The effects of CPET-guided cardiac rehabilitation on exercise tolerance in older persons with CHD after PCI

The effects of CPET-guided cardiac rehabilitation on exercise tolerance in older persons with CHD after PCI | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The effects of CPET-guided cardiac rehabilitation on exercise tolerance in older persons with CHD after PCI Tao Shen, Yuwei Wang, Chuan Ren, Yanxin Song, Wei Gao, Fen Liu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3196230/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Nov, 2023 Read the published version in Scientific Reports → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Prescribing appropriate exercise is an important means to improve the safety and efficacy of cardiac rehabilitation. Improper exercise may induce an increased cardiovascular risk in older persons with coronary heart disease. Cardiopulmonary exercise testing (CPET)-guided cardiac rehabilitation could be helpful for providing clinical evidence for cardiac rehabilitation therapy in older persons after percutaneous coronary intervention (PCI). Methods: We retrospectively included older persons who underwent PCI and cardiac rehabilitation based on CPET at the Cardiac Rehabilitation Center of XXX Hospital from January 2014 to December 2019. Patients' baseline and follow-up clinical data were collected. Results: A total of 403 older persons after PCI were included in the study. The mean age was 80.5±4.3. The mean follow-up time was 12±2 months. During the follow-up period, no significant exercise-related adverse events occurred, and the peak oxygen uptake (VO2peak) increased compared with baseline (15.5±3.8 ml/min/kg vs. 17.3±4.1 ml/min/kg). Among the 90 patients (22.2%) without exercise habits at baseline who started regular exercise during follow-up, the improvement in VO2peak was most significant, at 3.2±0.4 ml/min/kg. Conclusions: Cardiac rehabilitation based on CPET improved exercise habits and exercise tolerance in older persons with coronary heart disease after PCI. Health sciences/Cardiology Health sciences/Diseases Coronary Heart Disease Older persons Cardiopulmonary Exercise Testing Exercise Tolerance Cardiac Rehabilitation Figures Figure 1 Figure 2 Introduction Cardiac rehabilitation, as an important intervention measure, is of great significance for improving the clinical outcomes of patients with coronary heart disease (CHD) [1, 2] . For older persons who undergo revascularization, prescribing appropriate exercise is an important means to improve the safety and efficacy of exercise rehabilitation. Cardiopulmonary exercise testing (CPET) could provide essential guidance for determining the aerobic exercise intensity for CHD patients, but there has been insufficient research on its influence in older persons. The purpose of this study was to observe the impact of cardiac rehabilitation guidance based on CPET on cardiopulmonary exercise tolerance and exercise adherence in older persons with CHD after percutaneous coronary intervention (PCI) in the context of standardized drug treatment for CHD. This work will be helpful for providing clinical evidence for cardiac rehabilitation therapy in older persons with CHD after PCI. Materials And Methods 1.1 General Information We retrospectively included CHD patients aged ≥75 years who underwent PCI and exercise rehabilitation guided by CPET at the Cardiac Rehabilitation Center of Peking University Third Hospital from January 2014 to December 2019 (Figure 1). The inclusion criteria were as follows: age ≥75 years; successful PCI; CPET-guided cardiac rehabilitation with a clinical follow-up evaluation after one year; and complete clinical data, medication history, biochemical data, and echocardiographic data. The exclusion criteria were as follows: positive exercise electrocardiogram (ECG); NYHA class III-IV heart function; malignant arrhythmia; valvular heart disease; history of coronary artery bypass graft surgery; and concomitant malignant tumours, haematologic diseases, rheumatic immune diseases, or severe liver or kidney dysfunction. A positive exercise ECG was defined as follows: R-wave dominant leads, horizontal or downsloping ST-segment depression ≥0.1 mV at 60-80 ms after the J-point, lasting ≥2 minutes; and nonpathological Q-wave leads, upsloping ST-segment elevation ≥0.1 mV, lasting ≥1 minute. We collected and organized the following patient data: (1) general information, including sex, age, disease diagnosis, height, weight, etc.; (2) past medical history and family history, including history of cardiovascular risk factors such as hypertension, diabetes, hyperlipidaemia, respiratory diseases such as chronic obstructive pulmonary disease, musculoskeletal and neurological disease history, and family history of early-onset CHD, etc.; (3) personal history, including smoking history, exercise habits, etc.; and (4) laboratory test, echocardiography, and CPET results. 1.2 Cardiopulmonary Exercise Testing The testing equipment used was the Medgraphics (USA) ULTIMA CardiO2 Cardiopulmonary Exercise System. All patients performed exercise testing using a cycle ergometer, adopting a bicycle exercise protocol. Symptom-limited exercise was encouraged. Patients' electrocardiogram (ECG), blood pressure, and symptoms were monitored. The entire process was carried out under the supervision of a professional physician. During the test, continuous recording of patients' ECG, blood pressure, and gas exchange information was performed, including the following parameters: oxygen uptake at anaerobic threshold (VO 2 @AT); heart rate at anaerobic threshold (HR@AT); oxygen pulse at anaerobic threshold; peak oxygen uptake (VO 2 peak); peak heart rate (peak HR); ventilation per carbon dioxide output slope (VE/VCO 2 slope); oxygen uptake efficiency slope (OUES); and 1-min heart rate recovery. 1.3 Exercise Prescription Individualized exercise rehabilitation prescriptions based on the cardiopulmonary exercise testing system were implemented. Exercise intensity was prescribed using the anaerobic threshold heart rate ±5 bpm [3] , along with prescriptions for strength training and balance and coordination training. Aerobic exercise modalities such as walking, cycling, and swimming were recommended, with moderate-intensity continuous exercise performed 3-5 days per week for 30-60 minutes per day, including warm-up, training, and recovery sections. 1.4 Study Endpoints The primary endpoint of this study was the change in patients' exercise tolerance, represented by VO 2 peak and other CPET parameters during the follow-up period. Secondary endpoints included differences in exercise habits. According to the American College of Sports Medicine (ACSM) 10th Edition "ACSM's Guidelines for Exercise Testing and Prescription" [4] , exercising ≥3 times per week, ≥30 minutes per session, and for a duration of ≥3 months indicated the presence of exercise habits; those who did not meet this standard were considered to have no exercise habits. Other secondary endpoints included patients' blood test results, echocardiographic parameters, and adverse events during the follow-up period. 1.5 Statistical Methods SPSS 22.0 was used for data analysis and statistics. The Shapiro‒Wilk normality test was performed on all quantitative data in the analysed samples. Normally distributed quantitative data are expressed as the mean ± standard deviation (s), and nonnormally distributed quantitative data are expressed as the median (Q1, Q3). Group comparisons were made using paired t tests and Mann‒Whitney U tests, with paired t tests applied for normally distributed data and Mann‒Whitney U tests for nonnormally distributed data. Categorical variables were analysed using chi-square tests. A two-sided P < 0.05 was considered statistically significant. Results 2.1 General Patient Information A total of 403 older persons with CHD after PCI were analysed (Table 1). The average age of the patients was 80.5 ± 4.3 years, and there were 305 (75.6%) males. A total of 336 (83.4%) patients had one or more CHD risk factors (including hypertension, diabetes, hyperlipidaemia, and smoking). A total of 134 (16.6%) patients had a history of myocardial infarction. Complete revascularization was achieved in 316 (78.4%) patients. A total of 185 (45.9%) patients were classified as NYHA functional class II. 2.2 Comparison of Baseline and Follow-up Patient Indicators General patient data, laboratory indicators, echocardiographic parameters, and CPET indicators were analysed at baseline and during the follow-up period (Table 2). No deaths occurred during the follow-up period. In terms of laboratory indicators, patients had lower low-density lipoprotein (LDL) levels (2.0 ± 0.6 mmol/L vs. 1.4 ± 0.5 mmol/L, P = 0.032) and lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (305.5 ± 19.4 pg/ml vs. 225.6 ± 11.1 pg/ml, P = 0.013) during the follow-up period. In terms of echocardiographic parameters, there was no significant change in the left ventricular ejection fraction (LVEF) during the follow-up period (65.7 ± 8.3% vs. 66.8 ± 7.6%, P = 0.317), but indicators of left ventricular diastolic dysfunction, i.e., the ratio of early diastolic transmitral flow velocity to early diastolic tissue velocity (6.9 ± 2.2 vs. 7.5 ± 2.3, P = 0.028) and left atrium pressure (10.8 ± 2.8 mmHg vs. 10.1 ± 2.8 mmHg, P = 0.028), improved. In terms of cardiopulmonary exercise parameters, patients had higher VO 2 @AT (12.9 ± 3.7 ml/min/kg vs. 13.8 ± 4.2 mmHg, P < 0.001), VO 2 peak (15.5 ± 3.8 ml/min/kg vs. 17.3 ± 4.1 mmHg, P = 0.013), and peak HR (118 ± 17 bpm vs. 122 ± 16 bpm, P = 0.012) values during the follow-up period than at baseline. The VE/VCO 2 slope, reflecting respiratory efficiency, improved (31.9 ± 5.1 vs. 30.9 ± 6.1, P < 0.001), and the 1-min heart rate recovery increased (17 ± 7 bpm vs. 19 ± 8 bpm, P < 0.001). Patients were grouped based on whether they had exercise habits during the follow-up period. At the follow-up, patients with exercise habits were younger (80.7 ± 4.3 ml/kg/min vs. 83.9 ± 3.9 ml/kg/min, P = 0.007) and had higher ΔVO 2 peak (1.62 ± 0.31 ml/kg/min vs. -0.02 ± 0.01 ml/kg/min, P < 0.001) and VO 2 @AT (14.2 ± 4.1 ml/kg/min vs. 12.9 ± 3.4 ml/kg/min, P < 0.001) values than patients without exercise habits. No significant differences were observed between the two groups in terms of laboratory or echocardiographic parameters (Table 3). 