Aerobic and resistance exercise in heart failure inpatients: a scoping review.

Exercise performance is an essential tool for managing heart failure. Although the benefits of exercise are well documented for people with chronic and stable heart failure, there is still no consensus on their prescription in patients hospitalized with acute heart failure undergoing clinical stabilization. The aim of this study is to identify the literature on exercise programs encompassing the components of aerobic and resistance training for hospitalized patients admitted for acute heart failure. A scoping review was conducted according to the proposed methodology of the Joanna Briggs Institute. Studies with adults over 18 years old, hospitalized, and diagnosed with acute heart failure who participated in aerobic and resistance exercise training programs during their hospital stay were included. Three studies met the inclusion criteria. One was a retrospective, observational analytical cohort study, in which the main outcome of the exercise program was improvement in the previous disabilities of the participants. The other two were multicenter randomized controlled studies that showed greater improvement in physical function, functional capacity, depression, quality of life, and frailty status in the intervention groups. The exercise prescriptions differed according to the principles of the exercise prescription-frequency of exercise, intensity of exercise, exercise time (duration), type (mode), exercise volume, and progression. It is too early to make recommendations based on evidence of the type structure of an exercise program with aerobic and strength-training components in this population. However, in the exercise programs of the reviewed studies, the predominance of light to moderate intensity and the importance of progressively increase the frequency and duration of the training sessions were demonstrated, with bicycle ergometers and walking being the most common types of aerobic exercises. It is recommended that investment and research in this area should continue with more methodologically robust studies.

The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: Results of a multicenter randomized controlled trial (ERIC-HF study).

OBJECTIVE: To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. DESIGN: A randomized controlled clinical trial with follow-up at discharge. SETTINGS: Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. GROUP ASSIGNMENTS: Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). MAIN OUTCOME: Functional exercise tolerance was measured with a 6-min walking test at discharge. RESULTS: In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). CONCLUSION: The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.

Comparison of questionnaire and accelerometer-based assessments of physical activity in patients with heart failure with preserved ejection fraction: clinical and prognostic implications.

Objective. (i) To compare daily physical activity (PA) levels evaluated by the International Physical Activity Questionnaire (IPAQ) and by triaxial accelerometry in heart failure with preserved ejection fraction (HFpEF) patients; (ii) to describe daily PA patterns based in objective measurements; and (iii) to observe the association between prognostic indicators and PA measurements. Design. This is a cross-sectional study with 24 stable HFpEF patients. PA was assessed through the IPAQ short version and triaxial accelerometer. Time spent in moderate-to-vigorous PA (MVPA) from IPAQ was computed as self-reported walking and MVPA. Prognostic indicators were: distance on the 6-minute-walking test (6MWT), oxygen consumption (VO2) during the test, quality of life (QoL), BNP plasma level, and E/e' ratio. Results. Compared to accelerometry, IPAQ underestimated sedentary time (253 ± 156 vs. 392 ± 104 min/day, p = .001) and overestimated MVPA (44 ± 56 vs. 19.3 ± 26 min/day, p < .001). Accelerometer-derived data showed that HFpEF patients spent 50% of their waking time in sedentary behaviours and 2.5% in MVPA. Of measured surrogate prognostic markers, functional capacity (6MWT, r = 0.652, p = .04; VO2, r = 0.512, p = .02) and QoL (r=-0.490, p = .04) were correlated with MVPA. Conclusions. The IPAQ underestimated sedentary time and over-estimated MVPA in HFpEF patients. Using accelerometer-derived data, HFpEF patients spent only a minority of their time involved in MVPA, which was the only PA pattern positively associated with prognostic indicators.

Patient-reported outcome measures in knee injuries rehabilitation: A protocol for intervention.

Different musculoskeletal conditions affect people all over the world and were considered by the WHO to be the main cause of disability in 4 of 6 regions in 2017, with an increase in the associated burden and the impact they have on today's society. One of these conditions is related to the knee, which is associated with complex and vulnerable injuries associated with ligaments, menisci, and cartilage. After surgery, there is a reflex inhibition of motor neurons and immobilization, there is rapid atrophy and weakness in the different associated muscles, affecting proprioception, strength and muscle function, compromising quality of life. The aim of this article is to describe a protocol for a rehabilitation program after surgery for people with knee injuries. An experimental study will be carried out with 75 patients, with control and experimental groups. In both groups, initial measurements will be compared with measurements after the program, at different times. It is hoped that this study will generate significant information on rehabilitation intervention for people with knee injuries.

Risk and Management of Patients with Cancer and Heart Disease.

