Are the group-based interventions improving the functional exercise capacity and quality of life of frail subjects with chronic heart failure?

Abstract

Objectives: Frail subjects with chronic heart failure (CHF) often demonstrate limited tolerance of exertion, shortness of breath, and reduced walking capacity resulting poor quality of life (QoL). The aim of this study was to quantify the improvements in functional exercise capacity (FEC) and QoL among Bulgarian frail subjects with CHF performed group-based high-intensity aerobic interval training (HIAIT)/m-Ullevaal intervention and to compare it with moderate intensity continuous training (MICT) protocol. Methods: One hundred and twenty (n=120) frail subjects with mean age of 63.73±6.68 years, in CHF and NYHA class II-IIIB, were enrolled in the single-center, prospective, two-arm randomized controlled clinical trial conducted at the Medical Center for Rehabilitation and Sports Medicine-I-Plovdiv. The baseline assessment included 6-minute walk test (6ΜWT), peak oxygen uptake (VO2peak), modified Borg Perceived Exertion Scale (mBPES), and Minnesota living with the Heart Failure Questionnaire (MLHFQ). Results: The improvement in 6MWT (P<0.001), VO2peak (P<0.001), mBPES (P<0.001), and MLHFQ (P<0.001) observed among frail subjects performed HIAIT/m-Ullevaal intervention was significantly greater compared to the improvement observed in the subjects performed MICT protocol (P<0.001). Conclusions: The group-based HIAIT/m-Ullevaal intervention is a new perspective and challenge for both, Bulgarian cardiac rehabilitation (CR), and frail patients with CHF.

Prevention and Reversal of Frailty in Heart Failure ― A Systematic Review ―

“…Seven studies evaluated CR programs in chronic heart disease, including patients with HF (Table 3): [21][22][23][24][25][26][27][28] Studies were excluded if they were not in English, were systematic reviews or if they did not include an intervention.…”

“…26 Reeves et al reported a significantly greater improvement in the SPPB at 6 months in ADHF patients randomized to a 12-week multidomain physical rehabilitation program compared with control patients receiving usual care. 26 In a single-center study from Bulgaria, Papathanasiou 25 randomized 120 frail patients with HF to either high-intensity aerobic interval training (HIAIT) or moderate intensity inpatients with cardiovascular disease. The proportions of the study populations with a diagnosis of HF in these studies were 23%, 53% and 100% respectively.…”

“…A major limitation of that study, however, was the lack of a validated frailty instrument applied to the study population. 25 Two prospective multicenter randomized trials compared the effect of a structured exercise training program on top of standard multidisciplinary management in patients recently admitted with ADHF. 23, 24 In both trials, the intervention involved a 3-month center-based exercise training program followed by 3 months of home-based exercise.…”

Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure

“…The second lesson from this study is that using the 6MWT as an endpoint is valuable but should be considered with its limitations. Although the 6MWT has been used in previous HF studies to measure exercise capacity 28 and can measure changes over time, ceiling effects can occur. In patients with preserved exercise capacity, the ceiling effect may be a limitation to consider the lack of improvement.…”

Lower Lean Mass Is Associated with Greater Arterial Stiffness in Patients with Lower Extremity Artery Disease

“…Several investigations found that a higher-intensity resistance component in the training resulted in a reduction in the blood pressure, and that greater muscle strength has an inverse association with the blood pressure, especially in older individuals [49][50][51][52]. Regular exercise is beneficial for older individuals to prevent CV events; age should not be a contraindication for exercise [53,54].…”