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Gallo G, Autore C, Volterrani M, Barbato E, Volpe M. Monitoring the Effects of Cardiac Rehabilitation Programs in Heart Failure Patients: The Role of Biomarkers. High Blood Press Cardiovasc Prev 2025; 32:287-297. [PMID: 40327288 PMCID: PMC12098190 DOI: 10.1007/s40292-025-00707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 02/12/2025] [Indexed: 05/07/2025] Open
Abstract
Heart failure (HF) is characterized by poor exercise tolerance and reduced ability to perform routine daily activities. Cardiac rehabilitation (CR), which includes exercise training, has shown a role in improving cardiac remodeling, functional capacity and HF outcomes as a consequence of its beneficial effects on neurohormonal dysfunction, endothelial function, vascular tone and peripheral oxygen extraction. Although a multiparametric evaluation, including physical examination, blood sampling, echocardiographic and cardiopulmonary exercise testing parameters, is routinely performed during CR programs, the use of cardiac biomarkers, in particular natriuretic peptides (NPs), is still poorly adopted and characterized. In this article we analyze the potential role of biomarkers in monitoring the success of rehabilitation programs and the potential implications of their use in clinical practice. Indeed, NPs measurements might represent an important tool to modulate the rehabilitative interventions with a favorable cost-effectiveness profile.
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Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
- Cardiology Unit, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Camillo Autore
- Cardio-Pulmonary Department, San Raffaele Cassino, 03043, Cassino, FR, Italy
| | | | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy
- Cardiology Unit, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
- IRCCS San Raffaele, 00166, Rome, Italy.
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Valtueña-Gimeno N, Fabregat-Andrés Ó, Martínez-Hurtado I, Martínez-Olmos FJ, Lluesma-Vidal M, Arguisuelas MD, Ferrer-Sargues FJ. A cardiac rehabilitation programme based on neuromuscular training improves the functional capacity of patients with acute coronary syndrome: a preliminary randomised controlled trial. Physiotherapy 2025; 126:101428. [PMID: 39549308 DOI: 10.1016/j.physio.2024.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/09/2024] [Accepted: 09/17/2024] [Indexed: 11/18/2024]
Abstract
OBJECTIVES To evaluate the effects of a cardiac rehabilitation programme based on neuromuscular training (NMT) compared with classic rehabilitation strength training (CRST) in patients diagnosed with acute coronary syndrome (ACS). DESIGN Preliminary randomised, double-blinded, parallel clinical trial. SETTING University health clinic in Valencia, Spain. PARTICIPANTS Thirty patients with ACS. INTERVENTIONS Patients were assigned to one of two groups at random: the NMT group (n = 15) and the CRST group (n = 15). All patients attended the 20 sessions of the exercise programme. MAIN OUTCOME MEASURES The primary outcome was the Incremental Shuttle Walk Test (ISWT). The secondary outcomes were the Chester Step Test (CST), the 30-Second Chair Stand Test (30CST), and hip flexor dynamometry. Assessments were made at baseline, immediately post-treatment, and at 6-month follow-up. RESULTS The NMT group showed a greater improvement in the ISWT than the CRST group, both at post-treatment {mean 648 [standard deviation (SD) 197] vs 493 (SD 219), mean difference 155, 95% confidence interval (CI) -1 to 310} and at follow-up [732 (SD 183) vs 518 (SD 222), mean difference 214, 95% CI 61 to 367]. The secondary outcomes showed significant between-group differences in favour of the NMT group at 6-month follow-up, except for the 30CST. CONCLUSIONS These preliminary findings indicate that a cardiac rehabilitation programme based on NMT may improve functional capacity in terms of patient performance, cardiorespiratory fitness and muscle strength. Moreover, the improvements were maintained at medium-term follow-up. This could help improve the design of rehabilitation sessions, considering factors associated with performing everyday activities in patients affected by ACS. CLINICAL TRIAL REGISTRATION NUMBER NCT04246008. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Noemí Valtueña-Gimeno
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | | | - Isabel Martínez-Hurtado
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | | | - Marta Lluesma-Vidal
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain
| | - María Dolores Arguisuelas
- Department of Nursing and Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
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Akdal A, Karavelioglu Y, Gokdeniz T, Turk AC, Unal F, Kutukcu EC. Combined arm-leg endurance training vs. leg endurance training in patients with an implantable cardioverter defibrillator: A randomized controlled study. Heart Lung 2025; 70:82-92. [PMID: 39616892 DOI: 10.1016/j.hrtlng.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 11/15/2024] [Accepted: 11/15/2024] [Indexed: 02/24/2025]
Abstract
BACKGROUND There is a lack of evidence regarding the effect of combining arm and leg training on arm exercise capacity, upper extremity functionality and safety in patients with implantable cardioverter-defibrillators (ICDs). OBJECTIVE The aim of this study was to compare the effects of combined arm-leg endurance training (ETarm+leg) with leg endurance training (ETleg) alone on arm exercise capacity, cardiorespiratory fitness, and safety issues in patients with ICDs. METHODS In this prospective randomized controlled study, 24 caucasian patients with an ICD (NYHA class II-III, mean age: 59.38±11.54 years, 20 male, 4 female) underwent cardiopulmonary exercise testing (CPET) and arm ergometry. The ETleg intervention consisted of cycle ergometer training for 40 min at workload of 70-80 % of peak oxygen consumption (VO2peak). The ETarm+leg intervention also included arm ergometer training for 20 min at 60 % peak workload (Wpeak). Both exercise programs were performed for a total of 30 sessions (5 days for 6 weeks). Quade's non-parametric covariance analysis was performed for changes between groups by adjusting before treatment. RESULTS Significant increases in time to reach VO2peak (min), VO2peak (L), VO2peak/kg (L/kg/min), VO2peak (%), Wpeak, and test duration during arm ergometry were observed in the ETarm+leg group (p < 0.05). No shocks or ventricular tachycardia/fibrillation episodes were recorded. CONCLUSIONS ETarm+leg had a more pronounced effect on cardiopulmonary exercise capacity and arm exercise capacity in patients with ICDs. Arm exercise training is safe in terms of ICD parameters and should be incorporated into cardiac rehabilitation for patients with ICDs.
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Affiliation(s)
- Ayşe Akdal
- Hitit University, Erol Olcok Education and Research Hospital, Cardiac Rehabilitation Center, Corum, Turkey.
| | - Yusuf Karavelioglu
- Istinye University Hospital Medical Park Gaziosmanpaşa, Department of Cardiology, Istanbul, Turkey
| | - Teyyar Gokdeniz
- Istinye University Hospital Medical Park Gaziosmanpaşa, Department of Cardiology, Istanbul, Turkey
| | - Ayla Caglıyan Turk
- Hitit University, Erol Olcok Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Corum, Turkey
| | - Ferhat Unal
- Data Management Unit, Middle East Technical University, Ankara, Turkey
| | - Ebru Calik Kutukcu
- Hacettepe University, Faculty of Physical Physiotherapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Ankara, Turkey
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Barriault A, Iftikhar U, Stone JA. Cardiac Rehabilitation and Heart Failure with Reduced Ejection Fraction: Pathophysiology, Benefits, and Precautions. Can J Cardiol 2025; 41:443-455. [PMID: 39433254 DOI: 10.1016/j.cjca.2024.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 10/11/2024] [Accepted: 10/16/2024] [Indexed: 10/23/2024] Open
Abstract
Heart failure (HF) is a highly comorbid condition associated with significant mortality, despite advances in current medical management. Patients who suffer from HF represent a high needs disease care population in whom structured, long-term chronic disease care delivery models, such as cardiac rehabilitation (CR), have been shown to be highly cost effective in reducing hospitalizations and improving quality of life. HF with reduced ejection fraction affects a growing number of Canadians and health care costs secondary to this condition are increasing, with further increases over the next decade to be expected. CR is a guideline-directed medical therapy for patients living with HF with reduced ejection fraction, and with increasing numbers of HF patients across the world, there is a prescient need to revisit the benefits, safety, and the prescription of this intervention for the health care professionals who treat this condition. Certainly, there is a clinical need for HF practitioners to better understand the pathophysiological benefits of CR with respect to exercise training, as well as the prudent precautions required to facilitate the safe delivery of this highly cost-effective patient intervention.
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Affiliation(s)
- Alexandra Barriault
- Total Cardiology, Calgary, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Umair Iftikhar
- Total Cardiology, Calgary, Alberta, Canada; Department of Cardiac Sciences, Division of Cardiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A Stone
- Department of Cardiac Sciences, Division of Cardiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Symphony of Health Connections, Calgary Alberta, Canada
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Souza WMMD, Vieira MC, Nascimento PMC, Serra SM, Reis MS. Strength training improves functional capacity of individuals with chronic heart failure: Randomized clinical trial. J Bodyw Mov Ther 2024; 39:583-589. [PMID: 38876690 DOI: 10.1016/j.jbmt.2024.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Chronic heart failure (CHF) is characterized by dyspnea, exercise intolerance and impaired quality of life. Physical exercise is a key point in the treatment of these outcomes. OBJECTIVE To evaluate the effect of 24 weeks of two different training strategies on functional capacity, muscle strength and quality of life in individuals with CHF. METHODS The following tests and evaluations were performed before and after 24 weeks of training: exercise test, one-repetition maximum test (1- RM) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Subjects were randomized according to the modality they would perform first: aerobic training group (ATG - n=6) or strength training group (STG - n=7). RESULTS The sample consisted of 13 individuals (10 men), aged 55 ± 12 years and a left ventricular ejection fraction (LVEF) of 38.8 ± 5.3%. There was a significant increase in V'O 2peak only in STG (STG: 26.92 ± 9.81 vs 30.52 ± 8.39 mL.kg -1 .min -1 - p=0.025; ATG: 19.60 ± 7,00 vs 22.42 ± 8.54 mL.kg -1 .min -1 - p=0.119). Both groups showed significant improvements in muscle strength (STG: 45 ± 17 vs 51 ± 20 kg - p=0.001; ATG: 38 ± 19 vs 42 ± 20 kg - p=0.012). There was no significant difference in quality of life (STG: 30 ± 18 vs 24 ± 20 - p=0.109; ATG: 36 ± 16 vs 26 ± 15 - p=0.143). CONCLUSION The early implementation of strength training improves functional capacity and muscle strength of individuals with CHF.
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Affiliation(s)
- Wallace Machado Magalhães de Souza
- Research Group in Cardiorespiratory Evaluation and Rehabilitation, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, RJ, Brazil; School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Marcelo Carvalho Vieira
- Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | | | - Salvador Manoel Serra
- Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, RJ, Brazil
| | - Michel Silva Reis
- Research Group in Cardiorespiratory Evaluation and Rehabilitation, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Li Y, He W, Jiang J, Zhang J, Ding M, Li G, Luo X, Ma Z, Li J, Ma Y, Shen Y, Han X. Non-Pharmacological Interventions in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:963-974. [PMID: 37499852 DOI: 10.1016/j.apmr.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection fraction (HFrEF). DATA SOURCES We searched PubMed, Embase, and the Cochrane Clinical Trials Register from the date of database inception to April 22, 2023. STUDY SELECTION Randomized controlled trials involving non-pharmacologic interventions conducted in patients with HFrEF were included. DATA EXTRACTION Data were extracted by 2 independent reviewers based on a pre-tested data extraction form. The quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation method. DATA SYNTHESIS A total of 82 eligible studies (4574 participants) were included. We performed a random-effects model within a Bayesian framework to calculate weighted mean differences (WMDs) and 95% credibility intervals. High or moderate certainty evidence indicated that high-intensity aerobic interval training (HIAIT) was best on improving 6-minute walk distance (6MWD; 68.55 m [36.41, 100.47]) and left ventricular ejection fraction (6.28% [3.88, 8.77]), while high-intensity aerobic continuous training (HIACT) is best on improving peak oxygen consumption (Peak VO2; 3.48 mL/kg•min [2.84, 4.12]), quality of life (QOL; -17.26 [-29.99, -7.80]), resting heart rate (-8.20 bpm [-13.32, -3.05]), and N-terminal pro-B-type natriuretic peptide (-600.96 pg/mL [-902.93, -404.52]). Moderate certainty evidence supported the effectiveness of inspiratory muscle training to improve peak oxygen consumption and functional electrical stimulation to improve QOL. Moderate-intensity aerobic continuous training (MIACT) plus moderate-intensity resistance training (MIRT) had additional benefits in Peak VO2, 6MWD, and QOL. This review did not provide a comprehensive evaluation of adverse events. CONCLUSIONS Both HIAIT and HIACT are the most effective single non-pharmacologic interventions for HFrEF. MIACT plus MIRT had additional benefits in improving peak oxygen consumption, 6MWD, and QOL.
