Home-based training program in patients with chronic heart failure and reduced ejection fraction: a randomized pilot study.

OBJECTIVES: We aimed to compare the effects of home-and center-based exercise training programs on functional capacity, inspiratory muscle strength, daily physical activity level, and quality of life (QoL) in patients with chronic heart failure (CHF) over a 12-week period. METHODS: This study included 23 patients with CHF (left ventricular ejection fraction 31±6%) randomized to a home-based (n=11) or center-based (n=12) program. Patients underwent 12 weeks of aerobic training (60%-70% heart rate reserve): walking for the home-based and supervised cycling for the center-based group, both combined with resistance training (50% of 1 maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test variables, 6-min walk test distance (6 MWD), steps/day with accelerometry, and QoL (Minnesota Living with Heart Failure questionnaire). Maximal inspiratory pressure and handgrip strength were measured at baseline and after 4, 8, and 12 weeks of training. ClinicalTrials.gov: NCT03615157. RESULTS: There were no adverse events during training in either group. The home- and center-based training groups obtained similar improvements in peak oxygen uptake, maximal ventilation, and 6 MWD. However, there were significant between-group differences: center-based training was more effective in improving maximal inspiratory pressure (p=0.042), number of steps/day (p=0.001), and QoL (p=0.039). CONCLUSIONS: Home-based training is safe and can be an alternative to improve the exercise capacity of patients with stable CHF. However, center-based training was superior in improving inspiratory muscle strength, QoL, and daily physical activity.

Home-based training program in patients with chronic heart failure and reduced ejection fraction: a randomized pilot study

OBJECTIVES: We aimed to compare the effects of home-and center-based exercise training programs on functional capacity, inspiratory muscle strength, daily physical activity level, and quality of life (QoL) in patients with chronic heart failure (CHF) over a 12-week period. METHODS: This study included 23 patients with CHF (left ventricular ejection fraction 31±6%) randomized to a home-based (n=11) or center-based (n=12) program. Patients underwent 12 weeks of aerobic training (60%-70% heart rate reserve): walking for the home-based and supervised cycling for the center-based group, both combined with resistance training (50% of 1 maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test variables, 6-min walk test distance (6 MWD), steps/day with accelerometry, and QoL (Minnesota Living with Heart Failure questionnaire). Maximal inspiratory pressure and handgrip strength were measured at baseline and after 4, 8, and 12 weeks of training. ClinicalTrials.gov: NCT03615157. RESULTS: There were no adverse events during training in either group. The home- and center-based training groups obtained similar improvements in peak oxygen uptake, maximal ventilation, and 6 MWD. However, there were significant between-group differences: center-based training was more effective in improving maximal inspiratory pressure (p=0.042), number of steps/day (p=0.001), and QoL (p=0.039). CONCLUSIONS: Home-based training is safe and can be an alternative to improve the exercise capacity of patients with stable CHF. However, center-based training was superior in improving inspiratory muscle strength, QoL, and daily physical activity.

Smoking load reduction is insufficient to downregulate miR-301b, a lung cancer promoter.

Several circulating miRNAs identified in the plasma of smokers have been implicated as promoters of nasopharyngeal and lung carcinoma. To investigate the plasma profile of miRNAs in subjects who reduces the number of smoked cigarettes and who quit after six months. We accompanied 28 individuals enrolled in a Smoking Cessation Program over 6 months. At Baseline, clinical characteristics, co-morbidities, and smoking history were similar among subjects. After 6 months, two groups were defined: who successfully quitted smoking (named "quitters", n = 18, mean age 57 years, 11 male) and who reduced the number of cigarettes smoked (20-90%) but failed to quit smoking (named "smokers", n = 10, mean age 52 years, 3 male). No significant clinical changes were observed between groups at baseline and after a 6-month period, however, quitters showed significant downregulations in seven miRNAs at baseline: miR-17 (- 2.90-fold, p = 0.029), miR-20a (- 3.80-fold, p = 0.021); miR-20b (- 4.71-fold, p = 0.027); miR-30a (- 3.95-fold, p = 0.024); miR-93 (- 3.63-fold, p = 0.022); miR-125a (- 1.70-fold, p = 0.038); and miR-195 (- 5.37-fold, p = 0.002), and after a 6-month period in 6 miRNAs: miR-17 (- 5.30-fold, p = 0.012), miR-20a (- 2.04-fold, p = 0.017), miR-20b (- 5.44-fold, p = 0.017), miR-93 (- 4.00-fold, p = 0.041), miR-101 (- 4.82-fold, p = 0.047) and miR-125b (- 3.65-fold, p = 0.025). Using time comparisons, only quitters had significant downregulation in miR-301b (- 2.29-fold, p = 0.038) after 6-month. Reductions in the number of smoked cigarettes was insufficient to change the plasma profile of miRNA after 6 months. Only quitting smoking (100% reduction) significantly downregulated miR-301b related to hypoxic conditions, promotion of cell proliferation, decreases in apoptosis, cancer development, and progression as increases in radiotherapy and chemotherapy resistance.

Risk Factors for Inspiratory Muscle Weakness in Chronic Heart Failure.

