Various positive effects of pet ownership on cardiovascular health are well known. The aim of this prospective and
controlled longitudinal study was to determine the effects of everyday dog-walking on physical capacity in elderly patients
during the first year after myocardial infarction. Regularly dog-walking for at least 15 minutes three times a day
is related to significantly higher work load on the bicycle exercise test (72.5 ± 10.75 versus 67.6 ± 11.6 W, p<0.05) in the
»dog-walking« group (N=29, mean age 72.5 years) at 12 months compared to the control group (N=30, mean age 71.7
years). Our results suggest that dogs may help to maintain continuous physical activity in elderly cardiovascular patients
promoting their physical capacity. Further researches are needed to confirm this association as well to identify
other possible influences of dog ownership on the cardiovascular health and on the outcome in patients after myocardial
infarction

Alen Ružić

Bojan Miletić

Gordana Laškarin

Tatjana Ružić

Viktor Peršić

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Coll. Antropol. 35 (2011) Suppl. 2: 73–75Original scientific paperRegular Dog-Walking Improves Physical Capacityin Elderly Patients after Myocardial InfarctionAlen Ru`i}1,2,3, Bojan Mileti}1,2, Tatjana Ru`i}4, Viktor Per{i}1,2,3 and Gordana La{karin1,21 Clinic for Cardiovascular Disease Treatment, Prevention and Rehabilitation, Hospital Thalassotherapia Opatija, Croatia2 School of Medicine, University of Rijeka, Rijeka, Croatia3 School of Medicine, University »J. J. Strossmayer«, Osijek, Croatia4 Psychiatric Hospital Rab, Rab, CroatiaA B S T R A C TVarious positive effects of pet ownership on cardiovascular health are well known. The aim of this prospective andcontrolled longitudinal study was to determine the effects of everyday dog-walking on physical capacity in elderly pa-tients during the first year after myocardial infarction. Regularly dog-walking for at least 15 minutes three times a dayis related to significantly higher work load on the bicycle exercise test (72.5 ± 10.75 versus 67.6 ± 11.6 W, p<0.05) in the»dog-walking« group (N=29, mean age 72.5 years) at 12 months compared to the control group (N=30, mean age 71.7years). Our results suggest that dogs may help to maintain continuous physical activity in elderly cardiovascular pa-tients promoting their physical capacity. Further researches are needed to confirm this association as well to identifyother possible influences of dog ownership on the cardiovascular health and on the outcome in patients after myocardialinfarction.Key words: elderly, dog-walking, animal-assisted therapy, physical capacity, myocardial infarctionIntroductionCardiovascular diseases remain the leading cause ofoverall mortality in many developed countries despitethe progress of treatment achieved over the past decade1.The ageing of the population represents one of the mostimportant causes of cardiovascular diseases high preva-lence which is continuously raising a number of new im-portant issues and priorities in the treatment of thosepatients2. The regular physical activity significantly re-duces the major components of the cardiovascular risks.It improves the spontaneous regulation of the blood pres-sure and the heart rate, positively affects the glycemiccontrol and the lipid profile, also suppressing the endo-thelial dysfunction and the generalized low-grade in-flammation that both plays a key role in prognosis anddevelopment of the coronary artery disease3–5. In accord-ing to these findings, the regular physical activity has be-come an integral part of the primary and especially of thesecondary cardiovascular prevention1. At the time, weare also aware that among other factors dog ownershipcan be strongly related to the regularity of the physicalactivity. Regardless this important feature of animalowning, the pet’s influence on the health status can bealso mediated through different other mechanisms ofaction6. Despite the fact that owning and taking care ofdogs is nowadays recognized as the simplest form of ani-mal-assisted therapy (AAT), there is very little data onthe role of this effective, widely available and safe health--promoting habit on patients with established coronaryartery disease2,3,6. The aim of this study was therefore toinvestigate the influence of regular dog-walking on thephysical capacity in patients after myocardial infarction.Materials and MethodsPatientsIn this 12-months longitudinal prospective and con-trolled study we included fifty – nine male patients 4weeks after the onset of the myocardial infarction. Ex-aminees were divided in two groups: the interventiongroup of 29 dog-owners (mean age 72.5 years) that un-derwent