Effect of home-based rehabilitation in frail older adults after cardiac surgery: a prospective feasibility study
DOI:
https://doi.org/10.2340/jrm.v58.45667Keywords:
Cardiac surgery, Feasibility, Frailty, RehabilitationAbstract
Introduction: Frail older adults undergoing cardiac surgery are vulnerable to postoperative complications and functional decline. Vivifrail is a structured, multicomponent exercise programme designed to enhance physical performance. This study evaluated its feasibility in the postoperative period.
Methods: A non-interventional, prospective, single-centre, study was conducted at Nantes University Hospital between March and December 2024. Patients aged ≥ 75 years, with a baseline Short Physical Performance Battery test (SPPB) score < 9 were included. SPPB, Timed Up and Go (TUG), and handgrip tests were performed at baseline (D0) and 6 weeks (W6). The primary outcome was to assess feasibility based on recruitment, retention rate, and physical performance at W6.
Results: Among 45 eligible patients, 38 accepted the programme; 29 returned for assessment at W6. Mean programme completion rate was 54%. All functional assessments improved meaningfully over time, but adherence did not significantly modify these trajectories. However, adherent participants showed lower frailty at W6.
Conclusion: Home-based rehabilitation using Vivifrail proved to be feasible for frail older adults during postoperative recovery. Clinically meaningful improvements were observed in physical performance during the first 6 weeks of the programme. Future research should confirm this trend and consider Vivifrail for patients who cannot access specialized rehabilitation centres.
Downloads
References
Nakano M, Nomura Y, Suffredini G, Bush B, Tian J, Yamaguchi A et al. Functional outcomes of frail patients after cardiac surgery: an observational study. Anesth Analg 2020; 130: 1534–1544. DOI: https://doi.org/10.1213/ANE.0000000000004786
Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 2016; 16: 157. DOI: https://doi.org/10.1186/s12877-016-0329-8
Ijaz N, Buta B, Xue QL, Mohess DT, Bushan A, Tran H, et al. Interventions for frailty among older adults with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol 2022; 79: 482–503. DOI: https://doi.org/10.1016/j.jacc.2021.11.029
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–7. DOI: https://doi.org/10.1016/j.jamda.2013.03.022
Veronese N. Frailty and cardiovascular diseases: research into an elderly population. Vol. 1216. C ha, Switzerland: Springer International Publishing; 2020. DOI: https://doi.org/10.1007/978-3-030-33330-0
Brennan TH, Lewis LK, Gordon SJ, Prichard I. Effectiveness of interventions to prevent or reverse pre-frailty and frailty in middle-aged community dwelling adults: a systematic review. Prev Med 2024; 185: 108008. DOI: https://doi.org/10.1016/j.ypmed.2024.108008
Kolle AT, Lewis KB, Lalonde M, Backman C. Reversing frailty in older adults: a scoping review. BMC Geriatr 2023; 23: 751. DOI: https://doi.org/10.1186/s12877-023-04309-y
Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016; 67: 1–12. DOI: https://doi.org/10.1016/j.jacc.2015.10.044
Karnon J, Afzali HHA, Putro GVAA, Thant PW, Dompok A, Cox I, et al. A cost-effectiveness model for frail older persons: development and application to a physiotherapy-based intervention. Appl Health Econ Health Policy 2017; 15: 635–645. DOI: https://doi.org/10.1007/s40258-017-0324-z
Bjarnason-Wehrens B, McGee H, Zwisler AD, Piepoli MF, Benzer W, Schmid JP, et al.; Cardiac Rehabilitation Section European Association of Cardiovascular Prevention and Rehabilitation. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil 2010; 17: 410–18. DOI: https://doi.org/10.1097/HJR.0b013e328334f42d
Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, et al. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol 2019; 26: 824–835. DOI: https://doi.org/10.1177/2047487318825350
Lutz AH, Forman DE. Cardiac rehabilitation in older adults: apropos yet significantly underutilized. Prog Cardiovasc Dis 2022; 70: 94–101. DOI: https://doi.org/10.1016/j.pcad.2022.01.001
Brouwers RWM, Houben VJG, Kraal JJ, Spee RF, Kemps HMC. Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study. Neth Heart J 2021; 29: 151–157. DOI: https://doi.org/10.1007/s12471-020-01492-0
Essery R, Geraghty AW, Kirby S, Yardley L. Predictors of adherence to home-based physical therapies: a systematic review. Disabil Rehabil 2017; 39: 519–534. DOI: https://doi.org/10.3109/09638288.2016.1153160
Clark AM, King-Shier KM, Duncan A, Spaling M, Stone JA, Jaglal S, et al. Factors influencing referral to cardiac rehabilitation and secondary prevention programs: a systematic review. Eur J Prev Cardiol 2013; 20: 692–700. DOI: https://doi.org/10.1177/2047487312447846
Racine G, Huet J, Nicollet J, Roussel JC, Boureau AS. Dépistage d’altération des capacités intrinsèques via l’outil ICOPE à la suite d’une chirurgie cardiaque: implémentation, efficacité de l’intervention et évolution de la qualité de vie. Brest, France: SGOC; 2025.
Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE. et al. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation 2019; 140: e69–89. DOI: https://doi.org/10.1161/CIR.0000000000000663
McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, et al. Home-based versus centrebased cardiac rehabilitation. Cochrane Database Syst Rev 27 2023; 10: CD007130. DOI: https://doi.org/10.1002/14651858.CD007130.pub5
Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017.