BACKGROUND: Chronic heart failure is commonly associated with inspiratory muscle weakness. However, few studies have investigated the risk factors for inspiratory muscle weakness in individuals with chronic heart failure and systolic dysfunction (left-ventricular ejection fraction [LVEF] <40%). METHODS: Seventy subjects were recruited in a cardiac center. We assessed clinical parameters, smoking history, peripheral muscle strength, pulmonary function, echocardiographic variables, and brain natriuretic peptide. The subjects were classified with inspiratory muscle weakness when the maximum inspiratory pressure was <70% of predicted values. RESULTS: Thirty-six subjects (51%) had inspiratory muscle weakness. The subjects with inspiratory muscle weakness and the subjects with no inspiratory muscle weakness were similar in age, sex, body mass index, medication use, and physical activity. However, the subjects with inspiratory muscle weakness had lower LVEF (P = .003), systolic blood pressure (P = .01), diastolic blood pressure (P = .042), quadriceps muscle strength (P = .02), lung function (P = .035), increased brain natriuretic peptide (P = .02), smoking history (P = .01), and pulmonary hypertension incidence (P = .03). Multivariate logistic regression analysis found a lower LVEF, increased smoking history, and lower systolic blood pressure as significant independent predictors for inspiratory muscle weakness. CONCLUSIONS: The combination of lower LVEF, lower systolic blood pressure, and smoking history predicted inspiratory muscle weakness. Patients with suspected inspiratory muscle weakness should be examined and, if inspiratory muscle weakness exists, then inspiratory muscle training should be provided. Reducing inspiratory muscle weakness has the potential to improve many of the deleterious effects of chronic heart failure.

Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial.

BACKGROUND: Inspiratory and peripheral muscle training improves muscle strength, exercise tolerance, and quality of life in patients with chronic heart failure (HF). However, studies investigating different workloads for these exercise modalities are still lacking. OBJECTIVE: To examine the effects of low and moderate intensities on muscle strength, functional capacity, and quality of life. DESIGN: A randomized controlled trial. METHODS: Thirty-five patients with stable HF (aged >18 years, NYHA II/III, LVEF <40%) were randomized to: non-exercise control group (n = 9), low-intensity training group (LIPRT, n = 13, 15% maximal inspiratory workload, and 0.5 kg of peripheral muscle workload) or moderate-intensity training group (MIPRT, n = 13, 30% maximal inspiratory workload and 50% of one maximum repetition of peripheral muscle workload). The outcomes were: respiratory and peripheral muscle strength, pulmonary function, exercise tolerance by the 6-minute walk test, symptoms based on the NYHA functional class, and quality of life using the Minnesota Living with Heart Failure Questionnaire. RESULTS: All groups showed similar quality-of-life improvements. Low and moderate intensities training programs improved inspiratory muscle strength, peripheral muscle strength, and walking distance. However, only moderate intensity improved expiratory muscle strength and NYHA functional class in HF patients. CONCLUSIONS: The low-intensity inspiratory and peripheral resistance muscle training improved inspiratory and peripheral muscle strength and walking distance, demonstrating that LIPRT is an efficient rehabilitation method for debilitated HF patients. In addition, the moderate-intensity resistance training also improved expiratory muscle strength and NYHA functional class in HF patients.

Reproducibility for Heart Rate Variability Analysis during 6-Min Walk Test in Patients with Heart Failure and Agreement between Devices.

Heart rate variability (HRV) analysis is a useful method to assess abnormal functioning in the autonomic nervous system and to predict cardiac events in patients with heart failure (HF). HRV measurements with heart rate monitors have been validated with an electrocardiograph in healthy subjects but not in patients with HF. We explored the reproducibility of HRV in two consecutive six-minute walk tests (6MW), 60-minute apart, using a heart rate monitor (PolarS810i) and a portable electrocardiograph (called Holter) in 50 HF patients (mean age 59 years, NYHA II, left ventricular ejection fraction ~35%). The reproducibility for each device was analysed using a paired t-test or the Wilcoxon signed-rank test. Additionally, we assessed the agreement between the two devices based on the HRV indices at rest, during the 6MW and during recovery using concordance correlation coefficients (CCC), 95% confidence intervals and Bland-Altman plots. The test-retest for the HRV analyses was reproducible using Holter and PolarS810i at rest but not during recovery. In the second 6MW, patients showed significant increases in rMSSD and walking distance. The PolarS810i measurements had remarkably high concordance correlation [0.86

Teste de caminhada de seis minutos como preditor de morbidade e mortalidade cardiovascular em pacientes após infarto agudo do miocárdio / Morbidity and mortality predictor of six minute walk test after acute myocardial infarction patients

