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Gender and physical activity one year after myocardial revascularization for stable angina
Athanasios L P Markou1, Marijke Evers, Henry A van Swieten
1Department of Cardiothoracic Surgery, Heart Center, Radboud University Nijmegen, 677, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Insights
Patients undergoing coronary artery bypass grafting (CABG) show improved physical activity (PA) post-surgery. However, pre-operative high PA and certain health conditions independently predict poorer outcomes in men and women.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Public Health
Background:
- Physical activity (PA) improvement is a key benefit for patients after coronary artery bypass grafting (CABG).
- Previous research suggests women may experience less PA improvement than men post-CABG.
- Understanding factors influencing PA changes is crucial for optimizing patient recovery.
Purpose of the Study:
- To compare physical activity (PA) levels before and after coronary artery bypass grafting (CABG) in men and women.
- To identify predictors of physical activity (PA) improvement or decline following CABG.
- To investigate potential sex-based differences in PA recovery after CABG.
Main Methods:
- Prospective study of 568 patients (466 men, 102 women) undergoing isolated primary CABG for stable angina.
- Physical activity (PA) assessed preoperatively and at 1-year follow-up using Corpus Christi Heart Project criteria (coded 1-5).
- Multiple logistic regression analysis used to identify independent predictors of PA outcomes.
Main Results:
- Preoperatively, women were older, in higher NYHA classes, and had significantly lower PA levels than men (2.30 vs. 2.89).
- Mean PA significantly increased for both women (2.7) and men (3.2) at follow-up.
- Independent predictors for worse PA post-CABG included high preoperative PA (women: OR 11.0; men: OR 7.11), diabetes, vascular, and pulmonary disease (men only).
Conclusions:
- While CABG generally improves physical activity (PA), a significant proportion of patients experience decreased PA.
- Preoperative high PA is a strong predictor of limited improvement for both sexes.
- Comorbidities like diabetes and vascular/pulmonary diseases are independent risk factors for poorer PA outcomes specifically in men post-CABG.
Abstract:
Improvement in physical activity (PA) is an important benefit for patients undergoing CABG. It is suggested that women make less improvement than men. Of 568 patients (466 men and 102 women) undergoing an isolated primary CABG for stable angina (NYHA<4) pre- and 1-year postoperative PA was registered. The Corpus Christi Heart Project criteria are used for assessing PA. The different PA-levels are coded from 1, the worst, to 5, the best. Preoperatively, female patients were older, in a higher NYHA class, and PA level was significantly different and lower 2.30+/-1.01 vs. 2.89+/-1.03 (P=0.000). At follow-up, the mean PA increased significantly for women (2.7+/-1.02) and men (3.2+/-1.06) (P=0.000). Despite this broad increase, 20% of men and 10% of women had a decreased PA. Multiple logistic regression analysis identified a preoperative high PA-level, diabetes, vascular- and pulmonary disease (odds ratio 7.11, 2.6, 2.3, 2.69) as variables that contribute independently to a worse PA for men and only high preoperative PA level (odds ratio 11.0) for women. This study confirms that patients with a preoperative high level PA are unlikely to improve PA, but in men, diabetes, vascular- and pulmonary disease are also independent risk factors.
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