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Affiliation(s)
- Yilun Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Wenbo He
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jingwen Jiang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jiawen Zhang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Mingfeng Ding
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Gaiyun Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaolei Luo
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ziyuan Ma
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jingyi Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yichen Ma
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yanfei Shen
- Office of Legal Affairs, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xuemei Han
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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Feuerstein A, Schoenrath F, Belyavskiy E, Knierim J, Friede T, Placzek M, Bach D, Pieske-Kraigher E, Herrmann-Lingen C, Westenfeld R, Roden M, Rybczynski M, Verheyen N, Dörr M, von Haehling S, Störk S, Halle M, Falk V, Pieske B, Edelmann F. Supervised exercise training in patients with advanced heart failure and left ventricular assist device: A multicentre randomized controlled trial (Ex-VAD trial). Eur J Heart Fail 2023; 25:2252-2262. [PMID: 37702315 DOI: 10.1002/ejhf.3032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 09/14/2023] Open
Abstract
AIMS Small studies and observations suggested that exercise training may improve peak oxygen consumption (peakVO2 ) in patients with advanced heart failure and left ventricular assist device (LVAD). We investigated whether in this patient group a supervised exercise training can improve exercise capacity. METHODS AND RESULTS In this multicentre, prospective, randomized, controlled trial, patients with stable heart failure and LVAD were randomly assigned (2:1) to 12 weeks of supervised exercise training or usual care, with 12 weeks of follow-up. The primary endpoint was the change in peakVO2 after 12 weeks (51 patients provided a power of 90% with an expected group difference in peakVO2 of 3 ml/kg/min). Secondary endpoints included changes in submaximal exercise capacity and quality of life. Among 64 patients enrolled (97% male, mean age 56 years), 54 were included in the analysis. Mean difference in the change of peakVO2 after 12 weeks was 0.826 ml/min/kg (95% confidence interval [CI] -0.37, 2.03; p = 0.183). There was a positive effect of exercise training on 6-min walk distance with a mean increase in the intervention group by 43.4 m (95% CI 16.9, 69.9; p = 0.0024), and on the Kansas City Cardiomyopathy Questionnaire physical domain score (mean 14.3, 95% CI 3.7, 24.9; p = 0.0124), both after 12 weeks. The overall adherence was high (71%), and there were no differences in adverse events between groups. CONCLUSION In patients with advanced heart failure and LVAD, 12 weeks of exercise training did not improve peakVO2 but demonstrated positive effects on submaximal exercise capacity and physical quality of life.
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Affiliation(s)
- Anna Feuerstein
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Medizinisches Versorgungszentrum, Berlin, Germany
| | - Jan Knierim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Paulinenkrankenhaus gGmbH, Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Marius Placzek
- Department of Medical Statistics, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Doris Bach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Department of Endocrinology and Diabetology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan von Haehling
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Volkmar Falk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Burkert Pieske
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Gore S, Khanna H, Kumar A. Effects of Comprehensive Outpatient Cardiac Rehabilitation on Exercise Capacity, Functional Status, and Quality of Life in People With Heart Failure: A Systematic Review and Meta-Analysis. Phys Ther 2023; 103:pzad119. [PMID: 37658777 PMCID: PMC10630615 DOI: 10.1093/ptj/pzad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/20/2023] [Accepted: 07/02/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this study was to systematically review and conduct a meta-analysis to examine the impact of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in patients with heart failure. METHODS PubMed, Embase, and CINAHL were searched using keywords and MeSH terms on heart failure and cardiac rehabilitation. Randomized clinical trials published in English using outpatient exercise-based cardiac rehabilitation in patients with heart failure were included. The Grading of Recommendations Assessment, Development, and Evaluation was utilized for quality appraisal. Pooled estimates were computed using standardized mean differences (SMDs) and 95% CIs. Primary outcomes were functional status (6-minute walk distance, quality of life, exercise capacity using peak oxygen consumption, muscle strength, and endurance). RESULTS Eleven randomized controlled trials including 1523 participants ranging from 45 to 80 years old and an intervention duration ranging from 2 to 26 weeks were analyzed. Pooled results indicated significant improvements with comprehensive cardiac rehabilitation on 6-minute walk distance (SMD = 0.30; 95% CI = 0.06 to 0.54) and oxygen consumption (SMD = 0.23; 95% CI = 0.06 to 0.40). However, there was no additional benefit for the quality of life beyond that seen in the comparison groups. CONCLUSION Results of this study suggest that comprehensive outpatient cardiac rehabilitation is associated with significantly better clinical outcomes than single-component exercise programs in cardiac rehabilitation settings, multicomponent exercise in noncardiac rehabilitation settings, or no exercise. IMPACT Heart failure is significantly associated with an increased risk of poor exercise tolerance. Despite the proven benefit of cardiac rehabilitation on exercise tolerance and physical activities from individual randomized clinical trials, questions regarding its impact on clinical outcomes such as exercise capacity, functional status, and quality of life remain inadequate. This systematic review and meta-analysis provides strong evidence supporting comprehensive outpatient cardiac rehabilitation for improving clinical outcomes in heart failure.
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Affiliation(s)
- Shweta Gore
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Hargun Khanna
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Amit Kumar
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
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Kogel A, Machatschek M, Scharschmidt R, Wollny C, Lordick F, Ghanem M, Laufs U, Fikenzer S. Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled training study. Clin Res Cardiol 2023; 112:1699-1709. [PMID: 37698618 PMCID: PMC10584711 DOI: 10.1007/s00392-023-02300-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND PURPOSE No evidence-based treatment is available for patients with persisting symptoms post-COVID-19 infection. We hypothesized that physical exercise may represent a safe and effective treatment option for post-COVID. METHODS We performed a systematic search of the literature that revealed a lack of randomized training studies in patients post-COVID. Based on these findings, a prospective randomized controlled study with open-label and blinded endpoint evaluation was designed. 272 patients with symptoms of fatigue persisting over 6 weeks post-COVID infection were screened. Patients with pathological cardiovascular findings were excluded. 57 patients consented and were randomized to 4 weeks of supervised personalized strength and endurance training or usual care. The follow-up period was 3 and 6 months. RESULTS There were no adverse events related to the training. Spiroergometry of the training group showed a significantly higher increase in VO2peak (10.0 ± 12.7% vs. 0.1 ± 8.9%, p < 0.01, respectively) and oxygen pulse (9.8 ± 10.8% vs. 0.0 ± 13.9%, p < 0.05, respectively). Parameters of the Multidimensional Fatigue Inventory-20, McGill Quality of Life Questionnaire, and Post-COVID-19 Functional Status were improved after 4 weeks in both groups. In the follow-up period, the total physical activity per week was significantly greater in the exercise group than in controls (1280 ± 1192 min vs. 644 ± 554 min, p < 0.05, respectively). The improvements in fatigue and quality of life were not statistically different between the training and usual care groups. CONCLUSION Exercise is safe and improves maximal exercise capacity in post-COVID patients. Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of their allocation. REGISTRATION German Clinical Trials Register: DRKS00026686. Date of registration: 27.09.2021.
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Affiliation(s)
- Alexander Kogel
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Moritz Machatschek
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Ronja Scharschmidt
- Zentrale Einrichtung für Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carolin Wollny
- Zentrale Einrichtung für Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Florian Lordick
- Medizinische Klinik und Poliklinik 2-Onkologie, Gastroenterologie, Hepatologie, Pneumologie, Infektiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mohamed Ghanem
- Zentrale Einrichtung für Physikalische Therapie und Rehabilitation, Universitätsklinikum Leipzig, Leipzig, Germany
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Sven Fikenzer
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Wilson RL, Christopher CN, Yang EH, Barac A, Adams SC, Scott JM, Dieli-Conwright CM. Incorporating Exercise Training into Cardio-Oncology Care: Current Evidence and Opportunities: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:553-569. [PMID: 37969654 PMCID: PMC10635898 DOI: 10.1016/j.jaccao.2023.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 11/17/2023] Open
Abstract
Cancer treatment-induced cardiotoxicities are an ongoing concern throughout the cancer care continuum from treatment initiation to survivorship. Several "standard-of-care" primary, secondary, and tertiary prevention strategies are available to prevent the development or further progression of cancer treatment-induced cardiotoxicities and their risk factors. Despite exercise's established benefits on the cardiovascular system, it has not been widely adopted as a nonpharmacologic cardioprotective strategy within cardio-oncology care. In this state-of-the-art review, the authors discuss cancer treatment-induced cardiotoxicities, review the existing evidence supporting the role of exercise in preventing and managing these sequelae in at-risk and affected individuals living after cancer diagnoses, and propose considerations for implementing exercise-based services in cardio-oncology practice.
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Affiliation(s)
- Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Eric H. Yang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ana Barac
- Inova Schar Heart and Vascular and Inova Schar Cancer Institute, Falls Church, Virginia, USA
| | - Scott C. Adams
- Department of Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Jessica M. Scott
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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11
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Zeng X, Li L, Xia Z, Zou L, Kwok T, Su Y. Transcriptomic Analysis of Human Skeletal Muscle in Response to Aerobic Exercise and Protein Intake. Nutrients 2023; 15:3485. [PMID: 37571423 PMCID: PMC10421363 DOI: 10.3390/nu15153485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to provide a more comprehensive molecular insight into the effects of aerobic exercise (AE), protein intake (PI), and AE combined with PI on human skeletal muscle by comparing their transcriptomic profiles. Fourteen published datasets obtained from the Gene Expression Omnibus (GEO) database were used. The hub genes were identified in response to acute AE (ACTB, IL6), training AE (UBB, COL1A1), PI (EZH2), acute AE combined with PI (DDIT3), and training AE combined with PI (MYC). Both FOS and MYC were upregulated in response to acute AE, and they were, respectively, downregulated by higher PI and a combination of AE and PI. COL1A1 was upregulated by training AE but was downregulated by higher PI. Results from the gene set enrichment analysis (p < 0.05 and FDR < 25%) showed that AE and PI delivered their impacts on human skeletal muscle in analogous pathways, including aerobic respiration, mitochondrial complexes, extracellular matrix (ECM) remodeling, metabolic process, and immune/inflammatory responses, whereas, PI may attenuate the response of immune/inflammation and ECM remodeling which would be promoted by AE, irrespective of its types. Compared to PI alone, acute AE combined with PI would further promote protein turnover and synthesis, but suppress skeletal muscle contraction and movement.
