Cardiac Rehabilitation Exercise and Self-Care for Chronic Heart Failure

Abstract

Chronic heart failure (CHF) is highly prevalent in older individuals and a major cause of morbidity, mortality, hospitalizations and disability. Cardiac rehabilitation (CR) exercise training and CHF self-care counseling have each been shown to improve clinical status and clinical outcomes in CHF. Systematic reviews and meta-analyses of CR exercise training alone (without counseling) have demonstrated consistent improvements in CHF symptoms in addition to reductions of cardiac mortality and hospitalizations, although individual trials have been less conclusive of the latter two findings. The largest single trial, HF-ACTION, showed a reduction in the adjusted risk for the combined end point of all-cause mortality or hospitalization (HR: 0.89, 95% CI: 0.81-0.99; P=0.03). Quality of life and mental depression also improved. CHF-related counseling whether provided in isolation or in combination with CR exercise training improves clinical outcomes and reduces CHF-related hospitalizations We review current evidence on the benefits and risks of CR and self-care counseling in patients with CHF, provide recommendations for patient selection for third party payers, and discuss the role of CR in promoting self-care and behavioral changes.

Waon Therapy for Managing Chronic Heart Failure – Results From a Multicenter Prospective Randomized WAON-CHF Study –

“…However, there are few therapeutic tools targeting the whole body, including the cardiac and systemic vasculature. Although cardiac rehabilitation is an excellent tool for improving the peripheral circulation, 29 Waon therapy has wider indications, including patients with movement disorders such as stage D HF, osteoarthritis, or limb ischemia. Although we prohibited cardiac rehabilitation to assess the pure efficacy of Waon therapy, the combination of Waon therapy and cardiac rehabilitation would have strengthened the improvement in patients' activity assessed by 6MWD when patients can tolerate cardiac rehabilitation.…”

Cardiac Rehabilitation in Heart Failure. Part II. Does Higher Intensity Means Better Outcome?

“…In general, aerobic exercise-training-bout in CR in above described researches lasted 20 minutes or longer (to maximum 60 min) and were performed at 40% (Belardinelli et al, 1995) to 80% Vo 2 max, 40% to 80% of the HRmax, frequency 3-7 days/wk (Adsett, Mullins, 2010;Piña et al, 2003;Piepoli, et al, 2011;Selig et al, 2010;Ades et al, 2013). Noteworthy, it is crucial to examine the aerobic capacity before CR initiation, while some patients require CR protocol with lower intensity (Balady et al, 2011).…”

Reabilitação intra-hospitalar após transplante cardíaco

“…13 Já está largamente demonstrado que a prática de exercícios físicos promove a redução da atividade nervosa simpática; o aumento do fluxo sanguíneo periférico; a melhora da função endotelial e da função hemodinâmica central; reduz a mortalidade e a necessidade de hospitalização. 4,14 Além disso, o exercício físico aumenta o consumo de oxigênio (∨ ⋅ O 2 ) e, consequentemente, a oferta de O 2 para a musculatura em atividade, proporcionando melhor capacidade funcional.…”