IntroductionThe aim of the study was to evaluate the impact of individual training on the level of physical capacity and echocardiographic parameters in patients with systolic heart failure (SHF), NYHA III and an implantable cardioverter-defibrillator (ICD).Material and methodsThe study included 84 patients with SHF, randomly assigned to one of two groups: with regular training (ICD-Ex) and a control group (ICD-control). The ICD-Ex group participated in a hospital rehabilitation program which after discharge was individually continued for 6 months in an outpatient setting. The ICD-control group participated in a training program during hospitalization, but after discharge did not perform any controlled activities. Prior to discharge, at 6 and 18 months cardiopulmonary exercise testing (CPX), standard echocardiographic examination and the 6-minute walk test (6-MWT) were performed in all patients.ResultsAfter 18 months in the ICD-Ex group most of the CPX parameters improved significantly (VO2 peak, ml/kg/min: 13.0 ±4.1 vs. 15.9 ±6.1, p < 0.0017; VCO2 peak, l/min: 1.14 ±0.34 vs. 1.58 ±0.65, p < 0.0008; Watt: 74.5 ±29.7 vs. 92.6 ±39.1, p < 0.0006; METs 3.72 ±1.81 vs. 4.35 ±1.46, p < 0.0131). In the ICD-control group no significant improvement of any parameter was observed. Left ventricular systolic dimensions remained significantly lower at 18 months only in the ICD-Ex group (49.5 ±11.0 vs. 43.4 ±10.0, p < 0.011). Left ventricular ejection fraction in both groups significantly increased at 6 and 18 months compared to baseline (ICD-Ex: 25.07 ±5.4 vs. 31.4 ±9.2, p < 0.001, vs. 30.9 ±8.9, p < 0.002, ICD-C: 25.1 ±8.3 vs. 29.2 ±7.7, p < 0.012 vs. 30.1 ±9.1, p < 0.005). Distance of the 6-MWT was significantly improved after 6 and 18 months in the ICD-Ex group and was overall longer than in the ICD-control group (491 ±127 vs. 423 ±114 m, p < 0.04).ConclusionsAn individual, 6-month training program, properly controlled in patients with SHF and an implanted ICD, was safe and resulted in a significant improvement of exercise tolerance and capacity and echocardiographic parameters.

Background The population of elderly patients after acute coronary syndrome (ACS) is increasing due to the extension of life expectancy. Purpose The aim of the study was to demonstrate the impact of individual exercise training on the course of the disease, exercise tolerance and quality of life in patients over 75 years of age after ACS. Methods The randomized, prospective, controlled clinical trial included patients with ACS, age >75 years, after acute percutaneous coronary interventions (PCI). Patients were randomly assigned to two groups: a training group (ExT) subjected to individualized physical training and a control group, not subjected to training program (CG). ExT patients participated in trainings three times a week for 2 months according to model B or C of the second stage of rehabilitation. Patients from control group (CG) received general recommendations for activity. In addition, patients underwent exercise tolerance test (ETT), 6-minute walk tests (6-MWT), NHP questionnaires evaluation, laboratory tests, ECG, echocardiographic examinations. Results The study included 51 patients, mean age 80 years, men: 50%, n=25 ExT, n=26 (CG). The study was completed by all patients. Physical capacity at the beginning of the trainings assessed in ETT and 6-MWT was comparable in both groups, ns. After two months of training program the average ETT exercise time increased by 12.5% (from 416±152 to 468±153 sec, p=0.0114), and the load by 13% (69±5.2 WAT to 78±25.4 WAT, p=0.0005). The average distance in 6-MWT increased by 8.3% (446±90 to 483±60 m, p=0.006). In CG, the values of the ETT and 6-MWT parameters hadn't significantly changed. After trainings cessation, the mean distances in the study after 6 months and after 12 months returned to the initial values of 474±73 and 476±80 m (respectively: p=0.069, p=0.062) in comparison to the test performed before the beginning of rehabilitation. Similarly, after 1 year, the average duration of the exercise test (242±147 sec) and the average load obtained (70±22.4 WAT) decreased significantly compared to the results after rehabilitation (p=0.0009, p=0.0006), obtaining similar levels as in the initial tests (p=0.481, p=0.593). In the NHP questionnaire in the ExT group the level of pain was significantly lower after the end of the training with respect to the initial measurements (p=0.007) and after 12-months follow-up (p=0.029). In the scale of emotional reactions, a significant deterioration of the quality of life in the ExT group was found after 12 months in relation to measurements after rehabilitation (p=0.040). Conclusions In the octogenarians after ACS, cardiac rehabilitation is safe and in a short period of time improves physical performance. The cessation of the 2-month training results in loss of achieved effects and the deterioration of the quality of life after 12 months since ACS.

Background: Exercise training (ExT) in patients with heart failure and reduced ejection fraction (HFrEF) improves clinical condition and prognosis. Data are scarce regarding the efficacy and safety of ExT in patients with HFrEF and atrial fibrillation (AFib) and with a cardiac resynchronization therapy defibrillator (CRT-D) or an implantable cardioverter-defibrillator (ICD). Purpose: The aim of the study was to evaluate the impact of exercise training in patients with HFrEF (ejection fraction

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