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Affiliation(s)
- Xueqing Zeng
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China (Z.X.)
| | - Linghong Li
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China (Z.X.)
| | - Zhilin Xia
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China (Z.X.)
| | - Lianhong Zou
- Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People’s Hospital, Changsha 410009, China
| | - Timothy Kwok
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China (Z.X.)
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Caminiti G, Perrone MA, D'Antoni V, Marazzi G, Gismondi A, Vadalà S, Di Biasio D, Manzi V, Iellamo F, Volterrani M. The Improvement of Left Atrial Function after Twelve Weeks of Supervised Concurrent Training in Patients with Heart Failure with Mid-Range Ejection Fraction: A Pilot Study. J Cardiovasc Dev Dis 2023; 10:276. [PMID: 37504532 PMCID: PMC10381005 DOI: 10.3390/jcdd10070276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Left atrial dysfunction is associated with exercise intolerance and poor prognosis in heart failure (HF). The effects of exercise training on atrial function in patients with HF with mid-range ejection fraction (HFmrEF) are unknown. The purpose of the present study was to assess the effects of a supervised concurrent training (SCT) program, lasting 12 weeks, on left atrial function of patients with HFmrEF. The study included 70 stable patients, who were randomly assigned into two groups: SCT with (three sessions/week) or a control (CON) group directed to follow contemporary exercise preventive guidelines at home. Before starting the training program and at 12 weeks, all patients performed an ergometric test, a 6 min walk test, and echocardiography. Between-group comparisons were made by analysis of variance (ANOVA). At 12 weeks, the duration of the ergometric test and distance walked at 6 min walk test presented a significant greater increase in SCT compared to the control (between-group p 0.0001 and p 0.004 respectively). Peak atrial longitudinal strain and conduit strain presented an increase of 29% and 34%, respectively, in the SCT, and were unchanged in CON (between-group p 0.008 and p 0.001, respectively). Peak atrial contraction strain increased by 21% in SCT, with no changes in CON (between-group p 0.002). Left ventricular global longitudinal strain increased significantly in SCT compared to control (between-groups p 0.03). In conclusions, SCT improved left atrial and left ventricular function in HFmrEF. Further studies are needed in order to verify whether these favourable effects of SCT on LA function are sustained and whether they will translate into clinical benefits for patients with HFmrEF.
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Affiliation(s)
- Giuseppe Caminiti
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00163 Rome, Italy
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy
| | - Marco Alfonso Perrone
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | | | - Giuseppe Marazzi
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy
| | - Alessandro Gismondi
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Sara Vadalà
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy
| | - Deborah Di Biasio
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy
| | - Vincenzo Manzi
- Department of Humanities, Università Telematica Pegaso, 80132 Naples, Italy
| | - Ferdinando Iellamo
- Division of Cardiology and Sports Medicine, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maurizio Volterrani
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00163 Rome, Italy
- Cardiology Rehabilitation Unit, IRCCS San Raffaele, 00163 Rome, Italy
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Moneghetti K, Carrick-Ranson G, Howden EJ. Establishing the Optimum use of High-Intensity Interval Training in Heart Failure: Current Status and Future Directions. CURRENT OPINION IN PHYSIOLOGY 2023. [DOI: 10.1016/j.cophys.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Effects of Concurrent, Within-Session, Aerobic and Resistance Exercise Training on Functional Capacity and Muscle Performance in Elderly Male Patients with Chronic Heart Failure. J Clin Med 2023; 12:jcm12030750. [PMID: 36769399 PMCID: PMC9917949 DOI: 10.3390/jcm12030750] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The best format of exercise training (ET) in the setting of cardiac rehabilitation in patients with chronic heart failure (CHF) is still to be defined. Current guidelines recommend aerobic exercises, such as running and cycling, including some sessions per week of resistance exercise. AIM The aim of this study was to address the effectiveness of a concurrent exercise training program utilizing a circuit of sequential endurance and resistance exercises on functional capacity and muscular strength in patients with CHF. METHODS Ninety-five consecutive male patients (age 63.1 ± 6 years) with CHF (EF < 40%) in NYHA functional class II/III, were randomly assigned on 1:1 basis to a 12-week aerobic continuous training (AT) or concurrent CT), aerobic + resistance, training (CT), three times a week, with each session lasting 80 min. We used high quality, specifically designed ergometers, connected with each other and governed by a central console, and managed by a single physiotherapist. Before and after training all patients performed a symptoms-limited exercise test on a treadmill and a 6-min walking test (6MWT). Patients in the CT group also performed resistance exercises of upper and lower body. RESULTS The 6MWT and exercise duration at ergometric test increased significantly in both AT and CT groups, with the increase being greater in CT group (p < 0.001; ES = 0.13; p < 0.01; ES = 0.07). Muscular strength increased significantly in the CT group, particularly in the lower body muscular districts (p < 0.001). Quality of life improved in both groups, with a significantly greater improvement in the CT group (p < 0.05). No side effects leading to discontinuation of training were observed. CONCLUSIONS These findings indicate that concurrent, within-session training results in larger improvements in functional capacity, in addition to muscle performance, in patients with CHF, in comparison to single-mode aerobic training.
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15
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Edwards J, Shanmugam N, Ray R, Jouhra F, Mancio J, Wiles J, Marciniak A, Sharma R, O’Driscoll J. Exercise Mode in Heart Failure: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2023; 9:3. [PMID: 36622511 PMCID: PMC9829948 DOI: 10.1186/s40798-022-00549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Optimising exercise prescription in heart failure (HF) with a preserved (HFpEF) or reduced (HFrEF) ejection fraction is clinically important. As such, the aim of this meta-analysis was to compare traditional moderate intensity training (MIT) against combined aerobic and resistance training (CT) and high-intensity interval training (HIIT) for improving aerobic capacity (VO2), as well as other clinically relevant parameters. METHODS A comprehensive systematic search was performed to identify randomised controlled trials published between 1990 and May 2021. Research trials reporting the effects of MIT against CT or HIIT on peak VO2 in HFpEF or HFrEF were considered. Left-ventricular ejection fraction (LVEF) and various markers of diastolic function were also analysed. RESULTS Seventeen studies were included in the final analysis, 4 of which compared MIT against CT and 13 compared MIT against HIIT. There were no significant differences between MIT and CT for peak VO2 (weighted mean difference [WMD]: 0.521 ml min-1 kg-1, [95% CI] = - 0.7 to 1.8, Pfixed = 0.412) or LVEF (WMD: - 1.129%, [95% CI] = - 3.8 to 1.5, Pfixed = 0.408). However, HIIT was significantly more effective than MIT at improving peak VO2 (WMD: 1.62 ml min-1 kg-1, [95% CI] = 0.6-2.6, Prandom = 0.002) and LVEF (WMD: 3.24%, [95% CI] = 1.7-4.8, Prandom < 0.001) in HF patients. When dichotomized by HF phenotype, HIIT remained significantly more effective than MIT in all analyses except for peak VO2 in HFpEF. CONCLUSIONS HIIT is significantly more effective than MIT for improving peak VO2 and LVEF in HF patients. With the exception of peak VO2 in HFpEF, these findings remain consistent in both phenotypes. Separately, there is no difference in peak VO2 and LVEF change following MIT or CT, suggesting that the addition of resistance exercise does not inhibit aerobic adaptations in HF.
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Affiliation(s)
- Jamie Edwards
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK
| | - Nesan Shanmugam
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Robin Ray
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Fadi Jouhra
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jennifer Mancio
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jonathan Wiles
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK
| | - Anna Marciniak
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Rajan Sharma
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jamie O’Driscoll
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK ,grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
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Cardiac rehabilitation in heart failure with severely reduced ejection fraction: effects on mortality. Heart Fail Rev 2023; 28:1-19. [PMID: 35596876 DOI: 10.1007/s10741-022-10242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
Thirty years ago, patients with low ejection fraction (EF) have often been excluded from rehabilitation programs due to concern about possibility of sudden death or other adverse cardiovascular events during exercise sessions. Recent studies have highlighted the fact that cardiac rehabilitation could improve exercise capacity, cardiac function, and health-related quality of life in congestive heart failure patients. This encouraged us to write a review article and update our latest knowledge about the outcome of rehabilitation program in patients with severely depressed cardiac function. We were particularly interested in effect of cardiac rehabilitation on exercise capacity, quality of life, vascular effects, neuro-hormonal changes, and mortality. We also conducted a mini-systematic review and meta-analysis on randomized controlled trials comparing exercise training with usual care in patients with severely reduced left ventricular ejection fraction, for the mortality subsection to obtain precise estimates of overall treatment benefit on mortality. It is our privilege to submit our manuscript for possible publication in your prestigious journal.
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Aldhahir AM, Alhotye M, Alqahtani JS, Alghamdi SM, Alsulayyim AS, Alqarni AA, Alzahrani EM, Siraj RA, Alwafi H. Physicians' Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15208. [PMID: 36429925 PMCID: PMC9690397 DOI: 10.3390/ijerph192215208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians' perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions. METHODS Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors. RESULTS Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% (n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR. CONCLUSIONS CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians' perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians' and cardiac doctors' perspectives, respectively.
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Affiliation(s)
- Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 12211, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 32210, Saudi Arabia
| | - Saeed M. Alghamdi
- Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24211, Saudi Arabia
| | - Abdullah S. Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22230, Saudi Arabia
| | - Eidan M. Alzahrani
- Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam 32210, Saudi Arabia
| | - Rayan A. Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa 36291, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca 36291, Saudi Arabia
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Aldhahir AM. Nurses' Perception of, and Barriers to, Delivering Cardiopulmonary Rehabilitation for Heart Failure Patients: A National Survey in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13586. [PMID: 36294165 PMCID: PMC9602745 DOI: 10.3390/ijerph192013586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Heart failure (HF) patients require a holistic management approach to improve their clinical outcomes. Cardiopulmonary rehabilitation (CR) is a core component of HF patients' management and is supervised by a multidisciplinary team including nurses. Nursing attitudes regarding CR delivery for patients with HF and the possible barriers and factors that potentially affect referral have not been explored. Therefore, this study seeks to evaluate nurses' attitudes towards the delivery of CR programs and the possible barriers and factors that potentially influence the decision for a referral. METHODS An online survey with eight multiple-choice items was disseminated to all nurses between February and July 2022 in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. RESULTS Overall, 1056 nurses completed the online survey, of which 395 (37.40%) were male. Out of 1056 nurses, 414 (39.20%) strongly agreed that CR would improve patients' physical fitness, and 392 (37.10%) strongly agreed that CR would reduce breathlessness in patients with HF. In total, 381 nurses strongly agreed (36.10%) that CR would improve HF patients' palpitation and fatigue. Out of 1056 nurses, 396 (37.50%) strongly agreed that CR would improve HF patients' ability to perform daily activities, and 326 (30.90%) strongly agreed that CPR would reduce the rate of hospital readmission. The at-home program was the preferred mode of delivering CR programs among 607 (57.50%) nurses. Apart from the exercise component, symptom management was perceived by 704 (66.70%) nurses as the fundamental component of CR programs. The most common patient-related factor that strongly affected the decisions regarding referral was "mobility affected by breathlessness" (57%). A lack of CR centers (46%) was the most common barrier. CONCLUSION Nurses perceived CR as an effective management strategy for HF patients. Although a home-based program, with symptom management being an essential component, in addition to the exercise component, was perceived as the preferred mode of delivery, CR centers are lacking, which represented a significant barrier to CR referral from the nurses' perspective.