2.3 Improvement in Patients' Exercise Habits Changes in patients' exercise habits and exercise tolerance from baseline to follow-up were as follows: 57 patients (14.1%) had no exercise habits at baseline or during the follow-up period; 31 patients (7.6%) had exercise habits at baseline but did not maintain them during the follow-up period; 90 patients (22.2%) had no exercise habits at baseline but started regular exercise during the follow-up period; and 225 patients (55.8%) maintained exercise habits at baseline and during the follow-up period. The baseline and follow-up oxygen uptake in each group is shown in Figure 2, with ΔVO 2 peak values of -0.2±0.1 ml/kg/min, -0.3±0.1 ml/kg/min, 3.2±0.4 ml/kg/min, and 1.0±0.2 ml/kg/min, respectively. The improvement in VO 2 peak was most pronounced in patients who had no exercise habits at baseline but developed them during the follow-up period. VO 2 peak did not improve in patients without exercise habits during the follow-up period, regardless of whether they had exercise habits at baseline. Spearman correlation analysis was performed on patients' clinical data with ΔVO 2 peak. Exercise habits during the follow-up period (rs=-0.601, P <0.001), age (rs=-0.353, P<0.001), and history of myocardial infarction (rs=-0.293, P =0.029) were significantly correlated with ΔVO 2 peak, while other clinical data and combined medication use were not significantly correlated with ΔVO 2 peak. Multivariate linear regression analysis was performed on ΔVO 2 peak with the parameters that were significantly correlated with ΔVO 2 peak in the univariate analysis, with the main factors such as exercise habits during the follow-up period as independent variables. The results showed that exercise habits during the follow-up period (B=-0.406, SE=0.063, t=-6.650, P =0.001, 95% CI : -0.561~-0.284), age, and history of myocardial infarction were independent influencing factors of ΔVO 2 peak (Table 4). Discussion 3.1 Significant Clinical Benefits of Exercise Rehabilitation for Older persons with CHD PCI has become the most important means of revascularization for CHD patients, not only effectively improving patients' clinical symptoms but also significantly reducing the mortality of acute myocardial infarction and high-risk angina patients. However, for older persons, the cardiovascular risk of heart failure, arrhythmia, and sudden death remain after PCI due to the added effects of age-related physiological changes. Compared to non-CHD patients, exercise tolerance is significantly reduced in CHD patients. The decline in exercise tolerance is even more pronounced in older persons with CHD, who may also have mental issues such as depression and dementia, severely affecting their quality of life [5] . Previous studies found that increased daily physical activity was associated with a reduced mortality rate in CHD patients, particularly in those who were sedentary, as they experienced greater cardiovascular benefits [6] . Cardiac rehabilitation could promote the physical and mental health of older persons, improving their quality of life [7, 8] , and offer benefits for older CHD patients, such as reduced mortality and rehospitalization rates and further revascularization [9, 10] . Many studies have reported that aerobic exercise training improves exercise capacity, frailty, and quality of life in older CHD patients [11-14] . However, the patients included in these previous studies were relatively young compared with those in the current study. In particular, in CHD patients aged 75 and older, muscle degeneration and atrophy are more severe; additionally, there is a lack of ligament toughness and elasticity and a greatly reduced capacity for stress responses in the nervous system. Consequently, the risk of exercise-related injuries may increase. Providing an appropriate exercise intensity is a crucial aspect of cardiac rehabilitation, enhancing the efficacy and safety of the treatment. 3.2 Advantages of CPET-Guided Exercise Rehabilitation CPET is an objective and accurate method for assessing cardiopulmonary function in patients after PCI and is relatively safe [15, 16] . For older CHD patients, CPET not only reflects the level of cardiopulmonary function and disease severity but could also be used to assess patients' balance ability and quality of life [17] . By providing reasonable exercise recommendations based on the collected data, CPET could be used to prescribe exercise rehabilitation programs for older CHD patients, helping to mitigate risk during exercise training. In the past, the maximum heart rate has often been used as the standard for designing exercise programs in cardiac rehabilitation. It is usually difficult for older persons to achieve their maximum heart rate, and there are unpredictable exercise risks. Moreover, heart rate could be affected by medications such as beta-blockers. A more ideal standard is to individually evaluate patients' exercise capacity; as exercise capacity improves, CPET could provide guidance for different stages of exercise recommendations. 3.3 Impact of CPET-Guided Exercise Rehabilitation on Exercise Capacity and Exercise Habits In this study, the average age of the patients was 80.5 ± 4.3 years. Exercise intensity was guided based on patients' anaerobic threshold oxygen uptake during exercise tests, encouraging them to engage in regular, continuous, moderate-intensity exercise. The average follow-up period was 12 ± 2 months, after which patients' exercise habits were reassessed and CPET was repeated. The results showed a significant increase in VO 2 peak and other indicators in the regular exercise group, suggesting that CPET-guided exercise rehabilitation can significantly improve patients' exercise capacity. This study found that some patients' exercise habits changed during the follow-up period after receiving cardiac rehabilitation exercise guidance. At enrolment, 7.6% of patients had exercise habits but did not maintain them during the follow-up period. In contrast, more patients (22%) without exercise habits at enrolment began to develop regular exercise habits during the follow-up period. In previous research, cardiac rehabilitation increased exercise participation in CHD patients [18] . CPET-based exercise rehabilitation guidance may help older CHD patients gain more confidence in the safety of exercise, thus increasing their enthusiasm for physical activity. Additionally, this study found that patients with exercise habits during the follow-up period had a significantly higher exercise capacity than those without exercise habits. Patients who did not maintain exercise during the follow-up period experienced a decline in exercise capacity due to age or disease progression, which may counteract the benefits gained from their previous regular exercise. Many medical institutions conduct exercise assessments and cardiac exercise rehabilitation for older CHD patients due to concerns about exercise-related adverse events or potential risks, which limits the development of cardiac exercise rehabilitation programs. However, this study's results suggest that even older CHD patients after PCI can safely and effectively improve their exercise capacity through CPET-guided exercise rehabilitation, with the improvement of exercise habits being a crucial aspect. Current research has also explored the use of remote medical devices to improve patients' adherence to cardiac exercise rehabilitation [19, 20] . However, due to potential barriers in using remote medical devices and the greater social and economic challenges faced by older persons, further exploration of simpler and more effective methods is needed to enhance the therapeutic effects of exercise rehabilitation in this population. This study had certain limitations, as it was a single-centre study. The results may have limited generalizability, necessitating further validation in more medical institutions. Additionally, this study was retrospective and did not involve prospective interventional research. The older persons included in the study had few comorbidities and were able to cooperate with cardiopulmonary