How Patients With Heart Failure Perform Daily Life Activities

Abstract

Background: Cardiopulmonary exercise test and 6-minute walking test are frequently used tools to evaluate physical performance in heart failure (HF), but they do neither represent activities of daily living (ADLs) nor fully reproduce patients’ symptoms. We assessed differences in task oxygen uptake, both as absolute value and as percentage of peak oxygen consumption (peakVO 2 ), ventilation efficiency (VE/VCO 2 ratio), and dyspnea intensity (Borg scale) in HF and healthy subjects during standard ADLs and other common physical actions. Methods: Healthy and HF subjects (ejection fraction <45%, stable conditions) underwent cardiopulmonary exercise test. All of them, carrying a wearable metabolic cart, performed a 6-minute walking test, two 4-minute treadmill exercises (at 2 and 3 km/h), and ADLs: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 minutes), ADL6 (climbing 1 flight of stairs carrying a load). Results: Sixty patients with HF (age 65.2±12.1 years; ejection fraction 30.4±6.7%, peakVO 2 14.2±4.0 mL/[min·kg]) and 40 healthy volunteers (58.9±8.2 years, peakVO 2 28.1±7.4 mL/[min·kg]) were enrolled. For each exercise, patients showed higher VE/VCO 2 ratio, percentage of peakVO 2 , and Borg scale value than controls, while absolute values of task oxygen uptake and exercise duration were lower and higher, respectively, in all activities, except for treadmill (fixed execution time and intensity). Differently from Borg Scale data, metabolic values and exercise time length changed in parallel with HF severity, except for ADL duration in very short (ADL3) and composite (ADL1) activities. Borg scale values correlated with percentage of peakVO 2 . Conclusions: During ADLs, patients self-regulated activities in parallel with HF severity by decreasing intensity (VO 2 ) and prolonging the effort.

The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure

“…However, there was a significant reduction in the cumulative time required to perform those activities characterized by a non-fixed duration (ADL 1-4 and ADL6, Figure 1) and a reduction in maximal heart rate in ADL1 and ADL3. This is well in line with the already quoted findings from Gary (Gary et al, 2011) and supports the hypothesis of Mapelli that, to perform a given exercise, patients with HF spontaneously adapt to the task by self-regulating the effort intensity through a time prolongation (Mapelli et al, 2020). Indeed, CR, by improving physical function and muscle deconditioning ended up in a reduction of the time needed to perform those ADLs like getting dressed, folding towels, or making a bed for which there was no limit in time duration.…”

“…Moreover, for ADLs not requiring a fixed execution time, chronic HF patients needed more time to complete them ( Spruit et al, 2011 ). Mapelli et al (2020) studied 60 patients with HF and 40 healthy volunteers and confirmed the importance of prolongation of exercise time during ADLs with no fixed duration, as a means to reduce metabolic cost and optimize effort. Notably, patients with severe HF had a greater prolongation of exercise with respect to patients with less severe HF ( Mapelli et al, 2020 ).…”

“…The ADL battery test consisted of six domestic ADLs performed consecutively according to Mapelli et al (2020) protocol.…”

“…Moreover, Mapelli et al (2020) recently observed that, in severe chronic HF patients with reduced ejection fraction (HFrEF), the VO 2 used during ADLs tasks was even higher of peak VO 2 at cardiopulmonary exercise test (CPET), with a respiratory exchange ratio around or above 1. Moreover, patients were able to compensate for the high percentage of peak VO 2 needed for a given ADL by prolonging the time needed to complete the task ( Mapelli et al, 2020 ).…”

Effects of surgical and FFP2 masks on cardiopulmonary exercise capacity in patients with heart failure

“…Healthy adults rarely reach high levels of activity during daily activities that would incite exertion [ 10 ]. In contrast, patients with chronic heart failure (HF) reach maximum load and exertion more often in their daily lives, and they frequently adapt by decreasing intensity and prolonging the effort [ 11 ]. Hence, it is important to assess the potential effects of different face masks in these patients.…”