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Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
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Aldhahir AM, Alhotye M, Alqahtani JS, AlDraiwiesh IA, Alghamdi SM, Alsulayyim AS, Alqarni AA, Khormi SK, Alzahrani EM, Al Rajeh AM, Aldabayan YS, Siraj RA, Tawhari NA, Alhazmi FM, Najmi AA, Alwadeai KS, Alwafi H. Physiotherapists' Attitudes, and Barriers of Delivering Cardiopulmonary Rehabilitation for Patients with Heart Failure in Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc 2022; 15:2353-2361. [PMID: 36267851 PMCID: PMC9578487 DOI: 10.2147/jmdh.s386519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiopulmonary rehabilitation (CR) is an effective management approach for heart failure (HF) patients and is delivered by multidisciplinary teams including physiotherapists (PTs). PT attitudes about delivering CR and barriers that might affect referral have not been explored. Thus, this study is aimed to explore PT attitudes about delivering CR programs to patients with HF and identify factors and barriers that might affect referral decisions. METHODS A cross-sectional online survey was disseminated to all PTs in Saudi Arabia between 19 February and 27 June, 2022. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. RESULTS Overall, 553 PTs, 289 (52.30%) male and 264 (47.70%) females, completed the online survey. Of these, 360 (65.1%) strongly agreed that CR would improve patients' physical fitness and 334 (60.4%) strongly agreed that CR would reduce breathlessness in patients with HF. The majority of PTs (321, 58%) strongly agreed that CR would improve HF patients' palpitation and fatigue. Out of 553 PTs, 349 (63.1%) strongly agreed that CR would improve patients' ability to perform daily activities. A hospital-supervised program was the preferred mode of delivering CR programs by 499 (90.20%) of the respondents. Apart from the exercise component, stress management was perceived by 455 (82.30%) as an essential component of CR programs. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (42%). A lack of CR centers was reported by 59.90% as the most common referring barrier. CONCLUSION PTs perceived CR as a successful strategy for patients with HF. Although a supervised hospital-based program with stress management as an essential component aside from the exercise component was perceived as the preferred mode of delivery, CR was lacking, which caused a significant barrier to CR referral from the PTs' perspective.
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Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah S Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahad K Khormi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eidan M Alzahrani
- Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ahmed M Al Rajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Yousef S Aldabayan
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Rayan A Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Naif A Tawhari
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Faisal M Alhazmi
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ayat A Najmi
- Physical Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Khalid S Alwadeai
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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20
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Arciero PJ, Ives SJ, Mohr AE, Robinson N, Escudero D, Robinson J, Rose K, Minicucci O, O'Brien G, Curran K, Miller VJ, He F, Norton C, Paul M, Sheridan C, Beard S, Centore J, Dudar M, Ehnstrom K, Hoyte D, Mak H, Yarde A. Morning Exercise Reduces Abdominal Fat and Blood Pressure in Women; Evening Exercise Increases Muscular Performance in Women and Lowers Blood Pressure in Men. Front Physiol 2022; 13:893783. [PMID: 35711313 PMCID: PMC9194552 DOI: 10.3389/fphys.2022.893783] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 12/25/2022] Open
Abstract
The ideal exercise time of day (ETOD) remains elusive regarding simultaneous effects on health and performance outcomes, especially in women. Purpose: Given known sex differences in response to exercise training, this study quantified health and performance outcomes in separate cohorts of women and men adhering to different ETOD. Methods: Thirty exercise-trained women (BMI = 24 ± 3 kg/m2; 42 ± 8 years) and twenty-six men (BMI = 25.5 ± 3 kg/m2; 45 ± 8 years) were randomized to multimodal ETOD in the morning (0600–0800 h, AM) or evening (1830–2030 h, PM) for 12 weeks and analyzed as separate cohorts. Baseline (week 0) and post (week 12) muscular strength (1-RM bench/leg press), endurance (sit-ups/push-ups) and power (squat jumps, SJ; bench throws, BT), body composition (iDXA; fat mass, FM; abdominal fat, Abfat), systolic/diastolic blood pressure (BP), respiratory exchange ratio (RER), profile of mood states (POMS), and dietary intake were assessed. Results: Twenty-seven women and twenty men completed the 12-week intervention. No differences at baseline existed between groups (AM vs PM) for both women and men cohorts. In women, significant interactions (p < 0.05) existed for 1RM bench (8 ± 2 vs 12 ± 2, ∆kg), pushups (9 ± 1 vs 13 ± 2, ∆reps), BT (10 ± 6 vs 45 ± 28, ∆watts), SJ (135 ± 6 vs 39 ± 8, ∆watts), fat mass (−1.0 ± 0.2 vs −0.3 ± 0.2, ∆kg), Abfat (−2.6 ± 0.3 vs −0.9 ± 0.5, ∆kg), diastolic (−10 ± 1 vs−5 ± 5, ∆mmHg) and systolic (−12.5 ± 2.7 vs 2.3 ± 3, mmHg) BP, AM vs PM, respectively. In men, significant interactions (p < 0.05) existed for systolic BP (−3.5 ± 2.6 vs −14.9 ± 5.1, ∆mmHg), RER (−0.01 ± 0.01 vs −0.06 ± 0.01, ∆VCO2/VO2), and fatigue (−0.8 ± 2 vs −5.9 ± 2, ∆mm), AM vs PM, respectively. Macronutrient intake was similar among AM and PM groups. Conclusion: Morning exercise (AM) reduced abdominal fat and blood pressure and evening exercise (PM) enhanced muscular performance in the women cohort. In the men cohort, PM increased fat oxidation and reduced systolic BP and fatigue. Thus, ETOD may be important to optimize individual exercise-induced health and performance outcomes in physically active individuals and may be independent of macronutrient intake.
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Affiliation(s)
- Paul J Arciero
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Stephen J Ives
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Alex E Mohr
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Nathaniel Robinson
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Daniela Escudero
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Jake Robinson
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Kayla Rose
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Olivia Minicucci
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Gabriel O'Brien
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Kathryn Curran
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Vincent J Miller
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Feng He
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States.,Department of Kinesiology, California State University, Chico, CA, United States
| | - Chelsea Norton
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Maia Paul
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Caitlin Sheridan
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Sheriden Beard
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Jessica Centore
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Monique Dudar
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Katy Ehnstrom
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Dakembay Hoyte
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Heather Mak
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
| | - Aaliyah Yarde
- Human Nutrition and Metabolism Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, United States
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21
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Impact of concurrent training versus aerobic or resistance training on cardiorespiratory fitness and muscular strength in middle-aged to older adults: A systematic review and meta-analysis. Physiol Behav 2022; 254:113888. [PMID: 35728627 DOI: 10.1016/j.physbeh.2022.113888] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/29/2022]
Abstract
The effects of aerobic training (AT) on cardiorespiratory fitness (CRF), and resistance training (RT) on muscular strength, are well known in older adults. However, less is known about the potential additive benefits of concurrent training (CT) versus AT or RT alone in this population. We conducted a systematic review and meta-analysis to investigate the effects of CT, versus AT or RT, on CRF and muscular strength in middle-aged to older adults. PubMed and Web of Science were searched through October 2021 to identify randomized trials evaluating CT versus AT and/or RT in middle-aged and older adults (>50 yrs). Studies were included that measured CRF, using maximal or peak oxygen uptake (VO2max/peak); and/or lower- and upper-body muscular strength measured using 1-repetition maximum (1RM) to 10RM tests during isoinertial contractions, or peak torque during isometric dynamometry or isokinetic dynamometry at 30 to 60°/s. Standardized mean differences (SMD) and 95% confidence intervals (95% CIs) were determined using random or fixed effects models. Forty-nine studies involving 2,587 middle-aged to older participants with mean ages ranging from 55 to 88 years, were included in the meta-analysis. Results indicated that CT effectively increased VO2max/peak (SMD: 0.77, p = 0.005, 12 intervention arms) when compared to RT. In addition, CT effectively increased lower- (SMD: 0.60, p = 0.001, 43 intervention arms) and upper-body (SMD: 0.57, p = 0.001, 28 intervention arms) muscular strength when compared to AT. However, there were no differences in VO2max/peak (SMD: 0.09, p = 0.09, 33 intervention arms) between CT and AT, or in lower-body (SMD: 0.07, p = 0.48, 21 intervention arms) and upper-body (SMD: -0.07, p = 0.38, 17 intervention arms) muscular strength between CT and RT. Overall, CT was shown to be effective for increasing CRF and muscular strength in middle-aged to older adults and there was no negative effect on the magnitude of changes in these outcomes compared to either AT or RT alone. These results suggested that CT should be considered a viable strategy to improvement of CRF and muscular strength with aging.
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22
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Alonso WW, Kupzyk KA, Norman JF, Lundgren SW, Fisher A, Lindsey ML, Keteyian SJ, Pozehl BJ. The HEART Camp Exercise Intervention Improves Exercise Adherence, Physical Function, and Patient-Reported Outcomes in Adults With Preserved Ejection Fraction Heart Failure. J Card Fail 2022; 28:431-442. [PMID: 34534664 PMCID: PMC8920955 DOI: 10.1016/j.cardfail.2021.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%-80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group. CONCLUSIONS A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670.
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Affiliation(s)
- Windy W Alonso
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph F Norman
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Scott W Lundgren
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Alfred Fisher
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Merry L Lindsey
- Department of Cellular and Integrative Physiology, Center for Heart and Vascular Research, University of Nebraska Medical Center, Omaha, Nebraska; Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | | | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
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23
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El-Sobkey SB. Resistance training is an effective exercise therapy in cardiac rehabilitation program for patients with coronary artery disease: a systematic review. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Exercise-based cardiac rehabilitation program is a comprehensive intervention for the rehabilitation of coronary artery disease patients. Exercise therapy is a valuable, effective, and integral intervention of cardiac rehabilitation. Aerobic training is the gold standard exercise therapy in cardiac rehabilitation programs. In addition, combined training with added resistant training is also used. This systematic review aimed to provide the physical therapy clinicians with a consensus regarding the effect of resistant training by answering the question of what is the cardiovascular and non-cardiovascular effect (s) of resistant training in the cardiac rehabilitation program for patients with coronary artery disease?
Main body
The Physiotherapy evidence database (PEDro) was used as a search engine to select articles through study eligibility criteria. Adult or adult and old stable coronary artery disease patients engaged in a site-based (Phase II) exercise-based cardiac rehabilitation program that includes aerobic and resistant training. Selected articles applied cardiovascular and non-cardiovascular outcome measures to measure the effectiveness of resistant training. The author reviewed the selected articles and applied quantitative non-statistical analysis and appraisal for these articles. The systematic selection process resulted in 10 studies with a total participants number of 3877. Analyzing the articles revealed that adding resistant training to aerobic training resulted in a favorable improvement in outcome measures for coronary artery disease patients. Resistant training produced improvement in the exercise capacity (VO2 peak), blood pressure, skeletal muscle strength, endurance, body composition, sleep quality, depression, and health-related quality of life.
Short conclusions
The addition of resistant training to aerobic training in cardiac rehabilitation induces more positive cardiovascular and non-cardiovascular effects for stable coronary artery disease patients.