exercise tests and exercise rehabilitation. As such, the study's conclusions may not apply to older CHD patients with multiple comorbidities, a bedridden status, or a poor exercise capacity. Furthermore, due to a high amount of missing data regarding quality-of-life scores, such as the SF-36 questionnaire scores, these were not included in the statistical analysis. Conclusion Individualized exercise prescription based on CPET is a safe and effective way to guide cardiac rehabilitation in older CHD patients after PCI, improving their exercise capacity and exercise habits. Declarations Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Peking University Third Hospital (approval number 2020113). Informed Consent Statement: Patient consent was waived due to its retrospective nature of observation. Author contributions ： The authors confirm contribution to the paper as follows: study conception and design: Tao Shen, Zhimin Wei, Peng Wang, Wei Zhao; data collection: Chuan Ren, Yanxin Song, Wei Gao, Fen Liu, Gang Li; analysis and interpretation of results: Tao Shen, Yuwei Wang, Wei Zhao; draft manuscript preparation: Tao Shen, Wei Zhao. All authors reviewed the manuscript. Conflicts of Interest: The authors declare that they have no conflict of interest. Sponsor’s Role: The sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation ofthe paper. Data availability ： The study data are available from the corresponding author upon reasonable request and with the permission of all contributing authors. References Dibben G O, Faulkner J, Oldridge N, et al. 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Tables Table 1 Clinical information of older CHD patients after PCI Parameters Total (%), mean ± SD Age (years) 80.5±4.3 Male, N (%) 305 (75.6) BMI (Kg/m 2 ) 25.1±3.5 History of myocardial infarction, N (%) 134 (16.6) Complete revascularization, N (%) 316 (78.4) NYHA class II, N (%) 185 (49.5) Hypertension, N (%) 271 (67.2) Diabetes, N (%) 116 (28.7) Hyperlipidemia, N (%) 262 (65.0) Smoking history, N (%) 143 (35.4) Family history of CHD, N (%) 93 (23.0) Exercise habits, N (%) 256 (63.5) Abbreviation：CHD, coronary heart disease; PCI, percutaneous coronary intervention; BMI, body mass index; Table 2 Characteristics of older persons after PCI during the baseline and follow-up period Characteristics Baseline Follow-up P value BMI (kg/m 2 ) 25.1±2.9 25.0±2.8 0.726 Laboratory indicators Cr (μmol/L) 88.0±11.5 87.4±21.8 0.544 LDL (mmol/L) 2.0±0.6 1.4±0.5 0.032 Hb (g/L) 132.4±16.5 145.1±14.9 0.653 NT-proBNP (pg/ml) 305.5±19.4 225.6±11.1 0.013 Echocardiography indicators LVEDD (mm) 47.1±5.6 48.1±3.7 0.565 LVEF (%) 65.7±8.3 66.8±7.6 0.317 Sm (cm/s) 9.3±1.9 9.0±1.5 0.191 E/Em 6.9±2.2 7.5±2.3 0.028 LAP (mmHg) 10.8±2.8 10.1±2.8 0.017 CPET indicators VO 2 @AT (ml/min/kg) 12.9±3.7 13.8±4.2 <0.001 HR@AT (bpm) 98±13 97±11 0.809 VO 2 peak (ml/min/kg) 15.5±3.8 17.3±4.1 0.013 Peak HR (bpm) 118±17 122±16 0.012 Peak SBP (mmHg) 169±24 171±25 0.089 VE/VCO 2 slope 31.9±5.1 30.9±6.1 <0.001 OUES 1488.8±395.2 1498.1±328.1 0.453 HRR 17±7 19±8 <0.001 Abbreviation: PCI, percutaneous coronary intervention; BMI, body mass index; Cr, creatinine; LDL, low density lipoprotein; Hb, hemoglobin; NT-proBNP, N-terminal pro-brain natriuretic peptide; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; Sm, systolic velocity of mitral annulus; E/Em, the ratio of early diastolic transmitral flow velocity to early diastolic tissue velocity; LAP, left atrium pressure; VO 2 @AT, oxygen uptake at anaerobic threshold; HR@AT, heart rate at anaerobic threshold; VO 2 peak, peak oxygen uptake; Peak HR, peak heart rate; Peak SBP, peak systolic blood pressure; VE/VCO 2 slope, ventilation per carbon dioxide output slope; OUES, oxygen uptake efficiency slope; HRR, heart rate recovery. Table 3 CPET indicators of older persons after PCI during the follow-up period Characteristics With exercise habits (n=315) Without exercise habits (n=88) P value Age (years) 80.7±4.3 83.9±3.9 0.007 Male (%) 251(79.6) 54 (61.3) <0.001 BMI (kg/m 2 ) 25.0±2.9 25.4±3.0 0.736 Laboratory indicators Cr (μmol/L) 88.2±13.9 89.1±17.3 0.057 LDL (mmol/L) 1.9±0.6 1.8±0.5 0.609 Hb (g/L) 137.1±15.4 140.3±15.3 0.671 NT-proBNP (pg/ml) 274.7±14.5 251.5±13.8 0.217 Echocardiography indicators LVEDD (mm) 47.5±4.9 48.1±4.3 0.513 LVEF (%) 66.0±8.0 67.6±7.9 0.387 Sm (cm/s) 9.2±1.7 8.9±1.7 0.981 E/Em 7.2±2.2 7.8±2.4 0.384 LAP (mmHg) 10.3±2.8 11.1±3.0 0.540 CPET indicators VO 2 @AT (ml/min/kg) 14.2±4.1 12.9±3.4 0.002 HR@AT (bpm) 97±12 98±13 0.426 VO 2 peak (ml/min/kg) 17.6±4.0 13.9±4.3 <0.001 ΔVO 2 peak (ml/min/kg) 1.62±0.31 -0.02±0.01 <0.001 Peak HR (bpm) 123±16 119±17 0.026 Peak SBP (mmHg) 170±25 165±27 0.834 VE/VCO 2 slope 31.2±5.0 31.2±6.7 0.989 OUES 1505.9±350.5 1460.3±362.4 0.289 HRR 20±8 17±9 0.034 Abbreviation：PCI, percutaneous coronary intervention; BMI, body mass index; Cr, creatinine; LDL, low density lipoprotein; Hb, hemoglobin; NT-proBNP, N-terminal pro-brain natriuretic peptide; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; Sm, systolic velocity of mitral annulus; E/Em, the ratio of early diastolic transmitral flow velocity to early diastolic tissue velocity; LAP, left atrium pressure; VO 2 @AT, oxygen uptake at anaerobic threshold; HR@AT, heart rate at anaerobic threshold; VO 2 peak, peak oxygen uptake; Peak HR, peak heart rate; Peak SBP, peak systolic blood pressure; VE/VCO 2 slope, ventilation per carbon dioxide output slope; OUES, oxygen uptake efficiency slope; HRR, heart rate recovery. Table 4 Multiple factor analysis of ΔVO 2 peak B SE t P 95% CI. Age -0.114 0.087 -6.940 0.023 (-0.158, -0.061) Myocardial infarction history -1.054 0.610 -2.074 0.017 (-1.391, -0.772) With exercise habits during follow-up period -0.406 0.063 -2.650 0.001 (-0.561, -0.284) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Nov, 2023 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Major revision 25 Oct, 2023 Reviews received at journal 22 Oct, 2023 Reviews received at journal 20 Sep, 2023 Reviewers agreed at journal 19 Sep, 2023 Reviewers invited by journal 19 Sep, 2023 Editor assigned by journal 19 Sep, 2023 Editor invited by journal 04 Sep, 2023 Submission checks completed at journal 04 Sep, 2023 First submitted to journal 23 Jul, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3196230","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":230834491,"identity":"ab997bd9-93d5-4a46-b282-cf87b79e9e23","order_by":0,"name":"Tao Shen","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Shen","suffix":""},{"id":230834492,"identity":"3045a885-5950-46f0-b924-b63e9eb82846","order_by":1,"name":"Yuwei Wang","email":"","orcid":"","institution":"Health Service Department of the GuardHealth Service 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Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Gao","suffix":""},{"id":230834496,"identity":"1d3436d7-866f-42b8-92ca-9e1d89fc411b","order_by":5,"name":"Fen Liu","email":"","orcid":"","institution":"Health Service Department of the GuardHealth Service Department of the Guard Bureau of the Joint Staff Department","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fen","middleName":"","lastName":"Liu","suffix":""},{"id":230834497,"identity":"7206e8e1-52e9-434a-8b53-61fbaaceefae","order_by":6,"name":"Gang Li","email":"","orcid":"","institution":"Health Service Department of the GuardHealth Service Department of the Guard Bureau of the Joint Staff Department","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gang","middleName":"","lastName":"Li","suffix":""},{"id":230834498,"identity":"d5dbbae6-7b75-4e4c-8845-33dd286e759b","order_by":7,"name":"Zhimin Wei","email":"","orcid":"","institution":"Health Service Department of the GuardHealth Service Department of the Guard Bureau of the Joint Staff Department","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhimin","middleName":"","lastName":"Wei","suffix":""},{"id":230834499,"identity":"e16c7b56-54ed-4a97-bfcd-76b688c6d03d","order_by":8,"name":"Peng Wang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Wang","suffix":""},{"id":230834500,"identity":"3334310c-a20d-4ab6-a4d3-cfd5cff6aa59","order_by":9,"name":"Wei Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACAxiDX4IhAUQzNhChBaJIcgbJWgxuQAQIazFnb37+4APD4cTNtxuebuZhsJHdcID52QN8Wix7jhk2zgBq2XbnQNptHoY04w0H2MwN8GkxuJFg2AxSaXYjAaTlcOKGAzxsEni13H/+sfkPUIvxDLCW/0RoucFj2MzAYCNnIAHWcoCwFsuenMKZPUAtEkC/3JxjkGw88zCbGV4t5uzHN3z4wSDBwz+7J+3Gmwo72b7jzc/wagEDxn8gkicBkhiYCaqHA/YDxKsdBaNgFIyCEQUAJlhLdry8nHcAAAAASUVORK5CYII=","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2023-07-23 09:44:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3196230/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3196230/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-023-47494-x","type":"published","date":"2023-11-15T15:01:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":42779223,"identity":"748d878a-d9c8-49c9-812b-aa1e01157949","added_by":"auto","created_at":"2023-09-07 14:49:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41767,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3196230/v1/83577df9e8ad2fc8cfc27be3.png"},{"id":42779224,"identity":"788265e9-336d-40f5-9e71-6fb893c3f923","added_by":"auto","created_at":"2023-09-07 