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Introduction:Intensive Cardiac Rehabilitation [ICR: Dr. Dean Ornish Program] is proven to reduce risk factors associated with CVD by facilitating stress management education, plant-based nutrition, and structured exercise. The present study aimed to determine if ICR programs can show sustained improvement in high-risk (elderly and rural) populations.Hypothesis:We assessed the hypothesis that ICR participants would not show sustained atherosclerotic risk factor improvement in a 7-14-month timeframe after program completion.Methods:Participants (n=65, mean age 75 +/- 6.5 (56% Male)) with a prior diagnosis of stable angina pectoris, secondary to CVD, completed a nine-week ICR program. Patients’ biomarker data was tracked in the range of 7-14 months following program completion. Eight biomarkers were evaluated including LDL, HDL, and Hb-A1c. The analysis utilized either parametric or nonparametric paired tests, with an adjusted P-value of 0.00625 as eight variables were tested. Serum labs were drawn at least five months before program commencement and at most one week following program completion. BMI was recorded at a separate date, with the P-value set at 0.05.Results:The sample size was n=62. From baseline, patients’ LDL (11.8% decrease, 95% CI) and Hb-A1c (3.2% decrease, 95% CI) showed significant change (P<0.00625) using the paired Wilcoxon signed-rank test. During the follow-up period, the same methods were applied to a smaller sample size (n=30). This resulted in a significant change (P< 0.00625) for LDL (increased 13.4%) and HDL (increased 7.3%). With n=55, BMI showed significant change (3.9% decrease, 95% CI, P<0.05) using the paired Wilcoxon signed-ranked test directly after program completion. In the follow-up period, n=36 and BMI showed significant change (1.5% increase, 95% CI, P< 0.05) with the same method.Conclusion:Patients with atherosclerotic coronary disease optimized on medical therapy prior to enrollment in the ICR still showed improvement in biomarker levels with rehabilitation. However, these programmatic benefits were lost in the subsequent months due to a lack of structured supervision. In conclusion, we suggest long-term maintenance of ICR protocols and structured supervision in high-risk populations. |