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24
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Gasser BA, Boesing M, Schoch R, Brighenti-Zogg S, Kröpfl JM, Thesenvitz E, Hanssen H, Leuppi JD, Schmidt-Trucksäss A, Dieterle T. High-Intensity Interval Training for Heart Failure Patients With Preserved Ejection Fraction (HIT-HF)-Rational and Design of a Prospective, Randomized, Controlled Trial. Front Physiol 2021; 12:734111. [PMID: 34630155 PMCID: PMC8498586 DOI: 10.3389/fphys.2021.734111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pathophysiology of HF with preserved ejection fraction (HFpEF) has not yet been fully understood and HFpEF is often misdiagnosed. Remodeling and fibrosis stimulated by inflammation appear to be main factors for the progression of HFpEF. In contrast to patients with HF with reduced ejection fraction, medical treatment in HFpEF is limited to relieving HF symptoms. Since mortality in HFpEF patients remains unacceptably high with a 5-year survival rate of only 30%, new treatment strategies are urgently needed. Exercise seems to be a valid option. However, the optimal training regime still has to be elucidated. Therefore, the aim of the study is to investigate the effects of a high-intensity interval (HIT) training vs. a moderate continuous training (MCT) on exercise capacity and disease-specific mechanisms in a cohort of patients with HFpEF. Methods: The proposed study will be a prospective, randomized controlled trial in a primary care setting including 86 patients with stable HFpEF. Patients will undergo measurements of exercise capacity, disease-specific blood biomarkers, cardiac and arterial vessel structure and function, total hemoglobin mass, metabolic requirements, habitual physical activity, and quality of life (QoL) at baseline and follow-up. After the baseline visit, patients will be randomized to the intervention or control group. The intervention group (n = 43) will attend a supervised 12-week HIT on a bicycle ergometer combined with strength training. The control group (n = 43) will receive an isocaloric supervised MCT combined with strength training. After 12 weeks, study measurements will be repeated in all patients to quantify the effects of the intervention. In addition, telephone interviews will be performed at 6 months, 1, 2, and 3 years after the last visit to assess clinical outcomes and QoL. Discussion: We anticipate clinically significant changes in exercise capacity, expressed as VO2peak, as well as in disease-specific mechanisms following HIT compared to MCT. Moreover, the study is expected to add important knowledge on the pathophysiology of HFpEF and the clinical benefits of a training intervention as a novel treatment strategy in HFpEF patients, which may help to improve both QoL and functional status in affected patients. Trial registration: ClinicalTrials.gov, identifier: NCT03184311, Registered 9 June 2017.
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Affiliation(s)
- Benedikt A Gasser
- Department of Sport, Exercise and Health, Division of Sport and Exercise Medicine, University of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maria Boesing
- Faculty of Medicine, University of Basel, Basel, Switzerland.,University Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Raphael Schoch
- Department of Sport, Exercise and Health, Division of Sport and Exercise Medicine, University of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Julia M Kröpfl
- Department of Sport, Exercise and Health, Division of Sport and Exercise Medicine, University of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Elke Thesenvitz
- University Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Division of Sport and Exercise Medicine, University of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jörg D Leuppi
- Faculty of Medicine, University of Basel, Basel, Switzerland.,University Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division of Sport and Exercise Medicine, University of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thomas Dieterle
- Faculty of Medicine, University of Basel, Basel, Switzerland.,University Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Division of Cardiology, Clinic Arlesheim AG, Arlesheim, Switzerland
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25
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Sex-Specific Impacts of Exercise on Cardiovascular Remodeling. J Clin Med 2021; 10:jcm10173833. [PMID: 34501285 PMCID: PMC8432130 DOI: 10.3390/jcm10173833] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in men and women. Biological sex plays a major role in cardiovascular physiology and pathological cardiovascular remodeling. Traditionally, pathological remodeling of cardiovascular system refers to the molecular, cellular, and morphological changes that result from insults, such as myocardial infarction or hypertension. Regular exercise training is known to induce physiological cardiovascular remodeling and beneficial functional adaptation of the cardiovascular apparatus. However, impact of exercise-induced cardiovascular remodeling and functional adaptation varies between males and females. This review aims to compare and contrast sex-specific manifestations of exercise-induced cardiovascular remodeling and functional adaptation. Specifically, we review (1) sex disparities in cardiovascular function, (2) influence of biological sex on exercise-induced cardiovascular remodeling and functional adaptation, and (3) sex-specific impacts of various types, intensities, and durations of exercise training on cardiovascular apparatus. The review highlights both animal and human studies in order to give an all-encompassing view of the exercise-induced sex differences in cardiovascular system and addresses the gaps in knowledge in the field.
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26
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Adams SC, McMillan J, Salline K, Lavery J, Moskowitz CS, Matsoukas K, Chen MMZ, Santa Mina D, Scott JM, Jones LW. Comparing the reporting and conduct quality of exercise and pharmacological randomised controlled trials: a systematic review. BMJ Open 2021; 11:e048218. [PMID: 34380726 PMCID: PMC8359527 DOI: 10.1136/bmjopen-2020-048218] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/15/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Evaluate the quality of exercise randomised controlled trial (RCT) reporting and conduct in clinical populations (ie, adults with or at risk of chronic conditions) and compare with matched pharmacological RCTs. DESIGN Systematic review. DATA SOURCES Embase (Elsevier), PubMed (NLM) and CINAHL (EBSCO). STUDY SELECTION RCTs of exercise in clinical populations with matching pharmacological RCTs published in leading clinical, medical and specialist journals with impact factors ≥15. REVIEW METHODS Overall RCT quality was evaluated by two independent reviewers using three research reporting guidelines (ie, Consolidated Standards of Reporting Trials (CONSORT; pharmacological RCTs)/CONSORT for non-pharmacological treatments; exercise RCTs), CONSORT-Harms, Template for Intervention Description and Replication) and two risk of bias assessment (research conduct) tools (ie, Cochrane Risk of Bias, Jadad Scale). We compared research reporting and conduct quality within exercise RCTs with matched pharmacological RCTs, and examined factors associated with quality in exercise and pharmacological RCTs, separately. FINDINGS Forty-eight exercise RCTs (11 658 patients; median sample n=138) and 48 matched pharmacological RCTs were evaluated (18 501 patients; median sample n=160). RCTs were conducted primarily in cardiovascular medicine (43%) or oncology (31%). Overall quality score (composite of all research reporting and conduct quality scores; primary endpoint) for exercise RCTs was 58% (median score 46 of 80; IQR: 39-51) compared with 77% (53 of 68; IQR: 47-58) in the matched pharmacological RCTs (p≤0.001). Individual quality scores for trial reporting and conduct were lower in exercise RCTs compared with matched pharmacological RCTs (p≤0.03). Factors associated with higher overall quality scores for exercise RCTs were journal impact factor (≥25), sample size (≥152) and publication year (≥2013). CONCLUSIONS AND RELEVANCE Research reporting and conduct quality within exercise RCTs is inferior to matched pharmacological RCTs. Suboptimal RCT reporting and conduct impact the fidelity, interpretation, and reproducibility of exercise trials and, ultimately, implementation of exercise in clinical populations. PROSPERO REGISTRATION NUMBER CRD42018095033.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Julia McMillan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kirsten Salline
- Internal Medicine, NYU Langone Health, New York, New York, USA
| | - Jessica Lavery
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chaya S Moskowitz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Maggie M Z Chen
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jessica M Scott
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lee W Jones
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
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27
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Harwood AE, Russell S, Okwose NC, McGuire S, Jakovljevic DG, McGregor G. A systematic review of rehabilitation in chronic heart failure: evaluating the reporting of exercise interventions. ESC Heart Fail 2021; 8:3458-3471. [PMID: 34235878 PMCID: PMC8497377 DOI: 10.1002/ehf2.13498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
A large body of research supports the use of exercise to improve symptoms, quality of life, and physical function in patients with chronic heart failure. Previous reviews have focused on reporting outcomes of exercise interventions such as cardiorespiratory fitness. However, none have critically examined exercise prescription. The aim of this review was to evaluate the reporting and application of exercise principles in randomised control trials of exercise training in patients with chronic heart failure. A systematic review of exercise intervention RCTs in patients with CHF, using the Consensus on Exercise Reporting Template (CERT), was undertaken. The Ovid Medline/PubMed, Embase, Scopus/Web of Science, and Cochrane Library and Health Technology Assessment Databases were searched from 2000 to June 2020. Prospective RCTs in which patients with CHF were randomized to a structured exercise programme were included. No limits were placed on the type or duration of exercise structured exercise programme or type of CHF (i.e. preserved or reduced ejection fraction). We included 143 studies, comprising of 181 different exercise interventions. The mean CERT score was 10 out of 19, with no study achieving a score of 19. Primarily, details were missing regarding motivational strategies, home-based exercise components, and adherence/fidelity to the intervention. Exercise intensity was the most common principle of exercise prescription missing from intervention reporting. There was no improvement in the reporting of exercise interventions with time (R2 = 0.003). Most RCTs of exercise training in CHF are reported with insufficient detail to allow for replication, limiting the translation of evidence to clinical practice. We encourage authors to provide adequate details when reporting future interventions. Where journal word counts are restrictive, we recommend using supplementary material or publishing trial protocols prior to beginning the study.
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Affiliation(s)
- Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Sophie Russell
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Nduka C Okwose
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK
| | - Scott McGuire
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Djordje G Jakovljevic
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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28
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Effect of Endurance and Resistance Training on Adropin and Insulin Resistance among Overweight Men: A Randomized Clinical Trial. PHYSIOLOGY AND PHARMACOLOGY 2021. [DOI: 10.52547/phypha.26.3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Buckley JP. The changing landscape of cardiac rehabilitation; from early mobilisation and reduced mortality to chronic multi-morbidity management. Disabil Rehabil 2021; 43:3515-3522. [PMID: 33989103 DOI: 10.1080/09638288.2021.1921062] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM This paper aims to demonstrate how the rationale and delivery of cardiac rehabilitation (CR), in those countries with long term established standards of practice, has changed over the past eight decades. METHODS A narrative report based on the evolution of key published guidelines, systematic reviews and medical policies since the 1940s. RESULTS Case reports of the value of exercise in cardiac disease can be dated back to 1772. Formative groundwork for exercise-based CR was published between 1940 and 1970. However, it was not until the late 1980s that a large enough data set of controlled trials was available to show significant reductions in premature all-cause and cardiac mortality. Since the mid 1990s, cardiac mortality has been greatly reduced due to enhanced public health, emergency care and more sensitive diagnostic techniques and aggressive treatments. As a result, there appears to be an associated reduced potency of CR to affect mortality. New rationales for why, how and where CR is delivered have emerged including: adapting to a longer surviving ageing multi-morbid population, where healthcare cost savings and quality of life have become increasingly important. CONCLUSIONS In light of these results, an emerging focus for CR, and in some cases "pre-habilitation", is that of a chronic disability management programme increasingly delivered in community and home settings. Within this delivery model, the use of remote personalised technologies is now emerging, especially with new needs accelerated by the pandemic of COVID-19. IMPLICATIONS FOR REHABILITATIONWith continued advances in medical science and better long term survival, the nature of cardiac rehabilitation has evolved over the past eight decades. It was originally an exercise-focused intervention on short term recovery and reducing cardiac and all-cause mortality, to now being one part of a multi-factor lifestyle, behavioural, and medical chronic disease management programme.Throughout history, the important influence of psycho-social well-being and human behaviour has, however, always been of key importance to patients.The location of rehabilitation can now be suited to patient need, both medically and socially, where the same components can be delivered in either a traditional outpatient clinic, community settings, at home and more recently all of these being supported or augmented with the advent of mobile technology.