14:49:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10730,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatients’ exercise habits and VO\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sub\u003e\u003cstrong\u003epeak before and after intervention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3196230/v1/550ba8cc3fc50034bcaf211b.png"},{"id":46780035,"identity":"55a058ab-6ef0-4ef5-99e8-5bca9921031b","added_by":"auto","created_at":"2023-11-20 15:08:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":560069,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3196230/v1/2398f96c-6c21-4948-9065-2214f969f91c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effects of CPET-guided cardiac rehabilitation on exercise tolerance in older persons with CHD after PCI","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiac rehabilitation, as an important intervention measure,\u0026nbsp;is\u0026nbsp;of great significance\u0026nbsp;for\u0026nbsp;improving the clinical outcomes of patients with coronary heart disease (CHD)\u0026nbsp;\u003csup\u003e[1, 2]\u003c/sup\u003e. For older persons who undergo revascularization, prescribing appropriate exercise is an important means to improve the safety and efficacy of exercise rehabilitation. Cardiopulmonary exercise testing (CPET) could provide essential guidance for determining the aerobic exercise intensity for CHD patients, but there has been insufficient research on its influence in older persons. The purpose of this study was to observe the impact of cardiac rehabilitation guidance based on CPET on cardiopulmonary exercise tolerance and exercise adherence in older persons with CHD after percutaneous coronary intervention (PCI) in the context of standardized drug treatment for CHD. This work will be helpful for providing clinical evidence for cardiac rehabilitation therapy in older persons with CHD after PCI.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 General Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively included CHD patients aged \u0026ge;75 years who underwent PCI and exercise rehabilitation guided by CPET at the Cardiac Rehabilitation Center of Peking University Third Hospital from January 2014 to December 2019 (Figure 1).\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows: age \u0026ge;75 years; successful PCI; CPET-guided cardiac rehabilitation with a clinical follow-up evaluation after one year;\u0026nbsp;and\u0026nbsp;complete clinical data, medication history, biochemical data, and echocardiographic data.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The exclusion criteria were as follows: positive exercise electrocardiogram (ECG); NYHA class III-IV heart function; malignant arrhythmia; valvular heart disease; history of coronary artery bypass graft surgery; and concomitant malignant tumours, haematologic diseases, rheumatic immune diseases, or severe liver or kidney dysfunction.\u003c/p\u003e\n\u003cp\u003eA positive exercise ECG was defined as follows: R-wave dominant leads, horizontal or downsloping ST-segment depression \u0026ge;0.1 mV\u0026nbsp;at 60-80 ms\u0026nbsp;after the J-point, lasting \u0026ge;2 minutes; and\u0026nbsp;nonpathological\u0026nbsp;Q-wave leads, upsloping ST-segment elevation \u0026ge;0.1 mV, lasting \u0026ge;1 minute.\u003c/p\u003e\n\u003cp\u003eWe collected and organized the following patient data: (1) general information, including\u0026nbsp;sex, age, disease diagnosis, height, weight, etc.; (2) past medical history and family history, including history of cardiovascular risk factors such as hypertension, diabetes, hyperlipidaemia, respiratory diseases such as chronic obstructive pulmonary disease, musculoskeletal and neurological disease history, and family history of early-onset CHD, etc.; (3) personal history, including smoking history, exercise habits, etc.;\u0026nbsp;and\u0026nbsp;(4) laboratory test, echocardiography, and CPET results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 \u0026nbsp;Cardiopulmonary Exercise Testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe testing equipment used was the Medgraphics (USA) ULTIMA CardiO2 Cardiopulmonary Exercise System. All patients performed exercise testing using a cycle ergometer, adopting a bicycle exercise protocol.\u0026nbsp;Symptom-limited exercise was encouraged. Patients\u0026apos; electrocardiogram (ECG), blood pressure, and symptoms were monitored. The entire process was carried out under the supervision of a professional physician.\u003c/p\u003e\n\u003cp\u003eDuring the test, continuous recording of patients\u0026apos; ECG, blood pressure, and gas exchange information\u0026nbsp;was\u0026nbsp;performed, including the following parameters: oxygen uptake at anaerobic threshold (VO\u003csub\u003e2\u003c/sub\u003e@AT); heart rate at anaerobic threshold (HR@AT); oxygen pulse at anaerobic threshold; peak oxygen uptake (VO\u003csub\u003e2\u003c/sub\u003epeak); peak heart rate (peak HR); ventilation per carbon dioxide output slope (VE/VCO\u003csub\u003e2\u003c/sub\u003e slope); oxygen uptake efficiency slope (OUES); and 1-min heart rate recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 \u0026nbsp; Exercise Prescription\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividualized exercise rehabilitation prescriptions based on the cardiopulmonary exercise testing system were implemented. Exercise intensity was prescribed using the anaerobic threshold heart rate \u0026plusmn;5 bpm \u003csup\u003e[3]\u003c/sup\u003e, along\u0026nbsp;with\u0026nbsp;prescriptions for\u0026nbsp;strength training and balance and coordination training. Aerobic exercise modalities such as walking, cycling, and swimming were recommended, with moderate-intensity continuous exercise performed 3-5 days per week for 30-60 minutes per day, including warm-up, training, and recovery sections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 \u0026nbsp;Study Endpoints\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary endpoint of this study was the change in patients\u0026apos; exercise tolerance, represented by VO\u003csub\u003e2\u003c/sub\u003epeak and other CPET parameters during the follow-up period. Secondary endpoints included differences in exercise habits. According to the American College of Sports Medicine (ACSM) 10th Edition \u0026quot;ACSM\u0026apos;s Guidelines for Exercise Testing and Prescription\u0026quot;\u003csup\u003e[4]\u003c/sup\u003e,\u0026nbsp;exercising\u0026nbsp;\u0026ge;3 times per week,\u0026nbsp;\u0026ge;30 minutes per session, and for a duration of\u0026nbsp;\u0026ge;3 months indicated the presence of exercise habits; those who did not meet this standard were considered to have no exercise habits. Other secondary endpoints included patients\u0026apos; blood test results, echocardiographic parameters, and adverse events during the follow-up period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.5 Statistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS 22.0 was used for data analysis and statistics.\u0026nbsp;The\u0026nbsp;Shapiro‒Wilk normality test was performed on all quantitative data in the analysed samples. Normally distributed quantitative data\u0026nbsp;are\u0026nbsp;expressed as\u0026nbsp;the\u0026nbsp;mean \u0026plusmn; standard deviation (s), and\u0026nbsp;nonnormally\u0026nbsp;distributed quantitative data are expressed as\u0026nbsp;the\u0026nbsp;median (Q1, Q3). Group comparisons were made using paired t tests and Mann‒Whitney U tests, with paired t tests applied for normally distributed data and Mann‒Whitney U tests for\u0026nbsp;nonnormally\u0026nbsp;distributed data. Categorical variables were analysed using chi-square tests. A two-sided\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 General Patient Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 403 older persons with CHD after PCI were analysed (Table 1). The average age of the patients was 80.5 \u0026plusmn; 4.3 years, and there were 305 (75.6%) males.\u0026nbsp;A total of\u0026nbsp;336 (83.4%) patients had one or more CHD risk factors (including hypertension, diabetes, hyperlipidaemia, and smoking).\u0026nbsp;A total of\u0026nbsp;134 (16.6%) patients had a history of myocardial infarction. Complete revascularization was achieved in 316 (78.4%) patients.\u0026nbsp;A total of\u0026nbsp;185 (45.9%) patients were classified as NYHA functional class II.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Comparison of Baseline and Follow-up Patient Indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeneral patient data, laboratory indicators, echocardiographic parameters, and CPET indicators were analysed at baseline and during the follow-up period (Table 2). No deaths occurred during the follow-up period. In terms of laboratory indicators, patients had lower low-density lipoprotein (LDL) levels (2.0 \u0026plusmn; 0.6 mmol/L \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e1.4 \u0026plusmn; 0.5 mmol/L, \u003cem\u003eP\u003c/em\u003e = 0.032) and lower N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (305.5 \u0026plusmn; 19.4 pg/ml \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e225.6 \u0026plusmn; 11.1 pg/ml, \u003cem\u003eP\u003c/em\u003e = 0.013) during the follow-up period.