Martínez-Velilla N, Casas-Herrero A, Zambom-FerraresiF, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. JAMA Intern Med 2019; 179: 28. DOI: https://doi.org/10.1001/jamainternmed.2018.4869
Casas-Herrero Á, Sáez de Asteasu Ml, Antón-Rodrigo I, Sánchez-Sánchez Jl, Montero-Odasso M, Marín-Epelde I, et al. Effects of Vivifrail multicomponent intervention on functional capacity: a multicentre, randomized controlled trial. J Cachexia Sarcopenia Muscle 2022; 13: 884–893. DOI: https://doi.org/10.1002/jcsm.12925
Aguado Ortego R, Gómez González L, Gómez Rubiano M, Fernández Rodriguez E, Baztán Cortés JJ, Gómez-Pavón J. Beneficios de un programa ambulatorio de ejercicio multicomponente unido a la valoración geriátrica integral para pacientes mayores de la comunidad con fragilidad física [Benefits of an outpatient multicomponent exercise program combined with comprehensive geriatric assessment for elderly community patients with physical frailty]. Rev Esp Geriatr Gerontol 2025; 60: 101625. Spanish. DOI: https://doi.org/10.1016/j.regg.2025.101625
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16–31. DOI: https://doi.org/10.1093/ageing/afy169
Perracini MR, Mello M, de Oliveira Máximo R, Bilton TL, Ferriolli E, Lustosa LP, et al. Diagnostic accuracy of the Short Physical Performance Battery for detecting frailty in older people. Phys Ther 2020; 100: 90–98. DOI: https://doi.org/10.1093/ptj/pzz154
Lee L, Patel T, Costa A, Bryce E, Hillier LM, Slonim K, et al. Screening for frailty in primary care: Accuracy of gait speed and hand-grip strength. Can Fam Physician 2017; 63: e51–e57.
Ruiz-Ruiz L, Jimenez AR, Garcia-Villamil G, Seco F. Detecting fall risk and frailty in elders with inertial motion sensors: a survey of significant gait parameters. Sensors 2021; 21: 6918. DOI: https://doi.org/10.3390/s21206918
Izquierdo M. Prescripción de ejercicio físico. El programa Vivifrail como modelo [Multicomponent physical exercise program: Vivifrail]. Nutr Hosp 2019; 36(Spec. No. 2): 50–56. Spanish. DOI: https://doi.org/10.20960/nh.02680
Petersen J, Vettorazzi E, Winter L, Schmied W, Kindermann I, Schäfers HJ. Physical and mental recovery after conventional aortic valve surgery. J Thorac Cardiovasc Surg 2016; 152: 1549–1556.e2. DOI: https://doi.org/10.1016/j.jtcvs.2016.07.072
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997; 315: 1065–1069. DOI: https://doi.org/10.1136/bmj.315.7115.1065
Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, O’Loughlin P, et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012; 345: e4547. DOI: https://doi.org/10.1136/bmj.e4547
Jansson AK, Lubans DR, Duncan MJ, Smith JJ, Bauman A, Attia J, et al. Increasing participation in resistance training using outdoor gyms: a study protocol for the ecofit type III hybrid effectiveness implementation trial. Contemp Clin Trials Commun 2024; 41: 101358. DOI: https://doi.org/10.1016/j.conctc.2024.101358
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006; 54: 743–749. DOI: https://doi.org/10.1111/j.1532-5415.2006.00701.x
Kameniar K, Mackintosh S, Van Kessel G, Kumar S. The psychometric properties of the short physical performance battery to assess physical performance in older adults: a systematic review. J Geriatr Phys Ther 2022; 47: 43–54. DOI: https://doi.org/10.1519/JPT.0000000000000337
Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, Cooper C, Martin FC, Reginster JY, et al. Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci 2018; 73: 1653–1660. DOI: https://doi.org/10.1093/gerona/gly011
Yu R, Leung J, Leung G, Woo J. Towards healthy ageing: using the concept of intrinsic capacity in frailty prevention. J Nutr Health Aging 2022; 26: 30–36. DOI: https://doi.org/10.1007/s12603-021-1715-2
Shur NF, Creedon L, Skirrow S, Atherton PJ, MacDonald IA, Lund J, et al. Age-related changes in muscle architecture and metabolism in humans: the likely contribution of physical inactivity to age-related functional decline. Ageing Res Rev 2021; 68: 101344. DOI: https://doi.org/10.1016/j.arr.2021.101344
Coelho PNMP, Miranda LMRPC, Barros PMP, Fragata JIG. Quality of life after elective cardiac surgery in elderly patients. Interact Cardiovasc Thorac Surg 2019; 28: 199–205. DOI: https://doi.org/10.1093/icvts/ivy235
Wu S, Nan J, Chang J, Jiang D, Cao Z, Zhou S, et al. Adherence to exercise intervention for community-dwelling older adults with sarcopenia: a systematic review and meta-analysis. Age Ageing 2025; 54(4): afaf094. DOI: https://doi.org/10.1093/ageing/afaf094
Komonski A, Meunier C, Boureau AS. Factors influencing the implementation of a home-based rehabilitation program in frail older patients after cardiac surgery: a qualitative study using reflexive thematic analysis. BMC Sports Sci Med Rehabil 2026. Online ahead of print. DOI: https://doi.org/10.31235/osf.io/63cwh_v1
Lee S, Chang BC, Yoo KJ. Surgical management of coexisting coronary artery and valvular heart disease. Yonsei Med J 2010; 51: 326–331. DOI: https://doi.org/10.3349/ymj.2010.51.3.326
Published
How to Cite
License
Copyright (c) 2026 Ambre Komonski, Killian Jouanneau, Anne Sophie Boureau, Jeremie HUET
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