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Affiliation(s)
- John P Buckley
- Centre for Active Living, University Centre Shrewsbury/University of Chester, Chester, UK
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30
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Righi GDA, Schuch FB, Tolves T, De Nardi AT, Righi NC, Signori LU, da Silva AMV. Combined aerobic and strength training for fitness outcomes in heart failure: meta-analysis and meta-regression. Disabil Rehabil 2021; 44:4149-4160. [PMID: 33789068 DOI: 10.1080/09638288.2021.1900411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the effects of combined training (CT) versus aerobic training (AT) or versus control on VO2 peak and quadriceps muscle strength in patients with heart failure (HF). MATERIALS AND METHODS Major electronic databases were searched, from inception to November 2020, for randomized clinical trials comparing the effects of CT against AT or control on VO2 peak and/or quadriceps muscle strength in patients with HF. Random effects meta-analyses were conducted, calculating the standardized mean difference (SMD). RESULTS Twenty-eight articles were included. An increase on VO2 peak (SMD = 0.77, 95%CI 0.39-1.14, I2=80.1%) and quadriceps muscle strength (SMD = 0.67, 95%CI 0.18-1.16, I2=0%) was found in CT compared to control. CT increased quadriceps muscle strength, versus AT (SMD = 0.44, 95%CI 0.15-0.74, I2=0%). There were no differences between CT and AT on VO2 peak (SMD=-0.01, 95%CI -0.36 to 0.34, I2=65%). Time of session and training duration moderate the effects of CT over control on VO2 peak. CONCLUSIONS CT promotes increases on quadriceps muscle strength and aerobic capacity over control and provides additional gains on quadriceps muscle strength, having the same effects on VO2 peak compared to AT. A longer time of session is associated with greater benefits to aerobic capacity.Implications for rehabilitationCombining aerobic and strength training increases the functional capacity and quadriceps muscle strength in heart failure patients.Using longer sessions of training has a greater impact on aerobic capacity.
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Affiliation(s)
| | - Felipe Barreto Schuch
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | - Tainara Tolves
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Luis Ulisses Signori
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | - Antônio Marcos Vargas da Silva
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
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31
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Bozkurt B, Fonarow GC, Goldberg LR, Guglin M, Josephson RA, Forman DE, Lin G, Lindenfeld J, O'Connor C, Panjrath G, Piña IL, Shah T, Sinha SS, Wolfel E. Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel. J Am Coll Cardiol 2021; 77:1454-1469. [PMID: 33736829 DOI: 10.1016/j.jacc.2021.01.030] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Cardiac rehabilitation is defined as a multidisciplinary program that includes exercise training, cardiac risk factor modification, psychosocial assessment, and outcomes assessment. Exercise training and other components of cardiac rehabilitation (CR) are safe and beneficial and result in significant improvements in quality of life, functional capacity, exercise performance, and heart failure (HF)-related hospitalizations in patients with HF. Despite outcome benefits, cost-effectiveness, and strong practice guideline recommendations, CR remains underused. Clinicians, health care leaders, and payers should prioritize incorporating CR as part of the standard of care for patients with HF.
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Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine and DeBakey VA Medical Center, Houston, Texas, USA.
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Lee R Goldberg
- Cardiovascular Division, Perelman School of Medicine at the, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maya Guglin
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Richard A Josephson
- Cardiovascular and Pulmonary Rehabilitation, Harrington Heart & Vascular Institute, Case Western Reserve University, Division of Cardiovascular Medicine, University Hospitals Health System, Cleveland, Ohio, USA
| | - Daniel E Forman
- Divisions of Cardiology and Geriatrics, University of Pittsburgh and VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chris O'Connor
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia, USA; Duke University, Durham, North Carolina, USA
| | - Gurusher Panjrath
- Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ileana L Piña
- Wayne State University, Detroit, Michigan, USA; Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Tina Shah
- Department of Cardiology, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia, USA; Duke University, Durham, North Carolina, USA
| | - Eugene Wolfel
- Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Laoutaris ID, Piotrowicz E, Kallistratos MS, Dritsas A, Dimaki N, Miliopoulos D, Andriopoulou M, Manolis AJ, Volterrani M, Piepoli MF, Coats AJS, Adamopoulos S. Combined aerobic/resistance/inspiratory muscle training as the 'optimum' exercise programme for patients with chronic heart failure: ARISTOS-HF randomized clinical trial. Eur J Prev Cardiol 2020; 28:1626-1635. [PMID: 33624071 DOI: 10.1093/eurjpc/zwaa091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
AIMS An 'optimum' universally agreed exercise programme for heart failure (HF) patients has not been found. ARISTOS-HF randomized clinical trial evaluates whether combined aerobic training (AT)/resistance training (RT)/inspiratory muscle training (IMT) (ARIS) is superior to AT/RT, AT/IMT or AT in improving aerobic capacity, left ventricular dimensions, and secondary functional outcomes. METHODS AND RESULTS Eighty-eight patients of New York Heart Association II-III, left ventricular ejection fraction ≤ 35% were randomized to an ARIS, AT/RT, AT/IMT, or AT group, exercising 3 times/week, 180 min/week for 12 weeks. Pre- and post-training, peakVO2 was evaluated with cardiopulmonary exercise testing, left ventricular dimensions using echocardiography, walking distance with the 6-min walk test (6MWT), quality of life by the Minnesota Living with HF Questionnaire (MLwHFQ), while a programme preference survey (PPS) was used. Seventy-four patients of [mean 95% (confidence interval, CI)] age 66.1 (64.3-67.9) years and peakVO2 17.3 (16.4-18.2) mL/kg/min were finally analysed. Between-group analysis showed a trend for increased peakVO2 (mL/kg/min) [mean contrasts (95% CI)] in the ARIS group [ARIS vs. AT/RT 1.71 (0.163-3.25)(.), vs. AT/IMT 1.50 (0.0152-2.99)(.), vs. AT 1.38 (-0.142 to 2.9)(.)], additional benefits in circulatory power (mL/kg/min⋅mmHg) [ARIS vs. AT/RT 376 (60.7-690)*, vs. AT/IMT 423 (121-725)*, vs. AT 345 (35.4-656)*], left ventricular end-systolic diameter (mm) [ARIS vs. AT/RT -2.11 (-3.65 to (-0.561))*, vs. AT -2.47 (-4.01 to (-0.929))**], 6MWT (m) [ARIS vs. AT/IMT 45.6 (18.3-72.9)**, vs. AT 55.2 (27.6-82.7)****], MLwHFQ [ARIS vs. AT/RT -7.79 (-11 to (-4.62))****, vs. AT -8.96 (-12.1 to (-5.84))****], and in PPS score [mean (95% CI)] [ARIS, 4.8 (4.7-5) vs. AT, 4.4 (4.2-4.7)*] [(.) P ≤ 0.1; *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001; ****P ≤ 0.0001]. CONCLUSION ARISTOS-HF trial recommends exercise training for 180 min/week and supports the prescription of the ARIS training regime for HF patients (Clinical Trial Registration: http://www.clinicaltrials.gov. ARISTOS-HF Clinical Trial number, NCT03013270).
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Affiliation(s)
- Ioannis D Laoutaris
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
| | - Ewa Piotrowicz
- National Institute of Cardiology, Telecardiology Center, Alpejska 42, 04-628, Warsaw, Poland
| | - Manolis S Kallistratos
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Athanasios Dritsas
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
| | - Niki Dimaki
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Dimitris Miliopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
| | - Maria Andriopoulou
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Athanasios J Manolis
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Maurizio Volterrani
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana 235, 00163, Rome, Italy
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, G. da Saliceto Hospital, via taverna Giuseppe 49, 291121, AUSL, Piacenza, Italy
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana 235, 00163, Rome, Italy
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
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Brubaker PH, Avis T, Rejeski WJ, Mihalko SE, Tucker WJ, Kitzman DW. Exercise Training Effects on the Relationship of Physical Function and Health-Related Quality of Life Among Older Heart Failure Patients With Preserved Ejection Fraction. J Cardiopulm Rehabil Prev 2020; 40:427-433. [PMID: 32604218 PMCID: PMC7647941 DOI: 10.1097/hcr.0000000000000507] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Although exercise training (ET) has been shown to improve both physical function and health-related quality of life (HRQOL) in older patients with heart failure and preserved ejection fraction (HFpEF), the relationship between changes in these important patient-centered outcome measures has not been adequately investigated. METHODS Patients (n = 116) with HFpEF (from 2 previous randomized controlled trials) were assigned to either 16 wk of endurance ET or attention control (CON). The ET in both trials consisted of ≤ 60 min of moderate-intensity endurance ET 3 time/wk. Peak exercise oxygen uptake (V˙o2peak) and other exercise capacity measures were obtained from a cardiopulmonary exercise test on an electronically braked cycle ergometer and 6-min walk test (6MWT). HRQOL was assessed using the Minnesota Living with Heart Failure (MLHF) Questionnaire and the 36-item Short Form Health Survey (SF-36). RESULTS Compared with CON, the ET group demonstrated significant improvement in measures of physical function (V˙o2peak and 6MWT) at 16 wk of follow-up. There were no significant differences observed between the groups for MLHF scores, but the ET group showed significant improvements on the SF-36. There were no significant correlations between change in any of the physical function and HRQOL measures in the ET group. CONCLUSIONS While endurance ET improved both physical function and some domains of HRQOL, the lack of significant correlations between changes in these measures suggests the effects of ET on physical function and HRQOL are largely independent of one another. Since these measures assess important and unique patient-centered outcomes in HFpEF patients, both physical function and HRQOL should be assessed in exercise-based programs and clinical trials.
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Affiliation(s)
- Peter H Brubaker
- Departments of Health and Exercise Science (Drs Brubaker, Rejeski, and Mihalko and Ms Avis) and Internal Medicine (Cardiology) (Dr Kitzman), Wake Forest University, Winston-Salem, North Carolina; and Department of Nutrition and Food Sciences, Texas Woman's University, Houston (Dr Tucker)
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Papathanasiou JV, Petrov I, Tokmakova MP, Dimitrova DD, Spasov L, Dzhafer NS, Tsekoura D, Dionyssiotis Y, Ferreira AS, Lopes AJ, Rosulescu E, Foti C. Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial. Eur J Phys Rehabil Med 2020; 56:479-488. [PMID: 31976639 DOI: 10.23736/s1973-9087.20.06013-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In recent decades, many studies are focused on different training modalities comparison in patients with cardiac diseases. High intensity aerobic interval training (HIAIT) has been considered as an alternative approach to moderate-intensity continuous training (MICT) in rehabilitation of patients with chronic heart failure (CHF). AIM To highlight the superiority of the modified group-based HIAIT intervention (m-Ullevaal) compared to the moderate-intensity continuous training (MICT), also to encourage physical and rehabilitation medicine (PRM) physicians to apply the m-Ullevaal intervention in routine cardiac rehabilitation (CR) practice. DESIGN А single-blind, prospective randomized controlled trial. SETTING Medical Center of Rehabilitation and Sports Medicine, Plovdiv, Bulgaria outpatients were enrolled. POPULATION One hundred and twenty subjects of both genders, mean age of 63.73±6.68 years, with stable CHF, NYHA classes II to IIIB, were randomly assigned to m-Ullevaal group (N.=60) or to MICT (N.=60) group. Both CR protocols were conducted throughout a 12-week period. METHODS Functional exercise capacity (FEC), assessed with six-minute walk test, and peak oxygen uptake (VO2peak), left ventricular ejection fraction (LVEF), m-Borg's perceived exertion scale (mBPES), and quality of life (QoL) were outcome measures evaluated. RESULTS Significant improvement in FEC (P<0.001), LVEF (P<0.001), mBPES and QoL (P<0.001), was observed 12 weeks after both CR interventions (T2). However, the participants performed m-Ullevaal protocol achieved a greater improvement compared to those performed MICT (P<0.001). CONCLUSIONS The m-Ullevaal protocol seems to be more beneficial and more effective compared to MICT. PRM physicians can efficiently apply the m-Ullevaal protocol in CHF patients rehabilitation. CLINICAL REHABILITATION IMPACT Group-based HIAIT interventions can be widely applied by PRM physicians in CHF patients rehabilitation.