\u003c/p\u003e\n\u003cp\u003eIn terms of echocardiographic parameters, there was no significant change in the left ventricular ejection fraction (LVEF) during the follow-up period (65.7 \u0026plusmn; 8.3% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e66.8 \u0026plusmn; 7.6%, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.317), but indicators of left ventricular diastolic dysfunction, i.e., the ratio of early diastolic transmitral flow velocity to early diastolic tissue velocity (6.9 \u0026plusmn; 2.2 \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e7.5 \u0026plusmn; 2.3, \u003cem\u003eP\u003c/em\u003e = 0.028) and left atrium pressure (10.8 \u0026plusmn; 2.8 mmHg \u003cem\u003evs.\u003c/em\u003e 10.1 \u0026plusmn; 2.8 mmHg, \u003cem\u003eP\u003c/em\u003e = 0.028), improved.\u003c/p\u003e\n\u003cp\u003eIn terms of cardiopulmonary exercise parameters, patients had higher VO\u003csub\u003e2\u003c/sub\u003e@AT (12.9 \u0026plusmn; 3.7 ml/min/kg\u003cem\u003e\u0026nbsp;vs.\u0026nbsp;\u003c/em\u003e13.8 \u0026plusmn; 4.2 mmHg, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), VO\u003csub\u003e2\u003c/sub\u003epeak (15.5 \u0026plusmn; 3.8 ml/min/kg\u003cem\u003e\u0026nbsp;vs.\u0026nbsp;\u003c/em\u003e17.3 \u0026plusmn; 4.1 mmHg, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.013), and\u0026nbsp;peak\u0026nbsp;HR (118 \u0026plusmn; 17 bpm \u003cem\u003evs.\u003c/em\u003e 122 \u0026plusmn; 16 bpm, \u003cem\u003eP\u003c/em\u003e = 0.012) values during the follow-up period\u0026nbsp;than at\u0026nbsp;baseline. The VE/VCO\u003csub\u003e2\u003c/sub\u003e slope, reflecting respiratory efficiency, improved (31.9 \u0026plusmn; 5.1 \u003cem\u003evs.\u003c/em\u003e 30.9 \u0026plusmn; 6.1, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), and the 1-min heart rate recovery increased (17 \u0026plusmn; 7 bpm \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e19 \u0026plusmn; 8 bpm, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003ePatients were grouped based on whether they had exercise habits during the follow-up period. At the follow-up, patients with exercise habits were younger (80.7 \u0026plusmn; 4.3 ml/kg/min \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e83.9 \u0026plusmn; 3.9 ml/kg/min, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e= 0.007) and had higher \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak (1.62 \u0026plusmn; 0.31 ml/kg/min \u003cem\u003evs.\u003c/em\u003e -0.02 \u0026plusmn; 0.01 ml/kg/min, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) and VO\u003csub\u003e2\u003c/sub\u003e@AT (14.2 \u0026plusmn; 4.1 ml/kg/min \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e12.9 \u0026plusmn; 3.4 ml/kg/min, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) values than patients without exercise habits. No significant differences were observed between the two groups in terms of laboratory or echocardiographic parameters (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Improvement in Patients\u0026apos; Exercise Habits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChanges in patients\u0026apos; exercise habits and exercise tolerance from baseline to follow-up\u0026nbsp;were\u0026nbsp;as follows: 57 patients (14.1%) had no exercise habits at baseline\u0026nbsp;or\u0026nbsp;during the follow-up period; 31 patients (7.6%) had exercise habits at baseline but did not maintain them during the follow-up period; 90 patients (22.2%) had no exercise habits at baseline but started regular exercise during the follow-up period; and 225 patients (55.8%) maintained exercise habits at baseline and during the follow-up period. The baseline and follow-up oxygen uptake in each group is shown in Figure 2, with \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak values of -0.2\u0026plusmn;0.1 ml/kg/min, -0.3\u0026plusmn;0.1 ml/kg/min, 3.2\u0026plusmn;0.4 ml/kg/min, and 1.0\u0026plusmn;0.2 ml/kg/min, respectively. The improvement in VO\u003csub\u003e2\u003c/sub\u003epeak was most pronounced in patients who had no exercise habits at baseline but developed them during the follow-up period. VO\u003csub\u003e2\u003c/sub\u003epeak did not improve in patients without exercise habits during the follow-up period, regardless of whether they had exercise habits at baseline.\u003c/p\u003e\n\u003cp\u003eSpearman correlation analysis was performed on patients\u0026apos; clinical data with \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak. Exercise habits during the follow-up period (rs=-0.601,\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.001), age (rs=-0.353, P\u0026lt;0.001), and history of myocardial infarction (rs=-0.293, \u003cem\u003eP\u003c/em\u003e=0.029) were significantly correlated with \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak, while other clinical data and combined medication use were not significantly correlated with \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak. Multivariate linear regression analysis was performed on \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak with the parameters that were significantly correlated with \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak in the univariate analysis, with the main factors such as exercise habits during the follow-up period as independent variables. The results showed that exercise habits during the follow-up period (B=-0.406, SE=0.063, t=-6.650, \u003cem\u003eP\u003c/em\u003e=0.001,\u003cem\u003e\u0026nbsp;95% CI\u003c/em\u003e: -0.561~-0.284), age, and history of myocardial infarction were independent influencing factors of \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e3.1 Significant Clinical Benefits of Exercise Rehabilitation for Older persons with CHD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePCI has become the most important means of revascularization for CHD\u0026nbsp;patients,\u0026nbsp;not only effectively improving patients\u0026apos; clinical symptoms but also significantly reducing the mortality of acute myocardial infarction and high-risk angina patients. However, for older persons, the cardiovascular risk of heart failure, arrhythmia, and sudden death remain after PCI due to the added effects of age-related physiological changes. Compared to non-CHD patients, exercise tolerance is significantly reduced in CHD patients. The decline in exercise tolerance is even more pronounced in older persons with CHD, who may also have mental issues such as depression and dementia, severely affecting their quality of life\u0026nbsp;\u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePrevious studies found that increased daily physical activity was associated with a reduced mortality rate in CHD patients, particularly in those who were sedentary, as they experienced greater cardiovascular benefits\u0026nbsp;\u003csup\u003e[6]\u003c/sup\u003e. Cardiac rehabilitation could promote the physical and mental health of older persons, improving their quality of life\u0026nbsp;\u003csup\u003e[7, 8]\u003c/sup\u003e, and\u0026nbsp;offer\u0026nbsp;benefits for older CHD patients, such as reduced mortality and rehospitalization rates and further revascularization\u0026nbsp;\u003csup\u003e[9, 10]\u003c/sup\u003e. Many studies\u0026nbsp;have\u0026nbsp;reported that aerobic exercise training\u0026nbsp;improves\u0026nbsp;exercise capacity, frailty, and quality of life in older CHD patients\u0026nbsp;\u003csup\u003e[11-14]\u003c/sup\u003e. However, the patients included in these previous studies were relatively young compared with those in the current study. In particular, in CHD patients aged 75 and older, muscle degeneration and atrophy are more severe; additionally, there is\u0026nbsp;a lack\u0026nbsp;of ligament toughness and elasticity and a greatly reduced capacity for stress responses in the nervous system. Consequently, the risk of exercise-related injuries may increase. Providing an appropriate exercise intensity is a crucial aspect of cardiac rehabilitation, enhancing the efficacy and safety of the treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Advantages of CPET-Guided Exercise Rehabilitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCPET\u0026nbsp;is\u0026nbsp;an objective and accurate method for assessing cardiopulmonary function in patients after PCI and\u0026nbsp;is\u0026nbsp;relatively safe\u0026nbsp;\u003csup\u003e[15, 16]\u003c/sup\u003e. For older CHD patients, CPET not only reflects the level of cardiopulmonary function and disease severity but could also be used to assess patients\u0026apos; balance ability and quality of life\u0026nbsp;\u003csup\u003e[17]\u003c/sup\u003e. By providing reasonable exercise recommendations based on the collected data, CPET could be used to prescribe exercise rehabilitation programs for older CHD patients, helping to mitigate risk during exercise training.