Cancer and cardiovascular disease are two of the leading causes of global mortality and morbidity. Medical research has generated powerful lifesaving treatments for patients with cancer; however, such treatments may sometimes be at the expense of the patient's myocardium, leading to heart failure. Anti-cancer drugs, including anthracyclines, can result in deleterious cardiac effects, significantly impacting patients' functional capacity, mental well-being, and quality of life. Recognizing this, recent international guidelines and expert papers published recommendations on risk stratification and care delivery, including that of cardio-oncology services. This review will summarize key evidence with a focus on anthracycline therapy, providing clinical guidance for the non-oncology professional caring for a patient with cancer and heart failure.

Self-Care in Heart Failure Inpatients: What Is the Role of Gender and Pathophysiological Characteristics? A Cross-Sectional Multicentre Study.

Heart failure is often characterised by low exercise capacity and a great impairment of performance in the activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. The aims of this study are to understand the relationship of gender and pathophysiological characteristics with self-care behaviour and to evaluate the self-care behaviour in a sample of Portuguese heart failure inpatients, using the Self-Care of Heart Failure Index (SCHFI). A cross-sectional multicentre study enrolling 225 heart failure inpatients from eight hospitals from Portugal was performed. At admission, each patient's functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. A comparison between self-care behaviour with gender was performed. The patients' mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% had reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance, self-care management and self-care confidence, respectively. Heart failure inpatients present inadequate levels of self-care behaviour. The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

Early rehabilitation in cardiology - heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation.

BACKGROUND: Decompensated heart failure patients are characterised by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, functional capacity and an increase in exercise tolerance. However, the benefits of early rehabilitation have not yet been validated. OBJECTIVE: To evaluate the safety and feasibility of an aerobic exercise training programme in functional capacity of decompensated heart failure patients. METHODOLOGY: A single centre, parallel, randomised controlled, open label trial, with 100 patients. The training group (TG, n=50) performed the training protocol and the control group (CG, n=50) performed the usual rehabilitation procedures. The London chest activity of daily living (LCADL) scale, the Barthel index (BI) and the 6 minute walking test (6MWT) at discharge were used to evaluate the efficacy of the protocol. Safety was measured by the existence of adverse events. RESULTS: The mean age of the patients was 70 years, 20% were New York Heart Association (NYHA) class IV and 80% NYHA class III at admission. The major heart failure aetiology was ischaemic (35 patients) and valvular disease (25 patients). There were no significant differences between groups at baseline in terms of sociodemographic or pathophysiological characteristics. There was a statistically significant difference of 54.2 meters for the training group (P=0.026) in the 6MWT and at LCADL 12 versus 16 (P=0.003), but the BI did not: 96 versus 92 (P=0.072). No major adverse events occurred. CONCLUSIONS: The training protocol demonstrated safety and efficacy, promoting functional capacity. This study elucidated about the benefits of a systematised implementation of physical exercise during the patient's clinical stabilisation phase, which had not yet been demonstrated.Trial registration: Clinicaltrials.gov NCT03838003, URL: https://clinicaltrials.gov/ct2/show/NCT03838003.

Dynamic Balance and Mobility Explain Quality of Life in HFpEF, Outperforming All the Other Physical Fitness Components. / Equilíbrio Dinâmico e Mobilidade Explicam a Qualidade de Vida na ICFEP, Superando Todos os Outros Componentes da Aptidão Física.

Background Physical fitness is an important determinant of quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients. However, how the different physical fitness components correlate with the specific dimensions of QoL in HFpEF patients remains unknown. Objective To evaluate the association between different physical fitness components and QoL dimensions in HFpEF patients, and, assess which physical fitness components were independently associated to QoL. Methods Patients with HFpEF were assessed for physical fitness [dynamic balance and mobility (8-foot-up-and go test), upper body strength (handgrip), cardiorespiratory fitness (CRF) (6-minute-walking test) and body composition (body mass index)] and for QoL (Minnesota Living With Heart Failure Questionnaire). Partial correlation was used to verify the association between physical fitness components and QoL dimensions. The determination of independent predictors in QoL dimensions was assessed through stepwise multivariate linear regression analysis. Statistical significance was set at p<0.05. Results Both CRF and dynamic balance and mobility are significantly associated with the total score and physical dimensions of QoL (p<0.05), but only dynamic balance and mobility were concomitantly associated with the emotional dimension (r=0.597; p=0.004). Dynamic balance and mobility were independently associated with total score (ß=0.651; r2=0.424; p=0.001), physical (ß=0.570; r2=0.324; p=0.04) and emotional (ß=0.611; r2=0.373 p=0.002) dimensions of QoL. Conclusion Our data suggests that dynamic balance and mobility better assess QoL than CRF, which is commonly measured in clinical practice. Whether interventions specifically targeting dynamic balance and mobility have different impacts on QoL remains unknown. (Arq Bras Cardiol. 2020; 114(4):701-707).

