Absence of exercise capacity improvement after in-hospital short-term cardiac rehabilitation is associated with long-term clinical outcome in heart failure patients

Background Previous studies suggest Cardiac rehabilitation (CR) improve exercise capacity and decline mortality in heart failure (HF) patients. However, some studies show there are HF patients who do not improve exercise capacity by CR and these patients have a higher risk of adverse events in long-term clinical outcome. We investigated whether absence of exercise capacity improvement after in-hospital short-term CR also has adverse effect in long-term clinical outcome. Methods In this retrospective study, 130 HF patients who underwent two weeks in-hospital CR after received standardized HF treatment between July 2014 and August 2020 were included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (delta-Peak VO2) measured at 1st and 14th day of CR by cardiopulmonary test. The median delta-PeakVO2 was 1.3 ml·kg-1·min-1. Patients were classified as responder if they demonstrated delta-PeakVO2 ≥1.3 ml·kg-1·min-1 and as non-responder if they demonstrated delta-PeakVO2 <1.3ml·kg-1·min-1. MeanΩ follow-up was 1236 days. The primary outcome was all-cause death. Result 63 patients (48.4%) were classified as non-responder. Non-responders were older (75.5±10.6 vs 70.8±11.0, P=0.01) and lower estimated glomerular filtration rate (eGFR) (49.7±19.4 vs 57.9±19.2) and lower albumin (3.5±0.5 vs 3.7±0.3 g/dL, P=0.04) than responders. Transtricuspid pressure gradient (TRPG) measured by transthoracic echocardiography was also higher in non-responders (28.5±10.9 vs 22.7±6.3). Predictor of non-responders were TRPG (OR = 1.1, 95% CI 1.02–1.26) and albumin (OR =0.04, 95% CI: 0.003–0.40). In multivariate analysis including delta-PeakVO2 <1.3 ml·kg-1·min-1 (non-responder), age >75, male gender, PeakVO2 at 1st day of CR, body mass index (BMI), left ventricular ejection fraction measured by transthoracic echocardiography, medication of β-blockers showed that delta-PeakVO2 <1.3 ml·kg-1·min-1 (HR =2.8, 95% CI 1.0–7.5), age>75 (HR11.2, 95% CI 2.1–60.1), BMI (HR =0.8, 95% CI 0.6–0.96) were associated with all-cause death. Conclusion The absence of exercise capacity improvement after in-hospital short-term CR was the risk of all-cause death. Especially, the HF patients with higher TRPG and lower albumin have a higher probability of becoming a non-responder. FUNDunding Acknowledgement Type of funding sources: None.

Exercise-Training Regulates Apolipoprotein B in Drosophila to Improve HFD-Mediated Cardiac Function Damage and Low Exercise Capacity

Apolipoprotein B plays an essential role in systemic lipid metabolism, and it is closely related to cardiovascular diseases. Exercise-training can regulate systemic lipid metabolism, improve heart function, and improve exercise capacity, but the molecular mechanisms involved are poorly understood. We used a Drosophila model to demonstrate that exercise-training regulates the expression of apoLpp (a homolog of apolipoprotein B) in cardiomyocytes, thereby resisting heart insufficiency and low exercise capacity caused by obesity. The apoLpp is an essential lipid carrier produced in the heart and fat body of Drosophila. In a Drosophila genetic screen, low expression of apoLpp reduced obesity and cardiac dysfunction induced by a high-fat diet (HFD). Cardiac-specific inhibition indicated that reducing apoLpp in the heart during HFD reduced the triglyceride content of the whole-body and reduced heart function damage caused by HFD. In exercise-trained flies, the result was similar to the knockdown effect of apoLpp. Therefore, the inhibition of apoLpp plays an important role in HFD-induced cardiac function impairment and low exercise capacity. Although the apoLpp knockdown of cardiomyocytes alleviated damage to heart function, it did not reduce the arrhythmia and low exercise capacity caused by HFD. Exercise-training can improve this condition more effectively, and the possible reason for this difference is that exercise-training regulates climbing ability in ways to promote metabolism. Exercise-training during HFD feeding can down-regulate the expression of apoLpp, reduce the whole-body TG levels, improve cardiac recovery, and improve exercise capacity. Exercise-training can downregulate the expression of apoLpp in cardiomyocytes to resist cardiac function damage and low exercise capacity caused by HFD. The results revealed the relationship between exercise-training and apoLpp and their essential roles in regulating heart function and climbing ability.