\u003c/p\u003e\n\u003cp\u003eIn the past, the maximum heart rate has often been used as the standard for designing exercise programs in cardiac rehabilitation. It\u0026nbsp;is\u0026nbsp;usually difficult for older persons to achieve their maximum heart rate, and there\u0026nbsp;are\u0026nbsp;unpredictable exercise risks. Moreover, heart rate could be affected by medications such as beta-blockers. A more ideal standard is to individually evaluate patients\u0026apos; exercise capacity; as exercise capacity improves, CPET could provide guidance for different stages of exercise recommendations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Impact of CPET-Guided Exercise Rehabilitation on Exercise Capacity and Exercise Habits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the average age of\u0026nbsp;the\u0026nbsp;patients was 80.5 \u0026plusmn; 4.3\u0026nbsp;years. Exercise intensity was guided based on patients\u0026apos; anaerobic threshold oxygen uptake during exercise tests, encouraging them to engage in regular, continuous, moderate-intensity exercise. The average follow-up period was 12 \u0026plusmn; 2 months, after which patients\u0026apos; exercise habits were reassessed and CPET was repeated. The results showed a significant increase in VO\u003csub\u003e2\u003c/sub\u003epeak and other indicators in the regular exercise group, suggesting that CPET-guided exercise rehabilitation can significantly improve patients\u0026apos; exercise capacity.\u003c/p\u003e\n\u003cp\u003eThis study found that some patients\u0026apos; exercise habits changed during the follow-up period after receiving cardiac rehabilitation exercise guidance. At enrolment, 7.6% of patients had exercise habits but did not maintain them during the follow-up period. In contrast, more patients (22%) without exercise habits at enrolment began to develop regular exercise habits during the follow-up period.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In previous research, cardiac rehabilitation increased exercise participation in CHD patients\u0026nbsp;\u003csup\u003e[18]\u003c/sup\u003e. CPET-based exercise rehabilitation guidance may help older CHD patients gain more confidence in the safety of exercise, thus increasing their enthusiasm for physical activity. Additionally, this study found that patients with exercise habits during the follow-up period had a significantly higher exercise capacity than those without exercise habits. Patients who did not maintain exercise during the follow-up period experienced a decline in exercise capacity due to age or disease progression, which may counteract the benefits gained from their previous regular exercise.\u003c/p\u003e\n\u003cp\u003eMany medical institutions conduct exercise assessments and cardiac exercise rehabilitation for older CHD patients due to concerns about exercise-related adverse events or potential risks, which limits the development of cardiac exercise rehabilitation programs. However, this study\u0026apos;s results suggest that even older CHD patients after PCI can safely and effectively improve their exercise capacity through CPET-guided exercise rehabilitation, with the improvement of exercise habits being a crucial aspect. Current research\u0026nbsp;has\u0026nbsp;also explored the use of remote medical devices to improve patients\u0026apos; adherence to cardiac exercise rehabilitation\u0026nbsp;\u003csup\u003e[19, 20]\u003c/sup\u003e. However, due to potential barriers in using remote medical devices and the greater social and economic challenges faced by older persons, further exploration of simpler and more effective methods\u0026nbsp;is\u0026nbsp;needed to enhance the therapeutic effects of exercise rehabilitation in this population.\u003c/p\u003e\n\u003cp\u003eThis study had certain limitations, as it was a single-centre study. The results may have limited generalizability, necessitating further validation in more medical institutions. Additionally, this study was retrospective and did not involve prospective interventional research. The older persons included in the study had few comorbidities and were able to cooperate with cardiopulmonary exercise tests and exercise rehabilitation. As such, the study\u0026apos;s conclusions may not apply to older CHD patients with multiple comorbidities, a bedridden status, or a poor exercise capacity. Furthermore, due to a high amount of missing data regarding quality-of-life scores, such as the SF-36 questionnaire scores, these were not included in the statistical analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIndividualized exercise prescription based on CPET is a safe and effective way to guide cardiac rehabilitation in older CHD patients after PCI, improving their exercise capacity and exercise habits.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Peking University Third Hospital (approval number 2020113).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003ePatient consent was waived due to its retrospective nature of observation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe authors confirm contribution to the paper as follows: study conception and design: Tao Shen, Zhimin Wei, Peng Wang, Wei Zhao; data collection: Chuan Ren, Yanxin Song, Wei Gao, Fen Liu, Gang Li; analysis and interpretation of results: Tao Shen, Yuwei Wang, Wei Zhao; draft manuscript preparation: Tao Shen, Wei Zhao. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSponsor\u0026rsquo;s Role:\u0026nbsp;\u003c/strong\u003eThe sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation ofthe paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe study data are available from the corresponding author upon reasonable request and with the permission of all contributing authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDibben G O, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis [J]. Eur Heart J, 2023, 44(6): 452\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNichols S, McGregor G, Breckon J, et al. Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure [J]. International journal of sports medicine, 2021, 42(1): 19\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuazzi M, Adams V, Conraads V, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations [J]. Circulation, 2012, 126(18): 2261\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiebe D E J, Liguori G, et al. ACSM\u0026rsquo;s Guidelines for Exercise Testing and Prescription [J]. American College of Sports Medicine, 2018, pp\u0026nbsp;147\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlsen S J, Schirmer H, Wilsgaard T, et al. Cardiac rehabilitation and symptoms of anxiety and depression after percutaneous coronary intervention [J]. European journal of preventive cardiology, 2018, 25(10): 1017\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStewart R A H, Held C, Hadziosmanovic N, et al. Physical Activity and Mortality in Patients With Stable Coronary Heart Disease [J]. Journal of the American College of Cardiology, 2017, 70(14): 1689\u0026ndash;700.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo Y P, Chiang S L, Lin C H, et al. Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial [J]. International journal of environmental research and public health, 2020, 18(1): 101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmart T F F, Doleman B, Hatt J, et al. The role of resistance exercise training for improving cardiorespiratory fitness in healthy older adults: a systematic review and meta-analysis [J]. Age and ageing, 2022, 51(6): afac143.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruning R S, Sturek M. Benefits of exercise training on coronary blood flow in coronary arter y disease patients [J]. Prog Cardiovasc Dis, 2015, 57(5): 443\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWenger N K. Exercise testing and training of the elderly coronary patient [J]. Chest, 1992, 101(5 Suppl): 309s-11s.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C H, Chen Y J, Tu H P, et al. Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease [J]. Kaohsiung J Med Sci, 2014, 30(10): 521\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeigienė A, Petruševičienė D, Barasaitė V, et al. Cardiac Rehabilitation and Complementary Physical Training in Elderly Patients after Acute Coronary Syndrome: A Pilot Study [J]. Medicina (Kaunas, Lithuania), 2021, 57(6): 529.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeigienė A, Petruševičienė D, Barasaitė V, et al. Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome [J]. Medicina (Kaunas, Lithuania), 2021, 57(12): 1344.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeka P, Pathak D, Klompstra L, et al. High-Intensity Interval and Resistance Training Improve Health Outcomes in Older Adults With Coronary Disease [J]. Journal of the American Medical Directors Association, 2022, 23(1): 60\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen T, Ren C, Zhao W, et al. Development and Validation of a Prediction Model for Cardiovascular Events in Exercise Assessment of Coronary Heart Disease Patients After Percutaneous Coronary Intervention [J]. Frontiers in cardiovascular medicine, 2022, 9: 798446.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen T, Liu D, Lin Z, et al. A Machine Learning Model to Predict Cardiovascular Events during Exercise Evaluation in Patients with Coronary Heart Disease [J]. Journal of clinical medicine, 2022, 11(20): 6061.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuazzi M, Arena R, Halle M, et al. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations [J]. Eur Heart J, 2016, 39(14): 1144\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDibben G O, Dalal H M, Taylor R S, et al. Cardiac rehabilitation and physical activity: systematic review and meta-analysis [J]. Heart (British Cardiac Society), 2018, 104(17): 1394\u0026ndash;402.