P6324Contribution of muscle efficiency in heart failure patients post phase 2 cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Sa Mendes ◽  
A Durazzo ◽  
L Moreno ◽  
S Santos ◽  
M Neto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
Functional Class ◽  
Peak Exercise ◽  
Phase 2 ◽  
Biometric Data ◽  
Cardiac Rehabilitation Programme ◽  
Aerobic Threshold ◽  
Exercise Load

Abstract Background Muscle efficiency (ME), can help explain the observed improvement in patients without increase in oxygen uptake (VO2) after cardiac rehabilitation programme (CRP). The better use of energy, independent to the oxygen delivery to muscle, may improve the functional capacity in Heart failure (HF) patients. Our aim was to evaluate the contribution of muscle efficiency improvement after CR on functional capacity. Methods We analyse consecutive patients data that had their phase 2 CR concluded, with HF as admission indication with no medical therapy changes and CRT implantation during this period. The aetiology of HF and biometric data, functional class, BNP, Minnesotta and EuroQol questionnaires and cardiorespiratory test pre and post 4 months of CRP were collected. The average of the exercise load in the first two and last two training sessions were recorded. ME was calculated at peak exercise during cardiopulmonary exercise test in pre and post CRP (see formula above). Results From 55 HF patients sequentially admitted in our CRP, during the last 24 months, 45 were included, since 2 were transplanted, 1 died and the 7 didn't concluded the program or not had all the data mentioned in the methods. The mean age was 60,5±10,3 years and 78% were male. Ischemic aetiology with depressed ejection fraction (64%) was the main admission indication, followed by cardiomyopathies (18%). Betablockers, ACEi or ARBs or ARNi and MRA were taken in 91%, 93%, 46%, respectively. ICD and CRT were previously implanted in 44% of the patients. Comparing pre and post CRP VO2 at peak exercise and aerobic threshold levels no statically differences were found. In this cohort 27 (60%) patients increased ME. At the end of the CRP, this group had a higher improvement in METs (p=0,021), higher gain in lean mass (p=0,041), in EuroQoL (p=0,002) and in physical dimension of Minnesotta questionnaire (p=0,032), when compared with patients that didn't improve the ME in at least 5%. In 22 patients that increased ME, the VO2 at aerobic threshold level didn't improve by at least 5% and in this group the same benefits were confirmed. Formula of Muscle Efficiency Conclusions The improvement in exercise load reached in the post CRP cardiopulmonary test, independently of possible cardiac output changes (VO2 peak), seems to be explained in part by the increase in ME improvement.

scholarly journals Suppression of cerebral hemodynamics is associated with reduced functional capacity in patients with heart failure

2011 ◽  
Vol 300 (4) ◽  
pp. H1545-H1555 ◽  
Author(s):  
Tieh-Cheng Fu ◽  
Chao-Hung Wang ◽  
Chih-Chin Hsu ◽  
Wen-Jin Cherng ◽  
Shu-Chun Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Functional Capacity ◽  
Near Infrared ◽  
Vastus Lateralis ◽  
Functional Class ◽  
Vastus Lateralis Muscle ◽  
Functional Impairments ◽  
Patients With Heart Failure ◽  
Lateralis Muscle

This investigation elucidated the underlying mechanisms of functional impairments in patients with heart failure (HF) by simultaneously comparing cardiac-cerebral-muscle hemodynamic and ventilatory responses to exercise among HF patients with various functional capacities. One hundred one patients with HF [New York Heart Association HF functional class II (HF-II, n = 53) and functional class III (HF-III, n = 48) patients] and 71 normal subjects [older control (O-C, n = 39) and younger control (Y-C, n = 32) adults] performed an incremental exercise test using a bicycle ergometer. A recently developed noninvasive bioreactance device was adopted to measure cardiac hemodynamics, and near-infrared spectroscopy was employed to assess perfusions in the frontal cerebral lobe (Δ[THb]FC) and vastus lateralis muscle (Δ[THb]VL). The results demonstrated that the Y-C group had higher levels of cardiac output, Δ[THb]FC, and Δ[THb]VL during exercise than the O-C group. Moreover, these cardiac/peripheral hemodynamic responses to exercise in HF-III group were smaller than those in both HF-II and O-C groups. Although the change of cardiac output caused by exercise was normalized, the amounts of blood distributed to frontal cerebral lobe and vastus lateralis muscle in the HF-III group significantly declined during exercise. The HF-III patients had lower oxygen-uptake efficiency slopes (OUES) and greater V̇e-V̇o2 slopes than the HF-II patients and age-matched controls. However, neither hemodynamic nor ventilatory response to exercise differed significantly between the HF-II and O-C groups. Cardiac output, Δ[THb]FC, and Δ[THb]VL during exercise were directly related to the OUES and V̇o2peak and inversely related to the V̇e-V̇co2 slope. Moreover, cardiac output or Δ[THb]FC was an effect modifier, which modulated the correlation status between Δ[THb]VL and V̇e-V̇co2 slope. We concluded that the suppression of cerebral/muscle hemodynamics during exercise is associated with ventilatory abnormality, which reduces functional capacity in patients with HF.