Reabilitação funcional no doente com insuficiência cardíaca descompensada / Functional rehabilitation in patients with decompensated heart failure

A insuficiência cardíaca caracteriza se, do ponto de vista funcional, como uma patologia que provoca limitação na realização das atividades de vida diária e consequente perda de autonomia funcional e instrumental, devido aos seus sintomas clássicos como a dispneia, edemas, cansaço fácil e intolerância à atividade. Esta sintomatologia leva a que o doente se torne progressivamente dependente e procure a inatividade como forma de preservar energia e evitar os sintomas. Sabe se atualmente que o exercício físico é benéfico e seguro quando aplicado de acordo com as características do doente e a sua condição clínica, mesmo em fase de estabilização da fase aguda da sua patologia. Metodologia: Através do método exploratório, foram identificadas as variáveis clinicas e fisiológicas, que se alteram com a realização de exercício físico e quais as que potenciam uma melhor resposta ao mesmo, em fase aguda da patologia. Foram selecionados doentes que cumpriram um mínimo de 3 sessões de um programa de exercício físico, com níveis crescentes de intensidade, aplicado aos doentes com insuficiência cardíaca descompensada do serviço de Cardiologia do Hospital de Stº António. Foram avaliados sinais vitais, perceção subjetiva de esforço; índice de Barthel e dispneia associada às atividades de vida diária através da escala London Chest Activity Daily Living. Resultados: O estudo envolveu 20 doentes com internamento compreendido entre Setembro de 2013 e Abril de 2014. A média de idades foi de 64 anos (±9,9) com 80% de homens. No início do programa os doentes apresentam uma média de score LCADL de 29,9, tendo diminuído para 20,9 no final, com uma média de 4,4 sessões. A média de dias de internamento foi de 18,6 dias. Relativamente aos parâmetros de execução do EF, nomeadamente nº de voltas na pedaleira, nº de metros percorridos e nº de degraus verificou se uma variação positiva, assim como variação negativa de Borg pós EF, o que significa que os doentes melhoram a sua CF ao longo do programa apesar de estarem em fase aguda da IC. A análise descritiva e inferencial dos dados permite-nos concluir que os doentes com prática previa de EF, FC basal mais baixa, saturação de oxigénio mais elevada, menor número de FRCV associados apresentam uma melhor resposta ao EF, com melhor evolução ao longo do programa.

Heart failure is characterized, from a functional point of view, as a pathology that causes limitations in carrying out the activities of daily life and consequent loss of functional and instrumental autonomy, due to its classic symptoms such as; dyspnea, edema, easy tiredness and intolerance towards activity. These symptoms make the patient become increasingly dependent and search for inactivity as a way to preserve energy and avoid those symptoms. It is known today that exercise is beneficial and safe when applied according to the characteristics of the patient and his medical condition, even in the process of stabilization of the acute phase of its pathology. Methodology: Through the exploratory method, variables have been identified, from the clinic and physiologic point of view, that change with exercise and which allow a better response to exercise, in the acute phase of the disease. Patients with decompensated heart failure of the cardiology department of the Santo António Hospital were selected to comply with a minimum of 3 sessions of a program of physical exercise with increasing levels of intensity. Vital signs were evaluated and subjective perception of effort, using the Borg scale; the Barthel index and dyspnea associated with the activities of daily life through the London Chest Activity Daily Living (LCADL) scale. Results: The study involved 20 patients with hospitalization between September 2013 and April 2014. The average age was 64 years (± 9.9) with 80% being men. At the beginning of the program patients had an average score of 29.9 LCADL, having fallen to 20.9 in the end, with an average of 4.4 sessions. The average number of days of hospitalization was 18.6 days. With regard to the parameters for the application of exercise, including the number of laps on the Pedal crank training equipment, number of meters travelled, number of steps, the Borg variation and after the exercise, there was a positive variation, meaning that patients improved their functional capacity along the program despite being in acute phase of heart failure. The descriptive and inferential statistics analysis of the data allows us to conclude that patients with previous practice of exercise, lower basal heart rate, higher oxygen saturation, lower number of associated cardiovascular risk factors presented a better response to the exercise and with a better evolution throughout the program.