Prevalence and Impact of Musculoskeletal Comorbidities in Cardiac Rehabilitation

BACKGROUND: With the demographic of patients entering cardiac rehabilitation (CR) indicating an older and more obese population, musculoskeletal comorbidities (MSKCs) may be escalating. METHODS: Musculoskeletal comorbidities affecting exercise were ascertained in 322 patients (233 men and 89 women) by a questionnaire and then an interview before and after 3 months of CR. Outcome variables were measured at baseline and 6 months. RESULTS: Musculoskeletal comorbidities perceived to affect exercise were reported by 50% of subjects at CR entry (48.1% of males, 55.1% of females; P = .26); most commonly occurring in the knee(s) (25%) and back (19%) due predominantly to arthritis (36.6%) and strains/sprains (28.6%). Multivariate regression revealed that greater body mass, older age, and lower peak oxygen uptake ((V) over dotO(2peak)) were predictors of baseline MSKCs. At entry, patients with MSKCs were less likely to be exercising 30 minutes or more, 5 times per week than those without MSKCs (17.4% vs 28%, respectively, P = .03). Exercise modifications were required for 33.5% of patients with MSKC. By 3 months, 15.2% of patients developed 62 new MSKCs (26.5% strains/sprains). Six months of CR yielded significant (P < .001) and similar improvements in (V) Over dotO(2peak) for patients with and without baseline MSKCs (16.3% and 18.8%, respectively, P = .28). The improvement was mitigated in those with arthritic conditions compared with others (7.8% vs 20%, respectively, P = .01). By 6 months, 31.1% and 29.8% of patients with and without baseline MSKCs respectively, discontinued CR (P = .81). CONCLUSIONS: At entry to CR, patients reporting MSKCs had a poorer health profile than those without MSKCs, including lower levels of physical activity and cardiovascular fitness, and unfavorable anthropometric measures. With exercise modifications, significant benefits were achievable without affecting compliance.