Open Access Highly Accessed Research article

Cardiovascular fitness associated with cognitive performance in heart failure patients enrolled in cardiac rehabilitation

Sarah Garcia1, Michael L Alosco1, Mary Beth Spitznagel12, Ronald Cohen3, Naftali Raz4, Lawrence Sweet3, Richard Josephson5, Joel Hughes12, Jim Rosneck2, Morgan L Oberle5 and John Gunstad12*

Author Affiliations

1 Department of Psychology, Kent State University, Kent, OH, 44242, USA

2 Summa Health System, Akron, OH, USA

3 Brown University, Providence, RI, USA

4 Wayne State University, Detroit, MI, USA

5 Department of Medicine, Case Western Reserve University School of Medicine, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA

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BMC Cardiovascular Disorders 2013, 13:29  doi:10.1186/1471-2261-13-29

Published: 16 April 2013



Reduced cognitive function is common in persons with heart failure (HF). Cardiovascular fitness is a known contributor to cognitive function in many patient populations, but has only been linked to cognition based on estimates of fitness in HF. The current study examined the relationship between fitness as measured by metabolic equivalents (METs) from a standardized stress test and cognition in persons with HF, as well as the validity of office-based predictors of fitness in this population.


Forty-one HF patients enrolled in cardiac rehabilitation completed a standardized exercise stress test protocol, a brief neuropsychological battery, the 2-minute step test (2MST), and a series of medical history and self-report questionnaires.


Maximum METs from stress testing demonstrated incremental predictive validity for attention (β = .41, p = .03), executive function (β = .37, p = .04), and memory domains (β = .46, p = .04). Partial correlations accounting for key medical and demographic characteristics revealed greater METs was associated with the 2MST (r (32) = .41, p = .02) but not with the Duke Activity Status Index (DASI) (r(32) = .24, p = .17).


The current findings indicate that better fitness levels measured by METs is independently associated with better cognitive function in older adults with HF. Results also showed that METs was closely associated with one office-based measure of fitness (2MST), but not another (DASI). Prospective studies are needed to clarify the mechanisms linking fitness and cognitive function in HF.

Heart failure; Cardiac rehabilitation; Metabolic equivalents task