The prognostic significance of improvement in exercise capacity in heart failure patients who participate in cardiac rehabilitation programme

2018 ◽  
Vol 25 (4) ◽  
pp. 354-361 ◽  
Author(s):  
Avi Sabbag ◽  
Israel Mazin ◽  
David Rott ◽  
Ilan Hay ◽  
Nelly Gang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Cardiovascular Fitness ◽  
Rehabilitation Programme ◽  
Exercise Stress ◽  
Cardiac Rehabilitation Programme ◽  
Heart Failure Patients ◽  
Baseline Fitness

Introduction There are limited contemporary data regarding the association between improvement in cardiovascular fitness in heart failure patients who participate in a cardiac rehabilitation programme and the risk of subsequent hospitalisations. Methods The study population comprised 421 patients with heart failure who participated in our cardiac rehabilitation programme between the years 2009 and 2016. All were evaluated by a standard exercise stress test before initiation, and underwent a second exercise stress test on completion of 3 ± 1 months of training. Participants were dichotomised by fitness level at baseline, according to the percentage of predicted age and sex norms achieved. Each group was further divided according to its degree of functional improvement, between the baseline and the follow-up exercise stress test. Major improvement was defined as improvement above the median value in each group. The combined primary endpoint was cardiac hospitalisation or all-cause mortality. Results A total of 211 (50%) patients had low baseline fitness (<73% (median)) for age and sex-predicted metabolic equivalents of task value. Compared to patients with higher fitness, those with a low baseline fitness were more commonly smokers, had diabetes and were obese ( P < 0.05 for all). Multivariable Cox proportional hazard regression analysis showed that, independent of baseline capacity, an improvement of 5% of predicted fitness was associated with a corresponding 10% reduced risk of cardiac hospitalisation or all-cause mortality ( P < 0.001). Conclusion In heart failure patients participating in a cardiac rehabilitation programme, improved cardiovascular fitness is associated with reduced mortality or cardiac hospitalisation risk during long-term follow-up, independent of baseline fitness.

scholarly journals Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure

2020 ◽  
Vol 42 (01) ◽  
pp. 19-26
Author(s):  
Simon Nichols ◽  
Gordon McGregor ◽  
Jeff Breckon ◽  
Lee Ingle
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Behaviour Change ◽  
Cardiac Patients ◽  
Community Based ◽  
Cardiac Rehabilitation Programme

AbstractCardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient’s priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The ‘dose’ of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

High-Intensity Interval Versus Moderate-Intensity Continuous Training in Cardiac Rehabilitation

2020 ◽  
Vol 9 (1) ◽  
pp. 10-16
Author(s):  
Dalynn T. Badenhop ◽  
Meghan M. Long ◽  
C. Matt Laurent ◽  
K. Todd Keylock
Keyword(s):  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
High Intensity ◽  
Rehabilitation Program ◽  
Moderate Intensity ◽  
Phase 2 ◽  
Continuous Training ◽  
Exercise Tests ◽  
Significant Difference ◽  
High Intensity Interval

ABSTRACT Background: Past research has compared the effects of moderate-intensity continuous training (MCT) versus high-intensity interval training (HIIT) in phase 2 cardiac rehabilitation patients, but with conflicting results. Therefore, the purpose of this study was to evaluate if HIIT leads to greater improvements in functional capacity when compared with MCT in a group of phase 2 cardiac rehabilitation patients. Methods: Eighteen patients in a phase 2 cardiac rehabilitation program completed precardiopulmonary and postcardiopulmonary exercise tests, a 12-min walk test (12MWT), and resting blood pressure (BP). After 2 weeks of run-in, patients were randomly assigned to 10 weeks of HIIT (alternating periods of 80%–90% heart rate [HR] reserve and 60%–70% HR reserve) or MCT (60%–80% HR reserve) exercise group. Changes in VO2 peak, 12MWT distance, and BP (mm Hg) were analyzed by independent t test. Results: The average patient was 65 years old, 1.75 m tall, and overweight. VO2 peak values improved for individuals in both exercise modalities. There was no significant difference between the exercise groups (P = 0.174). In addition, both groups improved their 12MWT distance, resting systolic, and diastolic BP (DBP), with no significant difference in improvements between the 2 exercise groups. Conclusion: In this study, HIIT was not more effective than MCT for improving functional capacity in a group of phase 2 cardiac rehabilitation patients. However, since HIIT was equally effective compared with MCT in several measures, it provides another option for exercise prescription to the traditional prescription for this population.

scholarly journals Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
LC Thygesen ◽  
L Zinckernagel ◽  
H Dalal ◽  
K Egstrup ◽  
C Glumer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Professional Education ◽  
Hospital Readmission ◽  
Lower Risk ◽  
Nyha Class ◽  
Temporal Trends ◽  
Functional Class ◽  
Alternative Methods ◽  
Chronic Obstructive

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background  Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines. Purpose The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral. Methods All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients. Results Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF &lt;50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral. Conclusions Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.

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