regular dog-walking for at least 15 minutes73Received for publication July 07, 2011three times a day and the control group consisted of 30male patients comparable in age (mean age 71.7 years)that underwent regular daily walk of 30 minutes. Thestandard Bruce bicycle-ergometry test was performed atthe beginning and at the end of the study. During thetrial, all patients received the standard medicamentoustherapy.StatisticsWe used Statistica software for the analysis and theinterpretation of results. The level of significance was setat p<0.05.ResultsAt the beginning of the study, the »dog-walking«group expressed higher levels of workload compared tothe control group. Both groups better tolerated the phys-ical exertion at the end of the follow up. However, themaximal workload at the final stress-test was signifi-cantly higher in the »dog-walking« group (72.5±10.75versus 67.6±11.6 W, p<0, 05). The maximal heart rateand the maximal blood pressure during the ergometrytest were not significantly different at the beginning andat the end of the investigation. The results are presentedin the Table 1.DiscussionOur results indicate significant improvement of func-tional cardiac capacity in both tested groups underliningthe importance of regular daily physical activity. Thehigher cardiac capacity in dog-walking group suggeststhe additional positive long-term effects of dog-owner-ship on the cardiovascular health status. However thereis a paucity of data in this important field, regular shorthikes seems to be associated with significantly betterfunctional capacity one year after the myocardial infarc-tion. As the improvement is significantly higher in thedog-walkers group, the difference is suggestible to be de-pendent on the dog-related frequent walking. Other pos-sible causes of this difference have to be tested, primarilythose from the field of psychological effects related to thepet-ownership. Our results are consistent with previousfindings that exercise training has positive effects onmyocardial perfusion and on the improvement of endo-thelial dysfunction in patients with coronary arterydisease7,8.During our study, we did not find significant changesof the maximal systolic blood pressure and the maximalheart frequency in the groups and between groups. How-ever, higher workload combined with unchanged reactiv-ity of blood pressure and heart frequency is strongly sug-gestive of improved functional capacity, especially in thedog-walking group. The AAT has become nowadays oneof the accepted and endorsed methods in the treatmentof different medical conditions such as mental diseases,child cerebral palsy, Alzheimer’s disease, dementia, Par-kinson’s disease, rheumatoid arthritis and AIDS9–11. Wealso know that AAT have many psychological benefits –it promote the feeling of self-worth, reduce anxiety; pro-vide better social contact and the feeling of being needed,especially in the elderly12. The dolphin therapy, horsetherapy and dog-assisted therapy are improving the qua-lity of life and adaptation to the illness in children13,14.The studies have shown that regular dog-walking re-duces systolic blood pressure in dog owners compared tonon-owners, lowers triglycerides and cholesterol plasmaconcentrations15. Rehabilitation programs that includedthe dog-assisted therapy for patients with chronic heartfailure showed to decrease the hospital length of stay andalmost doubled the walking distance capacity16. How-ever, the AAT is still not sufficiently applied in the pa-tients with coronary artery disease17 and it is poorly in-vestigated in the elderly nevertheless they represent thefastest growing population group in developed countrieswith high cardiovascular diseases prevalence1,10. Cardiacrehabilitation programs in elderly shows some importantspecificity respecting comorbidity and significant func-tional limitations. They require multidisciplinary ap-proach, interventions in the cognitive and emotionalfields and adapted methods of physical exercise with thepossibility of alternative rehabilitation programs imple-mentation18–20. The physical activity during cardiac reha-bilitation in elderly showed different positive effect onthe flexibility, balance and coordination that can be espe-cially important regarding the comorbidities and thelong-term outcome20,21. Despite exercise training remainkey components of cardiac rehabilitation program22 withpositive effect of on cardiovascular health outcomes23,cardiac rehabilitation programs are still underutilized24.Although the animal-assisted therapy needs more stud-ies to confirm the beneficial effects on the long-term out-come in patients at high risk or in those with establishedcardiovascular disease, the future seems to bring the in-tegration of animal-assisted therapy into conventionalmedical practice25.A. Ru`i} et al.: Dog-Walking after Myocardial Infarction, Coll. Antropol. 