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Affiliation(s)
- Jannis V Papathanasiou
- Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria -
- Department of Kinesitherapy, Medical University of Sofia, Sofia, Bulgaria -
| | - Ivo Petrov
- Clinic of Cardiology and Angiology, Acibadem City Clinic Cardiovascular Center University Hospital, Sofia, Bulgaria
| | - Maria P Tokmakova
- Department of Cardiology at Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Donka D Dimitrova
- Department of Health Management and Health Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Liubomir Spasov
- Cardiac Surgery Clinic Lozenets, University Hospital, Faculty of Medicine, St. Kliment Ohridski University, Sofia, Bulgaria
| | - Nigyar S Dzhafer
- Department of Health Policy and Management, Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria
| | | | - Yannis Dionyssiotis
- First Physical Medicine and Rehabilitation Department, National Rehabilitation Center, Athens, Greece
| | | | | | - Eugenia Rosulescu
- Department of Physical Therapy and Sports Medicine, Faculty of Physical Education and Sport, University of Craiova, Craiova, Romania
| | - Calogero Foti
- Department of Physical Medicine and Rehabilitation, Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
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Techniques de renforcement musculaire en réadaptation cardiaque. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX - PRATIQUE 2020; 2020:16-21. [PMID: 32562474 PMCID: PMC7243777 DOI: 10.1016/j.amcp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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36
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Preßler A. [Physical activity and exercise in chronic heart failure]. MMW Fortschr Med 2020; 162:40-44. [PMID: 32447679 DOI: 10.1007/s15006-020-0521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Beckers PJ, Gevaert AB. High intensity interval training for heart failure with preserved ejection fraction: High hopes for intense exercise. Eur J Prev Cardiol 2020; 27:1730-1732. [DOI: 10.1177/2047487320910294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Paul J Beckers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium
| | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
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Lan NS, Lam K, Naylor LH, Green DJ, Minaee NS, Dias P, Maiorana AJ. The Impact of Distinct Exercise Training Modalities on Echocardiographic Measurements in Patients with Heart Failure with Reduced Ejection Fraction. J Am Soc Echocardiogr 2020; 33:148-156. [DOI: 10.1016/j.echo.2019.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Zentner D, Celermajer DS, Gentles T, d’Udekem Y, Ayer J, Blue GM, Bridgman C, Burchill L, Cheung M, Cordina R, Culnane E, Davis A, du Plessis K, Eagleson K, Finucane K, Frank B, Greenway S, Grigg L, Hardikar W, Hornung T, Hynson J, Iyengar AJ, James P, Justo R, Kalman J, Kasparian N, Le B, Marshall K, Mathew J, McGiffin D, McGuire M, Monagle P, Moore B, Neilsen J, O’Connor B, O’Donnell C, Pflaumer A, Rice K, Sholler G, Skinner JR, Sood S, Ward J, Weintraub R, Wilson T, Wilson W, Winlaw D, Wood A. Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement. Heart Lung Circ 2020; 29:5-39. [DOI: 10.1016/j.hlc.2019.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
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40
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Gomes-Neto M, Durães AR, Conceição LSR, Roever L, Silva CM, Alves IGN, Ellingsen Ø, Carvalho VO. Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis. Int J Cardiol 2019; 293:165-175. [PMID: 31345646 DOI: 10.1016/j.ijcard.2019.02.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of combined aerobic and resistance training on peak oxygen consumption (peak VO2), minute ventilation/carbon dioxide production (VE/VCO2 slope), muscle strength and health-related quality of life (HRQoL) in heart failure patients with reduced left ventricular ejection fraction (HFrEF). METHODS We searched Cochrane, Pubmed, and PEDro (from the earliest date available to September 2018) for RCTs that evaluated the effects of combined aerobic and resistance training in HFrEF patients. Weighted mean differences (WMD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated. RESULTS 39 studies met the study criteria, including 2008 patients, 14 compared combined aerobic and resistance training versus aerobic training, and 25 compared combined aerobic and resistance training versus control. Compared to aerobic training, combined aerobic and resistance training resulted in improvement in muscle strength SMD 0.7 (95% CI: 0.3 to 1.0 N = 167) and, HRQoL WMD -2.6 (95% CI: -5.0 to -0.1 N = 138). A nonsignificant difference in peak VO2 and VE/VCO2 slope was found for participants in the combined aerobic and resistance training group compared with aerobic training group. Compared to control, combined aerobic and resistance training resulted in improvement in peak VO2 WMD 2.9 (95% CI: 1.6 to 4.4 N = 638), muscle strength SMD 0.64 (95% CI: 0.4 to 0.9 N = 315) and, HRQoL WMD -9.8 (95% CI: -15.2 to -4.5 N = 524). CONCLUSIONS Combined aerobic and resistance training improves peak VO2, muscle strength and HRQoL and should be considered as a component of care of HFrEF patients.
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Affiliation(s)
- Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Bahia, Brazil; Programa de Pós-Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil; Physiotherapy Research Group, UFBA, Brazil; The GREAT Group (GRupo de Estudos em ATividade física), Brazil.
| | | | - Lino Sergio Rocha Conceição
- The GREAT Group (GRupo de Estudos em ATividade física), Brazil; Federal University of Uberlândia, Department of Clinical Research, Brazil
| | - Leonardo Roever
- Federal University of Uberlândia, Department of Clinical Research, Brazil
| | - Cassio Magalhães Silva
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Bahia, Brazil; Physiotherapy Research Group, UFBA, Brazil
| | | | - Øyvind Ellingsen
- K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vitor Oliveira Carvalho
- Physiotherapy Research Group, UFBA, Brazil; The GREAT Group (GRupo de Estudos em ATividade física), Brazil; Physical Therapy Department, Federal University of Sergipe - UFS, Aracaju, SE, Brazil
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Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure - Digest Version. Circ J 2019; 83:2084-2184. [PMID: 31511439 DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 487] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women's Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
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Interval Endurance and Resistance Training as Part of a Community-Based Secondary Prevention Program for Patients With Diabetes Mellitus and Coronary Artery Disease. J Cardiopulm Rehabil Prev 2019; 40:17-23. [PMID: 31192806 DOI: 10.1097/hcr.0000000000000426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE High-intensity interval training (HIIT) has been observed to improve health and fitness in patients with cardiovascular disease. High-intensity interval training may not be appropriate in community-based settings. Moderate-intensity interval training (MIIT) and resistance training (RT) are emerging as effective alternatives to HIIT. These have not been well investigated in a community-based cardiac maintenance program. METHODS Patients with coronary artery disease and/or diabetes mellitus participated in clinical examinations and a 6-mo exercise program. Center-based MIIT and home-based moderate continuous intensity exercise were performed for 3-5 d/wk for 30-40 min/session. RT, nutritional counseling, coping, and behavioral change strategies were offered to all patients. Within-group changes in clinical metrics and exercise performance were assessed on a per-protocol basis after 6 mo. RESULTS Two hundred ninety-two patients (74%) concluded the 6-mo program. There were no serious adverse events. The peak oxygen uptake and peak workload increased significantly, 21.8 ± 6.1 to 22.8 ± 6.3 mL/kg/min and 128 ± 39 to 138 ± 43 W, respectively (both P < .001). Submaximal exercise performance increased from 68 ± 19 to 73 ± 22 W (P < .001). Glycated hemoglobin decreased from 6.57 ± 0.93% to 6.43 ± 0.12%, (P = .023). Daily injected insulin dosage was reduced from 42 IU (interquartile range: 19.0, 60.0) to 26 IU (interquartile range: 0, 40.3, P < .001). CONCLUSIONS MIIT and RT were feasible and effective in a community-based cardiac maintenance program for patients with cardiovascular disease, improving exercise performance, and blood glucose control.
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Žumbakytė-Šermukšnienė R, Slapšinskaitė A, Baranauskaitė M, Borkytė J, Sederevičiūtė R, Berškienė K. Exploring the Aortic Root Diameter and Left Ventricle Size Among Lithuanian Athletes. ACTA ACUST UNITED AC 2019; 55:medicina55060271. [PMID: 31212719 PMCID: PMC6630885 DOI: 10.3390/medicina55060271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/28/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023]
Abstract
Background and objectives: Aortic rupture is known as one of the potential causes of sudden cardiac death in athletes. Nevertheless, adaptation strategies for aortic root dilation in athletes vary. The purpose of this study was to investigate aortic root adaptation to physical workload and to determine if aortic roots and left ventricle sizes are contingent upon the physical workload. Materials and Methods: Echocardiography was applied to 151 subjects to measure the aortic root at aortic valve annulus (AA) and at sinus of Valsalva (VS). 122 were athletes (41 females and 81 males) and 29 were non-athletes (14 females and 15 males). Of the 41 female athletes, 32 were endurance athletes, and 9 were strength athletes. From 81 male athletes, 56 were endurance athletes, and 25 were strength athletes. AA and VS mean values for the body surface area were presented as AA relative index with body surface area (rAA) and VS relative index with body surface area (rVS). Left ventricle (LV) measures included LV end-diastolic diameter (LVEDD), interventricular septum thickness in diastole (IVSTd), LV posterior wall thickness in diastole (LVPWTd), LV mass (LVM), LV mass index, and LV end-diastolic diameter index (LVEDDI). Results: Results indicated that VS was higher in female athletes (28.9 ± 2.36 mm) than in non-athletes (27.19 ± 2.87 mm, p = 0.03). On the other hand, rAA was higher in strength athletes (12.19 ± 1.48 mm/m2) than in endurance athletes (11.12 ± 0.99 mm/m2, p = 0.04). Additionally, rVS and rAA were higher in female strength athletes (17.19 ± 1.78 mm/m2, 12.19 ± 1.48 mm/m2) than female basketball players (15.49 ± 1.08 mm/m2, p = 0.03, 10.75 ± 1.06 mm/m2, p = 0.02). No significant differences regarding aortic root were found between male athletes and non-athletes. Statistically significant positive moderate correlations were found between VS and LVEDD, LVM, IVSTd, LVPWTd, rVS, and LVEDDI parameters in all athletes. Conclusion: The diameter of Valsalva sinus was greater in female athletes compared to non-athletes. The rAA mean value for body surface area was greater in female athletes practising strength sports as compared to their counterparts who were practising endurance sports. The diameter of the aortic root at sinuses positively correlated with the LV size in all athletes.
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Affiliation(s)
| | - Agnė Slapšinskaitė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
- Health Research Institute, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | - Miglė Baranauskaitė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | - Julija Borkytė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | - Rasa Sederevičiūtė
- Radiology Clinic, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
| | - Kristina Berškienė
- Sports Medicine Clinics, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
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Abolahrari-Shirazi S, Kojuri J, Bagheri Z, Rojhani-Shirazi Z. Effect of Exercise Training on Heart Rate Variability in Patients with Heart Failure After Percutaneous Coronary Intervention. J Biomed Phys Eng 2019; 9:97-104. [PMID: 30881939 PMCID: PMC6409367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/14/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study aims to evaluate the effect of exercise training on heart rate variability (HRV) and to determine the correlation between parameters of HRV and the ejection fraction in patients with heart failure after percutaneous coronary intervention. MATERIAL AND METHODS Fifty patients with left ventricular ejection fraction ≤ 40% undergone percutaneous coronary intervention were randomly allocated in either an exercise training (ET) group or a control group. The ET group performed exercise training for 45 minutes, three times a week for seven weeks. Patients in both groups received a leaflet for daily exercising at home. HRV parameters comprising, the standard deviation of normal R-R intervals (SDNN), the square root of the mean of the squares of successive R-R intervals differences (RMSSD) ,the percentage of successive R-R intervals differing from more than 50 ms (PNN50), using 24-hour Holter electrocardiographic monitoring was measured. RESULTS After the intervention, the SDNN improved in the ET group (P=0.002), while changes in all remaining HRV indices were insignificant (P≥0.05). The control group showed no significant changes in any HRV parameters (P≥0.05). Changes in SDNN in the ET group were significantly different from the control group (P=0.003). At baseline, our results revealed a significant weak correlation between ejection fraction and SDNN (r =0.279, P=0.047). However, ejection fraction did not correlate significantly with RMSSD and PNN50. CONCLUSION Exercise training is safe and feasible in post percutaneous coronary intervention patients, even in those with reduced ejection fraction. In a seven-week period, exercise training was effective in improving HRV in heart failure patients after percutaneous coronary intervention.
