Role of balance and physical fitness in assessing the effectiveness of cardiac rehabilitation on functional recovery
C Rebelo, J B Bastos, V Afreixo, A AbreuAbstract
Background
Patients with reduced left ventricular ejection fraction (LVEF) often experience severe functional limitations, decreased mobility and increased dependency. These factors contribute to frailty and an increased risk of comorbidity. Physical inactivity exacerbates cardiovascular vulnerability and sedentary behaviour, which is recognised as a major cardiovascular risk factor, further diminishes physical independence, weakens resilience and accelerates disease progression.
Aim
The study will determine the relationship between balance, physical fitness, and cardiovascular risk factors in patients participating in a Phase I Cardiac Rehabilitation programme. The study will also examine whether balance assessments can serve as indicators of functional capacity and rehabilitation effectiveness.
Methods
A prospective longitudinal study was conducted among hospitalised patients with coronary artery disease. Physical fitness was assessed using the Fullerton Functional Fitness Test Battery (balance and mobility), handgrip strength (upper limb force), and measures of cardiorespiratory endurance. Patients completed the Morisky Medication Adherence Scale, STOP-Bang questionnaire, and IPAQ. Statistical analysis was performed using R (version 4.2.2). Simple and multiple linear regression models were applied, with variable selection based on the Akaike Information Criterion (AIC). Significance was set at p< 0.05.
Results
A total of 212 patients were evaluated at discharge (79% male; median age 66 years, interquartile range 57–74). Of these, 35% had an LVEF of ≤40%, 73% had hypertension and 75% had dyslipidaemia. The Shapiro–Wilk, Durbin–Watson and Breusch–Pagan tests confirmed normality, independence and homoscedasticity, while the variance inflation factor (VIF) tested for multicollinearity. A significant association (p < 0.05) was found between the Fullerton Balance Assessment Battery score and male sex, LVEF ≤40%, haemoglobin levels, lower limb strength, right upper limb flexibility, the "Timed Up and Go" test, the 6-minute walk test (6MWT), average right-hand strength, the IPAQ score and the HADS-Depression score.
Conclusions
Patients with poor balance had higher cardiovascular risk profiles, reduced exercise tolerance, and greater functional disability. This vulnerable subgroup may particularly benefit from tailored CR interventions. Balance evaluation could serve as a practical and sensitive marker of CR effectiveness, given its relationship with exercise capacity and physical independence. Incorporating balance assessment into CR programmes may enhance outcome prediction and support personalised rehabilitation strategies.Simple and multiple linear regressionFor image description, please refer to the figure legend and surrounding text.