Pre-Participation Physical Fitness does not Influence Adherence to a Supervised Exercise Program

Nishijuka, Fábio Akio; Silva, Christina Grüne de Souza e; Duarte, Carlos Vieira; Araújo, Claudio Gil Soares de

doi:10.5935/abc.20170132

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Original Article • Arq. Bras. Cardiol. 109 (4) • Oct 2017 • https://doi.org/10.5935/abc.20170132 copy

Pre-Participation Physical Fitness does not Influence Adherence to a Supervised Exercise Program

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Exercise-based cardiac rehabilitation tends to reduce mortality. However, it requires medium/long-term adherence to regular physical exercise. It is relevant to identify the variables that affect adherence to an supervised exercise program (SEP).

Objective:

To evaluate the influence of pre-participation levels of aerobic and non-aerobic physical fitness components in medium-term adherence to SEP.

Methods:

A total of 567 SEP participants (65 ± 12 years) (68% men) were studied. Participants adherent to the program for less than 6 months (48%) (non-adherent - NAD) were compared with 52% of participants who were adherent for 6 months or more (adherents - AD). In the non-aerobic fitness, flexibility (FLX) (Flexitest) and muscle power (MPW)/body weight in standing rowing (watts/kg) were evaluated while aerobic fitness was obtained by direct measure of VO₂max/body weight (VO₂). These measurements were normatized for sex and age based on percentiles (P) (P-FLX/P-MPW) of reference data or percentages of predicted (P-VO₂). Additionally, AD and NAD with extreme results (tertiles) were simultaneously compared for the three variables.

Results:

There was no difference between AD and NAD for non-aerobic results, in median [P25-P75], P-FLX: 30 [13-56] and 31 [9-52], respectively, (p = 0.69) and P-MPW: 34 [17-58] and 36 [16-62], respectively (p = 0.96), and for aerobic results (mean ± standard error) P-VO₂ (75.9 ± 1.3% and 75.0 ± 1.3%, respectively) (p = 0.83). When comparing extreme tertiles, a difference was found for P-MPW in the lower tertile only, with a slight advantage of AD over NAD- 9 [5-16] versus 4 [1-11] (p = 0.04).

Conclusion:

Although awareness of the pre-participation levels of aerobic and non-aerobic physical fitness components is useful for individualized exercise prescription, these variables do not seem to influence medium-term adherence to SEP.

Keywords:
Muscle Strength; Oxygen Consumption; Physical and Rehabilitation Medicine; Sports Medicine

	Participants			1^st (lower) tertile			3^rd (upper) tertile
	AD (n = 298)	NAD (n = 269)	p	AD1 (n = 18)	NAD1 (n = 25)	p	AD3 (n = 20)	NAD3 (n = 30)	p
Clinical features
Coronary artery disease (%)	58	53	0.24	22	48	0.08	50	57	0.64
Systemic arterial hypertension (%)	64	58	0.16	67	80	0.32	65	57	0.56
Dyslipidemia (%)	69	68	0.78	50	76	0.08	80	70	0.43
Diabetes mellitus (%)	30	29	0.90	44	60	0.31	10	23	0.23
Smoking history (%)	55	66	0.01	44	64	0.20	50	70	0.15
Sedentary lifestyle (%)	44	48	0.30	72	72	0.99	25	33	0.53
Use of medications
Beta-blockers (%)	66	60	0.17	72	72	0.99	65	63	0.90
Statins (%)	77	74	0.43	67	76	0.50	80	83	0.76
Antiplatelet agents (%)	73	72	0.64	50	68	0.23	60	77	0.21
Psychotropics (%)	58	60	0.79	56	64	0.58	30	50	0.16

	Participants			1^st (lower) tertile			3^rd (upper) tertile
	AD (n = 298)	NAD (n = 269)	p	AD1 (n = 18)	NAD1 (n = 25)	p	AD3 (n = 20)	NAD3 (n = 30)	p
Men (%)	66	70	0.26	64	56	0.57	83	90	0.51
Age ^(†) (†) mean ± standard error, t-test for age and Mann-Whitney test for the other variables. Comparison between men and women percentiles was performed by the chi-square test.	66 ± 0.7	64 ± 0.7	0.29	60 ± 2.8	57 ± 2.1	0.34	69 ± 1.8	70 ± 2.4	0.76
Body mass index (kg/m²) ^(†) (†) mean ± standard error, t-test for age and Mann-Whitney test for the other variables. Comparison between men and women percentiles was performed by the chi-square test.	27 ± 0.2	28 ± 0.3	0.25	32 ± 1.5	34 ± 1.5	0.43	26 ± 0.74	25 ± 0.43	0.75
Interval between assessment and enrollment (days) ^(†) (†) mean ± standard error, t-test for age and Mann-Whitney test for the other variables. Comparison between men and women percentiles was performed by the chi-square test.	9 ± 0.9	11 ± 1.2	0.44	7 ± 2.1	12 ± 4.9	0.73	14 ± 4.7	12 ± 4.6	0.28
Months of SEP ^(†) (†) mean ± standard error, t-test for age and Mann-Whitney test for the other variables. Comparison between men and women percentiles was performed by the chi-square test.	22 ± 1.1	2.9 ± 0.1		19 ± 3.5	3 ± 0.3		22 ± 5.4	3 ± 0.2
Number of sessions/month ^() ()** median (percentile 25 – percentile 75);	9 (7–10)	7 (4–9)	< 0.001	9 (9–13)	7 (5–9)	0.010	9 (7–10)	5 (3–8)	0.003

	Participants			1^st (lower) tertile			3^rd (upper) tertile
	AD (n = 298)	NAD (n = 269)	p	AD1 (n = 18)	NAD1 (n = 25)	p	NAD3 (n = 20)	NAD3 (n = 30)	p
Flexindex^* *()** age- and sex-percentile in median (25th percentile - 75th percentil);	30 (13–56)	31 (9–52)	0.69	6 (1–11)	4 (1–11)	0.70	70 (60–88)	74 (49–92)	0.85
Relative power ^* *()** age- and sex-percentile in median (25th percentile - 75th percentil);	34 (17–58)	36 (16–62)	0.96	9 (5–16)	4 (1–12)	0.039	78 (64–92)	73 (64–87)	0.42
Predicted relative maximum VO₂ (%)^(†) (†) percentile of predicted relative maximum VO2 in mean ± standard error, Mann‑Whitney test.	75.9 ± 1.27	75.0 ± 1.30	0.83	51.7 ± 2.65	52.1 ± 1.94	0.81	104.3 ± 3.54	103.0 ± 2.42	0.86

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[1] Mailing address: Dr. Claudio Gil Soares de Araújo, Clínica de Medicina do Exercício. Rua Siqueira Campos, 93/101, Postal Code: 22031-070, Rio de Janeiro, RJ - Brazil. E-mail: cgaraujo@iis.com.br