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Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial
  1. Gianluca Campo1,
  2. Elisabetta Tonet1,
  3. Giorgio Chiaranda2,
  4. Gianluigi Sella3,
  5. Elisa Maietti4,
  6. Giulia Bugani1,
  7. Francesco Vitali1,
  8. Matteo Serenelli1,
  9. Gianni Mazzoni5,
  10. Rossella Ruggiero1,
  11. Giovanni Villani6,
  12. Simone Biscaglia1,
  13. Rita Pavasini1,
  14. Andrea Rubboli3,7,
  15. Roberta Campana1,
  16. Serena Caglioni1,
  17. Stefano Volpato4,
  18. Jonathan Myers8,9,
  19. Giovanni Grazzi5,10
  1. 1 Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
  2. 2 Department of Public Health, AUSL Piacenza, and Sport Medicine Service, Piacenza, Italy
  3. 3 Sports Medicine Center, AUSL Ravenna, Ravenna, Italy
  4. 4 Department of Medical Science, University of Ferrara, Ferrara, Italy
  5. 5 Public Health Department, Azienda USL di Ferrara, Ferrara, Italy
  6. 6 Cardiology Unit, Ospedale S, Giovanni da Saliceto, Piacenza, Italy
  7. 7 Division of Cardiology, S. Maria Delle Croci Hospital, Ravenna, Italy
  8. 8 School of Medicine, Stanford University, Stanford, California, USA
  9. 9 Division of Cardiology, VA Palo Alto Health Care System, Palo Alto, California, USA
  10. 10 Center of Sport and Exercise Sciences, University of Ferrara, Ferrara, Italy
  1. Correspondence to Dr Gianluca Campo, Medical Sciences, Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona (FE), Italy; cmpglc{at}


Objective To establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS).

Methods The study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4–9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded.

Results Overall, 235 patients with ACS (median age 76 (73–81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70–90) vs 70 (50–80) points, p<0.001 and at 1 year 75 (70–87) vs 65 (50–80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04).

Conclusions The proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit.

Trial registration number NCT03021044.

  • acute coronary syndromes
  • quality and outcomes of care
  • cardiac rehabilitation

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  • Contributors Conceived and designed the research: GC, ET, SB, SV, GG, GM, GC. Acquired the data: GB, MS, RR, FV, AR, SC, RC, GV, GS. Performed statistical analysis: GC, EM, SV. Handled funding and supervision: RP. Drafted the manuscript: GC, SB, EM, ET, RP, GG. Made critical revision of the manuscript for key intellectual content: JM.

  • Funding The study was an investigator-driven clinical trial conducted by the University of Ferrara.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the ethical review boards at the participating hospitals. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request to corresponding author.