmill, he managed only four minutes at 1 mph before he began to turn blue. After three months of training, however, the same man could walk for 30 to 40 minutes at nearly 2 mph. Today, nine months after he began training, "the guy's out driving the car again and going shopping," Dr. Vaitkevicius said. If there is a limit to the improvement, he said, "we haven't found it yet."
The patients engaged in up to 90 minutes of various aerobic exercises, three days a week, in a well-equipped mini-gym at the new VA hospital. Closely monitored by medical staff, the men were pushed to "just short of getting chest pains."
"If you take patients like these and put them in a health club, you're asking for big problems," Dr. Vaitkevicius said. "These exercise programs really have to be individualized."
But, after monitoring their training for three months, he said, "I would feel comfortable sending them out on their own" with a prescription for continued exercise. Not only did the patients' hearts function better, but their arms and legs got stronger as well. The new muscle mass aids both mobility and metabolism.
Dr. Vaitkevicius said it is still not clear whether the workouts provide long-term protection against attacks. If so, it would argue even more strongly for aerobic rehabilitation of elderly heart-failure patients.
He is now recruiting 60 patients as part of a five-year, multi-hospital federal study to find out.
Interested persons may call (410) 605-7000, Ext. 5428 for information.