https://www.rehabiljournal.com/articles/pulmonary-rehabilitation-exercise-assessments-and-training-methods-for-patients-with-copd-a-literature-review.html

Pulmonary rehabilitation (PR) is an important part of the management of COPD, which can reduce symptoms of dyspnea, times of hospitalizations, and improve exercise capacity and health-related quality of patients. As a key element of PR, PR exercise training consists of exercise assessment and training methods. Exercise assessments should include the evaluation of dyspnea, exercise capacity, and health-related quality of life. Following a thorough assessment of patients, individualized exercise training programs, including endurance, resistance, and other exercise training methods, should be developed based on physiologic requirements and individual demands of patients. Although there have been many studies on the types of exercise for patients with COPD, there are still no conclusions about how to develop the best exercise prescription. Choosing the most appropriate methods for patients with COPD to calculate the situation is crucial. Therefore, this review aims to summarize the common methods of exercise assessments and exercise trainings in PR.

Feasibility of a prehabilitation program before major abdominal surgery

Objective Prehabilitation programs claim to improve exercise capacity and postoperative outcomes. The study aim was to assess the feasibility of a prehabilitation program and its effects on fitness and clinical outcomes after major abdominal surgery. Methods In this prospective pilot study, patients were assigned to high-intensity physical exercise training with 3 training sessions per week for 3 weeks preoperatively. Feasibility of this intervention was assessed based on recruitment and adherence to the training program. Impact on fitness (VO2 AT) was evaluated and correlated with complications and length of stay (LOS). Results Of 980 eligible patients, 87 patients (8.9%) were approached for inclusion. Main obstacles to not approach patients were insufficient time (< 3 weeks) prior to scheduled surgery (n = 276, 28.2%) or screening failure (n = 312, 31.8%). Out of these 87 patients, 24 (28%) declined to participate, 43 (49%) met exclusion criteria and 20 (23%) were included. Six patients (30%) could not complete the prehabilitation program due to contra-indication for exercise training evidenced during the test (n = 3), lack of motivation (n = 2) and modification of the planned operating date (n = 1). VO2 AT increased from 9.8 to 11.5 ml/min/kg (p = 0.050). There were no correlations between the change in VO2 AT and postoperative complications (r = -0.133, p = 0.649) and LOS (r = -0.94, p = 0.750). Conclusion Prehabilitation programs are difficult to implement and many patients are either not eligible or not motivated. Future efforts should concentrate on those patients who are most likely to benefit from these time- and cost-intensive interventions.

Mobile Technologies to Promote Physical Activity during Cardiac Rehabilitation: A Scoping Review

Promoting regular physical activity (PA) and improving exercise capacity are the primary goals of cardiac rehabilitation (CR). Mobile technologies (mTechs) like smartphones, smartwatches, and fitness trackers might help patients in reaching these goals. This review aimed to scope current scientific literature on mTechs in CR to assess the impact on patients’ exercise capacity and to identify gaps and future directions for research. PubMed, CENTRAL, and CDSR were systematically searched for randomized controlled trials (RCTs). These RCTs had to utilize mTechs to objectively monitor and promote PA of patients during or following CR, aim at improvements in exercise capacity, and be published between December 2014 and December 2019. A total of 964 publications were identified, and 13 studies met all inclusion criteria. Home-based CR with mTechs vs. outpatient CR without mTechs and outpatient CR with mTechs vs. outpatient CR without mTechs did not lead to statistically significant differences in exercise capacity. In contrast, outpatient CR followed by home-based CR with mTechs led to significant improvement in exercise capacity as compared to outpatient CR without further formal CR. Supplying patients with mTechs may improve exercise capacity. To ensure that usage of and compliance with mTechs is optimal, a concentrated effort of CR staff has to be achieved. The COVID-19 pandemic has led to an unprecedented lack of patient support while away from institutional CR. Even though mTechs lend themselves as suitable assistants, evidence is lacking that they can fill this gap.