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong Y, Ren C, Liu P, et al. Effect of Smartphone-Based Telemonitored Exercise Rehabilitation among Patients with Coronary Heart Disease [J]. Journal of cardiovascular translational research, 2020, 13(4): 659\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScherrenberg M, Zeymer U, Schneider S, et al. EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly? [J]. Int J Cardiol, 2021, 340: 1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Clinical information of older CHD patients after PCI\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%), mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e80.5\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eMale, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e305\u0026nbsp;(75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e25.1\u0026plusmn;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eHistory of myocardial infarction, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e134 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eComplete revascularization, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e316 (78.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eNYHA class II, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e185 (49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eHypertension, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e271 (67.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eDiabetes, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e116 (28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eHyperlipidemia, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e262 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eSmoking history, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e143 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eFamily history of CHD, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e93 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.60474308300395%\" valign=\"bottom\"\u003e\n \u003cp\u003eExercise habits, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.39525691699605%\" valign=\"bottom\"\u003e\n \u003cp\u003e256 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation：CHD, coronary heart disease; PCI, percutaneous coronary intervention; BMI, body mass index;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Characteristics of older persons after PCI during the baseline and follow-up period\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e25.1\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e25.0\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eCr (\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e88.0\u0026plusmn;11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e87.4\u0026plusmn;21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eLDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e2.0\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e1.4\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eHb (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e132.4\u0026plusmn;16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e145.1\u0026plusmn;14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eNT-proBNP (pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e305.5\u0026plusmn;19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e225.6\u0026plusmn;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEchocardiography indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e47.1\u0026plusmn;5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e48.1\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eLVEF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e65.7\u0026plusmn;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e66.8\u0026plusmn;7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eSm (cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e9.3\u0026plusmn;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e9.0\u0026plusmn;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eE/Em\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e6.9\u0026plusmn;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e7.5\u0026plusmn;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eLAP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e10.8\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e10.1\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPET indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eVO\u003csub\u003e2\u003c/sub\u003e@AT\u0026nbsp;(ml/min/kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e12.9\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e13.8\u0026plusmn;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eHR@AT (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e98\u0026plusmn;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e97\u0026plusmn;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eVO\u003csub\u003e2\u003c/sub\u003epeak (ml/min/kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e15.5\u0026plusmn;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e17.3\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003ePeak HR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e118\u0026plusmn;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e122\u0026plusmn;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003ePeak SBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e169\u0026plusmn;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e171\u0026plusmn;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eVE/VCO\u003csub\u003e2\u003c/sub\u003e slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e31.9\u0026plusmn;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e30.9\u0026plusmn;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eOUES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e1488.8\u0026plusmn;395.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e1498.1\u0026plusmn;328.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.95798319327731%\" valign=\"top\"\u003e\n \u003cp\u003eHRR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e17\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e19\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.672268907563026%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation: PCI, percutaneous coronary intervention; BMI, body mass index; Cr, creatinine; LDL, low density lipoprotein; Hb, hemoglobin; NT-proBNP, N-terminal pro-brain natriuretic peptide; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; Sm, systolic velocity of mitral annulus; E/Em, the ratio of early diastolic transmitral flow velocity to early diastolic tissue velocity; LAP, left atrium pressure; VO\u003csub\u003e2\u003c/sub\u003e@AT, oxygen uptake at anaerobic threshold; HR@AT, heart rate at anaerobic threshold; VO\u003csub\u003e2\u003c/sub\u003epeak, peak oxygen uptake; Peak HR, peak heart rate; Peak SBP, peak systolic blood pressure; VE/VCO\u003csub\u003e2\u003c/sub\u003e slope, ventilation per carbon dioxide output slope; OUES, oxygen uptake efficiency slope; HRR, heart rate recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 CPET indicators of older persons after PCI during the follow-up period\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith exercise habits\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=315)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout exercise habits\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=88)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e80.7\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e83.9\u0026plusmn;3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eMale (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e251(79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e54 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e25.0\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e25.4\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eCr (\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e88.2\u0026plusmn;13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e89.1\u0026plusmn;17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eLDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e1.8\u0026plusmn;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eHb (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e137.1\u0026plusmn;15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e140.3\u0026plusmn;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eNT-proBNP (pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e274.7\u0026plusmn;14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e251.5\u0026plusmn;13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEchocardiography indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eLVEDD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e47.5\u0026plusmn;4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e48.1\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eLVEF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e66.0\u0026plusmn;8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e67.6\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eSm (cm/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e9.2\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e8.9\u0026plusmn;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eE/Em\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e7.2\u0026plusmn;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e7.8\u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eLAP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e10.3\u0026plusmn;2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e11.1\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCPET indicators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eVO\u003csub\u003e2\u003c/sub\u003e@AT\u0026nbsp;(ml/min/kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e14.2\u0026plusmn;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e12.9\u0026plusmn;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eHR@AT (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e97\u0026plusmn;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e98\u0026plusmn;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.426\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eVO\u003csub\u003e2\u003c/sub\u003epeak (ml/min/kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e17.6\u0026plusmn;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e13.9\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak (ml/min/kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e1.62\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e-0.02\u0026plusmn;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003ePeak HR (bpm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e123\u0026plusmn;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e119\u0026plusmn;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003ePeak SBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e170\u0026plusmn;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e165\u0026plusmn;27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eVE/VCO\u003csub\u003e2\u003c/sub\u003e slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e31.2\u0026plusmn;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e31.2\u0026plusmn;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eOUES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e1505.9\u0026plusmn;350.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e1460.3\u0026plusmn;362.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.38926174496644%\" valign=\"top\"\u003e\n \u003cp\u003eHRR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.14765100671141%\" valign=\"top\"\u003e\n \u003cp\u003e20\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.013422818791945%\" valign=\"top\"\u003e\n \u003cp\u003e17\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.449664429530202%\" valign=\"top\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation：PCI, percutaneous coronary intervention; BMI, body mass index; Cr, creatinine; LDL, low density lipoprotein; Hb, hemoglobin; NT-proBNP, N-terminal pro-brain natriuretic peptide; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; Sm, systolic velocity of mitral annulus; E/Em, the ratio of early diastolic transmitral flow velocity to early diastolic tissue velocity; LAP, left atrium pressure; VO\u003csub\u003e2\u003c/sub\u003e@AT, oxygen uptake at anaerobic threshold; HR@AT, heart rate at anaerobic threshold; VO\u003csub\u003e2\u003c/sub\u003epeak, peak oxygen uptake; Peak HR, peak heart rate; Peak SBP, peak systolic blood pressure; VE/VCO\u003csub\u003e2\u003c/sub\u003e slope, ventilation per carbon dioxide output slope; OUES, oxygen uptake efficiency slope; HRR, heart rate recovery.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e \u003cstrong\u003eMultiple factor analysis of \u0026Delta;VO\u003csub\u003e2\u003c/sub\u003epeak\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.549194991055455%\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.806797853309481%\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.595706618962433%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.985688729874777%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.003577817531305%\"\u003e\n \u003cp\u003e\u003cem\u003e95% CI.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.549194991055455%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.806797853309481%\"\u003e\n \u003cp\u003e-0.114\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e0.087\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.595706618962433%\"\u003e\n \u003cp\u003e-6.940\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.985688729874777%\"\u003e\n \u003cp\u003e0.023\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.003577817531305%\"\u003e\n \u003cp\u003e(-0.158, -0.061)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.549194991055455%\" valign=\"bottom\"\u003e\n \u003cp\u003eMyocardial infarction history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.806797853309481%\"\u003e\n \u003cp\u003e-1.054\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e0.610\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.595706618962433%\"\u003e\n \u003cp\u003e-2.074\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.985688729874777%\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.003577817531305%\"\u003e\n \u003cp\u003e(-1.391, -0.772)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.549194991055455%\" valign=\"bottom\"\u003e\n \u003cp\u003eWith exercise habits during follow-up period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.806797853309481%\"\u003e\n \u003cp\u003e-0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.059033989266547%\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.595706618962433%\"\u003e\n \u003cp\u003e-2.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.985688729874777%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.003577817531305%\"\u003e\n \u003cp\u003e(-0.561, -0.284)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Coronary Heart Disease, Older persons, Cardiopulmonary Exercise Testing, Exercise Tolerance, Cardiac Rehabilitation","lastPublishedDoi":"10.21203/rs.3.rs-3196230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3196230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: Prescribing appropriate exercise is an important means to improve the safety and efficacy of cardiac rehabilitation. Improper exercise may induce an increased cardiovascular risk in older persons with coronary heart disease. Cardiopulmonary exercise testing (CPET)-guided cardiac rehabilitation could be helpful for providing clinical evidence for cardiac rehabilitation therapy in older persons after percutaneous coronary intervention (PCI). Methods: We retrospectively included older persons who underwent PCI and cardiac rehabilitation based on CPET at the Cardiac Rehabilitation Center of XXX Hospital from January 2014 to December 2019. Patients' baseline and follow-up clinical data were collected. Results: A total of 403 older persons after PCI were included in the study. The mean age was 80.5±4.3. The mean follow-up time was 12±2 months. During the follow-up period, no significant exercise-related adverse events occurred, and the peak oxygen uptake (VO2peak) increased compared with baseline (15.5±3.8 ml/min/kg vs. 17.3±4.1 ml/min/kg). Among the 90 patients (22.2%) without exercise habits at baseline who started regular exercise during follow-up, the improvement in VO2peak was most significant, at 3.2±0.4 ml/min/kg. Conclusions: Cardiac rehabilitation based on CPET improved exercise habits and exercise tolerance in older persons with coronary heart disease after PCI.","manuscriptTitle":"The effects of CPET-guided cardiac rehabilitation on exercise tolerance in older persons with CHD after PCI","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-07 14:49:13","doi":"10.21203/rs.3.rs-3196230/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-10-25T12:48:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-10-22T21:46:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-09-20T08:56:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1ce7e149-0a9c-4699-a0c8-20c99cda63a0","date":"2023-09-19T13:12:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-09-19T13:05:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-19T13:01:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-09-04T13:38:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-09-04T13:32:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2023-07-23T09:35:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14fcec28-5923-4a18-88f8-e469651a241a","owner":[],"postedDate":"September 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":24427174,"name":"Health sciences/Cardiology"},{"id":24427175,"name":"Health sciences/Diseases"}],"tags":[],"updatedAt":"2023-11-20T15:07:29+00:00","versionOfRecord":{"articleIdentity":"rs-3196230","link":"https://doi.org/10.1038/s41598-023-47494-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2023-11-15 15:01:16","publishedOnDateReadable":"November 15th, 2023"},"versionCreatedAt":"2023-09-07 14:49:13","video":"","vorDoi":"10.1038/s41598-023-47494-x","vorDoiUrl":"https://doi.org/10.1038/s41598-023-47494-x","workflowStages":[]},"version":"v1","identity":"rs-3196230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3196230","identity":"rs-3196230","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}