35 (2011) Suppl. 2: 73–7574TABLE 1FUNCTIONAL CAPACITY PARAMETERS DURING THE ERGOMETRY TEST IN PATIENTS AFTER MYOCARDIAL INFARCTION»Dog-walking« group (N = 29) Control group (N = 30)0 months 12 months p 0 months 12 months pMaximal workload (W) 65.75±11.30 72.5±10.75 <0.05 61.75±10.5 67.6±11.6 <0.05Maximal heart rate (%) 73.7±15.4 78.5±13.2 ns 77.5±14.3 81.3±16.5 nsMaximal blood pressure (mmHg) 170±17.5 178±15.5 ns 175±19.5 182±20.5 nsR E F E R E N C E S1. TASK FORCE MEMBERS OF THE EUROPEAN SOCIETY OFCARDIOLOGY ON CARDIOVASCULAR DISEASE PREVENTION INCLINICAL PRACTICE, Eur Journal Cardiovasc Prev Rehabil, 14 (2007)113. — 2. ROSSETTI J, KING C, J Psychosoc Nurs Ment Health Serv, 48(2010) 44. — 3. BRAVERMAN DL, Am J Phys Med Rehabil, 90 (2011)599. — 4. BALEN S, VUKELI]-DAMIJANI N, PER[I] V, RU@I] A, MI-LETI] B, SAMARD@IJA M, DOMANOVI] D, MIRAT J, NAKI] D, SOL-DO I, V^EV A, Coll Antropol, 32 (2008) 285. — 5. RU@I] A, PER[I] V,MILETI] B, V^EV A, MIRAT J, SOLDO I, BATINAC T, KOVA^ T, CollAntropol, 31 (2007), 185. — 6. WILLIS DA, Rehabil Nurs, 22 (1997) 78. —7. GIELEN S, ERBS S, SCHULER G, HAMBRECHT R, Minerva Car-dioangol, 50 (2002) 95. — 8. GIELEN S, HAMBRECHT R, Cardiol Clin,19 (2001) 357. — 9. DIMITRIJEVI] I, Psychiatr Danub, 21 (2009) 236. —10. TRIBET J, BOUCHARLAT M, MYSLINSKI M, Encephale, 34 (2008)183. — 11. ZAKERI N, BAIN PG, J Neurol, 257 (2010) 1396. — 12.MUDZYK A, BOURQUE M, GUILBERT H, SEGUIN AD, SAVOYE MJ,Soins Gerontol, 88 (2011) 11. — 13. BOUCHARD F, LANDRY M,BELLES-ISLES M, GAGNON J, Can Oncol Nurs J, 14 (2004) 14. — 14.LOTAN M, ScientificWorldJournal, 29 (2007) 698. — 15. LARSEN BA,LINGAAS F, Tidsskr Nor Laegeforen, 117 (1997) 4375. — 16. ABATE SV,ZUCCONI M, BOXER BA, J Cardiovasc Nurs, 26 (2011) 224. — 17. AN-TUNES-CORREA LM, KANAMURA BY, MELO RC, NOBRE TS, UENOLM, FRANCO FG, ROVEDA F, BRAGA AM, RONDON MU, BRUM PC,BARRETTO AC, MIDDLEKAUFF HR, NEGRAO CE, Eur J CardiovascPrev Rehabil, 2011 Jun 22 (Epub ahead of print). — 18. VIGORITO C,INCALZI RA, ACANFORA D, MARCHIONNI N, FATTIROLLI F, GRUP-PO ITALIANO DI CARDIOLOGIA RIABILITATIVA E PREVENTIVA,Monaldi Arch Chest Dis, 60 (2003) 25. — 19. ALDCROFT SA, TAYLORNF, BLACKSTOCK FC, O’HALLORAN PD, J Cardiopulm Rehabil Prev,2011 Jul 4 (Epub ahead of print). — 20. MOLINO-LOVA R, PASQUINIG, VANNETTI F, PAPERINI A, FORCONI T, POLCARO P, ZIPOLI R,CECCHI F, MACCHI C, Intern Emerg Med, 2011 Jul 9 (Epub ahead ofprint). — 21. KARGARFARD M, ROUZBEHANI R, BASATI F, Int J PrevMed, 1 (2010) 124. — 22. MUNOZ LASA S, FERRIERO G, BRIGATTI E,VALERO R, FRANCHIGNONI F, Panminerva Med, 53 (2011) 129. — 23.CARDIAC REHABILITATION SECTION OF THE EUROPEAN ASSO-CIATION OF CARDIOVASCULAR PREVENTION AND REHABILITA-TION, Eur J Cardiovasc Prev Rehabil, 17 (2010) 1. — 24. WENGER NK,J Am Coll Cardiol, 51 (2008) 1619. — 25. PALLEY LS, O’ROURKE PP,NIEMI SM. ILAR J, 51 (2010) 199.A. Ru`i}Clinic for Cardiovascular Diseases Treatment, Rehabilitation and Prevention, Hospital Thalassotherapia Opatija, M.Tita 188/1, 51410 Opatija, Croatia,e-mail: alen.ruzic1@ri.t-com.hrREDOVITO [ETANJE S PSOM POBOLJ[AVA FIZI^KU KONDICIJU U STARIJIH BOLESNIKA KOJISU PREBOLJELI INFARKT MIOKARDAS A @ E T A KPozitivno djelovanje ku}nih ljubimaca na kardiovaskularno zdravlje danas su dobro poznati. Cilj ove prospektivne ikontrolirane longitudinalne studije bio je odre|ivanje u~inka svakodnevnih {etnji psom na fizi~ku spremnost starijihbolesnika tijekom prve godine nakon akutnog infarkta miokarda. Redovito izvo|enje psa u {etnju barem 3 puta po 15minuta dnevno tijekom12 mjeseci nakon preboljelog akutnog infarkta miokarda povezano je sa zna~ajno ve}im radnimu~inkom tijekom bicikl-ergometrijskog testa (72,5 ± 10,75 prema 67,6 ± 11,6 W, p<0,05) u intervencijskoj skupini (N=29,prosje~na dob 72,5 godina) u usporebi s kontrolnom skupinom (N=30, prosje~na dob 71,7 godina). Na{i rezultati upu-}uju na mogu}nost da skrb o psu kao ku}nom ljubimcu mo`e biti zna~ajan ~imbenik u odr`avanju kontinuirane fizi~keaktivnosti kod starijih bolesnika s razvijenom kardiovaskularnom bole{}u, te da mo`e doprinijeti pobolj{anju njihovefizi~ke sposobnosti. Potrebna su daljnja istra`ivanja kako bi se potvrdila ova povezanost i ispitali drugi o~ekivani pozi-tivni utjecaji posjedovanja pasa na kardiovaskularno zdravlje i ishod u bolesnika nakon preboljelog infarkta miokarda.A. Ru`i} et al.: Dog-Walking after Myocardial Infarction, Coll. Antropol. 35 (2011) Suppl. 2: 73–7575

Regular Dog-Walking Improves Physical Capacity in Elderly Patients after Myocardial Infarction

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