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Affiliation(s)
- S Abolahrari-Shirazi
- PhD Candidate, Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - J Kojuri
- Cardiologist, Interventionist, Full professor, Clinical education improvement research center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Bagheri
- PhD of Biostatistics, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Rojhani-Shirazi
- PhD of Physiotherapy, Associated professor, Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical sciences, Shiraz, Iran
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45
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Marume K, Takashio S, Nakanishi M, Kumasaka L, Fukui S, Nakao K, Arakawa T, Yanase M, Noguchi T, Yasuda S, Goto Y. Efficacy of Cardiac Rehabilitation in Heart Failure Patients With Low Body Mass Index. Circ J 2019; 83:334-341. [PMID: 30651408 DOI: 10.1253/circj.cj-18-0852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Low body mass index (BMI) is a relevant prognostic factor for heart failure (HF), but HF patients with low BMI are reported to be at risk of not receiving optimal drug treatment. We sought to evaluate the efficacy of cardiac rehabilitation (CR) in patients with low vs. normal BMI. METHODS AND RESULTS We studied 152 consecutive patients (low BMI, n=32; normal BMI, n=119) who participated in a 3-month CR program. Low BMI was defined as <18.5 kg/m2and normal BMI, as 18.5≤BMI<25 kg/m2. All patients underwent cardiopulmonary exercise testing and muscle strength testing at the beginning and end of the 3-month CR program. After CR, a significantly greater proportion of HF patients with low BMI had a positive change in peak V̇O2than in the normal BMI group (91% vs. 70%; P=0.010). Average percent change in peak V̇O2was significantly greater in patients with low vs. normal BMI (17.1±2.8% vs. 7.8±1.5%; P<0.001). In addition, on multivariable logistic regression, low BMI was an independent predictor of a positive change in peak V̇O2after CR (OR, 3.97; 95% CI: 1.10-14.31; P=0.035). CONCLUSIONS CR has a greater effect in patients with low than normal BMI, and low BMI is an independent predictor of a positive change in peak V̇O2. Thus, CR should be strongly recommended for HF patients with low BMI.
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Affiliation(s)
- Kyohei Marume
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kumamoto University
| | - Seiji Takashio
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kumamoto University
| | - Michio Nakanishi
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Leon Kumasaka
- Department of Cardiovascular Medicine, Saitama Sekishinkai Hospital
| | - Shigefumi Fukui
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuhiro Nakao
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tetsuo Arakawa
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masanobu Yanase
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoichi Goto
- Department of Cardiovascular Medicine, Yoka Hospital
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Santos FV, Chiappa GR, Ramalho SHR, de Lima ACGB, de Souza FSJ, Cahalin LP, Durigan JLQ, de Castro I, Cipriano G. Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure: a systematic review and meta-analysis. Heart Fail Rev 2019; 23:73-89. [PMID: 29199385 DOI: 10.1007/s10741-017-9658-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent literature suggests that resistance training (RT) improves peak oxygen uptake ([Formula: see text] peak), similarly to aerobic exercise (AE) in patients with heart failure (HF), but its effect on cardiac remodeling is controversial. Thus, we examined the effects of RT and AE on [Formula: see text] peak and cardiac remodeling in patients with heart failure (HF) via a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Library and CINAHL, AMEDEO and PEDro databases search were extracted study characteristics, exercise type, and ventricular outcomes. The main outcomes were [Formula: see text] peak (ml kg-1 min-1), LVEF (%) and LVEDV (mL). Fifty-nine RCTs were included. RT produced a greater increase in [Formula: see text] peak (3.57 ml kg-1 min-1, P < 0.00001, I 2 = 0%) compared to AE (2.63 ml kg-1 min-1, P < 0.00001, I 2 = 58%) while combined RT and AE produced a 2.48 ml kg-1 min-1 increase in [Formula: see text]; I 2 = 69%) compared to control group. Comparison among the three forms of exercise revealed similar effects on [Formula: see text] peak (P = 0.84 and 1.00, respectively; I 2 = 0%). AE was associated with a greater gain in LVEF (3.15%; P < 0.00001, I 2 = 17%) compared to RT alone or combined exercise which produced similar gains compared to control groups. Subgroup analysis revealed that AE reduced LVEDV (- 10.21 ml; P = 0.007, I 2 = 0%), while RT and combined RT and AE had no effect on LVEDV compared with control participants. RT results in a greater gain in [Formula: see text] peak, and induces no deleterious effects on cardiac function in HF patients.
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Affiliation(s)
- Francisco V Santos
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
- Cancer Institute of Sao Paulo, Sao Paulo, Brazil
| | - Gaspar R Chiappa
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Sergio Henrique Rodolpho Ramalho
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
- Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Alexandra Correa Gervazoni Balbuena de Lima
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Fausto Stauffer Junqueira de Souza
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - João Luiz Quagliotti Durigan
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Isac de Castro
- Department of Medicine, Division of Molecular Medicine, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Gerson Cipriano
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil.
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Aronow WS, Shamliyan TA. Exercise for Preventing Hospitalization and Readmission in Adults With Congestive Heart Failure. Cardiol Rev 2019; 27:41-48. [PMID: 29734198 DOI: 10.1097/crd.0000000000000210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We critically appraised all available evidence regarding exercise interventions for improving patient survival and reducing hospital admissions in adults with chronic heart failure (HF). We searched 4 databases up to April 2018 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. We reviewed 7 meta-analyses and the publications of 48 randomized controlled trials (RCTs). In HF with reduced ejection fraction, low-quality evidence suggests that exercise prevents all-cause hospitalizations [Relative risk (RR), 0.77; 95% confidence interval (CI), 0.63 to 0.93; 1328 patients in 15 RCTs] and hospitalizations due to HF (RR, 0.57; 95% CI, 0.37 to 0.88; 1073 patients in 13 RCTs) and improves quality of life (standardized mean difference, -0.37; 95% CI, -0.60 to -0.14; 1270 patients in 25 RCTs) but has no effect on mortality. In HF with preserved ejection fraction, low-quality evidence suggests that exercise improves peak oxygen uptake (mean difference, 2.36; 95% CI, 1.16 to 3.57; 171 patients in 3 RCTs) and quality of life (mean difference, -4.65; 95% CI, -8.46 to -0.83; 203 patients in 4 RCTs). In patients after heart transplantation, low-quality evidence suggests that exercise improves peak oxygen uptake (standardized mean difference, 0.68; 95% CI, 0.43 to 0.93; 284 patients in 9 RCTs) but does not improve quality of life. In order to reduce hospitalization and improve quality of life for adults with HF and reduced ejection fraction, clinicians should recommend exercise interventions. For adults with HF and preserved ejection fraction and in those undergoing heart transplantation, clinicians may recommend exercise interventions in order to improve peak oxygen uptake.
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Affiliation(s)
- Wilbert S Aronow
- From the Division of Cardiology, Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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Bakker EA, Snoek JA, Meindersma EP, Hopman MTE, Bellersen L, Verbeek ALM, Thijssen DHJ, Eijsvogels TMH. Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients. Med Sci Sports Exerc 2018; 50:196-203. [PMID: 28938249 DOI: 10.1249/mss.0000000000001429] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to examine the clinical effect of cardiorespiratory fitness (CRF) and improvements in CRF after cardiac rehabilitation (CR) in heart failure (HF) patients for their risk for all-cause mortality and unplanned hospitalization and to investigate possible factors associated with the absence of improvement in CRF after rehabilitation. METHODS We included 155 HF patients receiving CR between October 2009 and January 2015. Patients performed an incremental bicycle test to assess CRF through peak oxygen uptake (V˙O2-peak) before and after CR-based supervised exercise training. Patients were classified as responders or nonresponders on the basis of pre-to-post CR changes in V˙O2-peak (≥6% and <6%, respectively). Cox proportional hazards models evaluated all-cause mortality and unplanned hospitalization during 5 yr of follow-up. Patient characteristics, HF features, and comorbidities were used to predict changes in V˙O2-peak using logistic regression analysis. RESULTS Seventy HF patients (45%) were classified as responder. Nonresponders had a significantly higher risk for all-cause mortality or hospitalization (hazard ratio, 2.15; 95% confidence interval (CI), 1.17-3.94) compared with responders. This was even higher in nonresponders with low CRF at baseline (hazard ratio, 4.88; 95% CI, 1.71-13.93). Factors associated with nonresponse to CR were age (odds ratio (OR), 1.07/yr; 95% CI, 1.03-1.11), baseline V˙O2-peak (OR, 1.16 mL·min·kg; 95% CI, 1.06-1.26), and adherence to CR (OR, 0.98/percentage; 95% CI, 0.96-0.998). CONCLUSIONS Independent from baseline CRF, the inability to improve V˙O2-peak by CR doubled the risk for death or unplanned hospitalization. The combination of lower baseline CRF and nonresponse was associated with even poorer clinical outcomes. Especially older HF patients with higher baseline V˙O2-peak and lower adherence have a higher probability of becoming a nonresponder.
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Affiliation(s)
- Esmée A Bakker
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Johan A Snoek
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Esther P Meindersma
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Louise Bellersen
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - André L M Verbeek
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Dick H J Thijssen
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
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Pozehl BJ, McGuire R, Duncan K, Kupzyk K, Norman J, Artinian NT, Deka P, Krueger SK, Saval MA, Keteyian SJ. Effects of the HEART Camp Trial on Adherence to Exercise in Patients With Heart Failure. J Card Fail 2018; 24:654-660. [PMID: 30010027 DOI: 10.1016/j.cardfail.2018.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Few exercise training studies in patients with heart failure (HF) report adherence to guideline-recommended 150 minutes of moderate-intensity exercise per week, and no studies have focused on a primary outcome of adherence. METHODS AND RESULTS This randomized controlled trial evaluated the effect of a multicomponent intervention, Heart Failure Exercise and Resistance Training (HEART) Camp, on adherence to exercise (after 6, 12, and 18 months) compared with an enhanced usual care (EUC) group. Patients (n = 204) were 55.4% male, overall average age was 60.4 years, and 47.5% were nonwhite. The HEART Camp group had significantly greater adherence at 12 (42%) and 18 (35%) months compared with the EUC group (28% and 19%, respectively). No significant difference (P > .05) was found at 6 months. The treatment effect did not differ based on patient's age, race, gender, marital status, type of HF (preserved or reduced ejection fraction) or New York Heart Association functional class. Left ventricular ejection fraction (LVEF) significantly moderated the treatment effect, with greater adherence at higher LVEF. CONCLUSIONS The multicomponent HEART Camp intervention showed efficacy with significant effects at 12 months and 18 months. Adherence levels remained modest, indicating a need for additional research to address methods and strategies to promote adherence to exercise in patients with HF.
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Affiliation(s)
| | - Rita McGuire
- University of Nebraska Medical Center, Lincoln, Nebraska
| | | | - Kevin Kupzyk
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Joseph Norman
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Pallav Deka
- University of South Dakota, Sioux Falls, South Dakota
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