O teste de caminhada de seis minutos (TC6M) é um teste muito utilizado para avaliar as condições de saúde de idosos e saudáveis, bem como pacientes com doenças pulmonares e cardiovasculares. Porém, poucos são os relatos na literatura científica habitual sobre a utilização do teste de caminhada de seis minutos para avaliar a morbidade e mortalidade de pacientes após infarto agudo do miocárdio (IAM). Objetivo: O objetivo deste estudo foi verificar se o TC6M tem valor preditivo para morbidade e/ou mortalidade cardiovascular após IAM. Queremos verificar o ponto de corte da distância no TC6M para síndrome coronariana aguda, insuficiência cardíaca, re-hospitalização ou óbito por causa cardiovascular. Método: Trata-se de um estudo observacional, no qual se utilizou análise de prontuários, contato telefônico, correio e SIM (Sistema de Informação de Mortalidade da Secretaria de Saúde) de pacientes com diagnóstico de IAM não complicado que realizaram o TC6M antes da alta hospitalar. Desfechos observados: síndrome coronariana aguda, insuficiência cardíaca, acidente vascular cerebral, re-hospitalização e óbito por causa cardiovascular. A coleta de dados se deu no Instituto Dante Pazzanese de Cardiologia, por meio de análise de prontuário e foram incluídos no estudo, os pacientes com diagnóstico de IAM não complicado que realizaram o teste de caminhada de seis minutos antes da alta hospitalar. Para análise estatística foram utilizados: correlação de Pearson ou Spearman, teste...

The six-minute walk test (6MWT) is a test used to assess the prognosis of patients with heart failure, chronic obstructive pulmonary disease and health status of the elderly. However, there are few reports in the scientific literature about the use of this test as a tool to assess the prognosis after acute myocardial infarction (AMI) patients. The aim of this study is to assess the prognostic value of the 6MWT in AMI patients. We also intend to point out whether there is a minimum distance in the 6MWT that defines a group of patients with worse prognosis, i.e, in the occurrence of death, re-infarction, or heart failure re-hospitalization from cardiovascular causes. Methods: This is an observational study for which we used analysis of medical records, telephone contact, mail and SIM (Mortality Information System of the Department of Health) of uncomplicated AMI patients who underwent 6MWT before hospital discharge. Observed outcomes: acute coronary syndrome, heart failure, stroke,re-hospitalization and cardiovascular death. Data collection has taken place at the Institute Dante Pazzanese of Cardiology, with analysis of medical records and has be included patients with uncomplicated AMI who underwent 6MWT before discharge. Statistical analysis: we used Pearson or Spearman correlation, Student/'s t test or Mann-Whitney test and ANOVA or Kruskal Wallis test to analyze the effects of physical and clinical characteristics in 6MWT distance. Such characteristics...

Estudo comparativo da resposta da pressão arterial e da frequência cardíaca entre exercícios isotônicos resistidos e isométricos em indivíduos hipertensos e normotensos / Comparative study of blood pressure and heart rate responses between isotonic and isometric resistance exercises in hypertensive and normotensive subjects

A monitorização da frequência cardíaca e da pressão arterial após o exercício físico é uma prática utilizada em programas de reabilitação cardiovascular. O objetivo do presente estudo foi verificar diferença nas respostas da pressão arterial e da frequência cardíaca entre exercícios físicos isotônicos resistidos e isométricos resistidos em hipertensos e normotensos...

Teste de caminhada de seis minutos após infarto agudo do miocárdio: comparação com teste ergométrico e peptídeo natriurético tipo B / Six minute walk test after acute myocardial infarction: comparation with exercice test and brain natriuretic peptide

Introdução: O infarto agudo do miocárdio continua sendo uma doença de interesse em Saúde Pública devido a sua morbimortalidade. O teste ergométrico e os marcadores biológicos, incluindo o peptídeo natriurérico tipo B (BNP) auxiliam na estratificação de risco dos pacientes, porém estes exames requerem materiais de alto custo. O teste de caminhada de seis minutos (TC6) é um teste de fácil aplicação e de baixo custo. Objetivo: Verificar e correlacionar a distância do TC6 após IAM não complicado com o consumo de oxigênio (VO2) obtido pelo teste ergométrico (TE) e as concentrações de BNP. Analisar que variáveis influenciaram no TC6 e comparar o comportamento da frequência cardíaca (FC) e da pressão arterial (PA) no TC6 e TE. Metodologia: Os critérios de inclusão foram: pacientes com IAM com supra desnível de ST, internados no Instituto "Dante Pazzanese" de Cardiologia entre junho de 2005 a abril de 2007, de ambos os gêneros, idade entre 21 a 80 anos e que assinaram o termo de consentimento livre e esclarecido. Foram excluídos os pacientes com evolução clínica complicada, resultados adversos de TE e com comorbidades impeditivas para caminhar. A dosagem do BNP e o TE foram realizados no 4º ou 5º dia de IAM e o TC6, após uma a dois dias. Para análise estatística foram utilizados os testes de Kolmogorov-Smirnov, t de Student ou de Wilcoxon; qui-quadrado; correlação de Pearson ou Spearman, ANOVA e ANCOVA. p-valor < 0,05. Resultados: Expressos em média e desvio padrão para variáveis quantitativas e número e porcentagem para variáveis categóricas. Casuística: 61 pacientes, 47 homens (78,7 por cento), 56,38 (9,98) anos, IMC=27,40 (4,44) Kg/m2. Todos os pacientes concluíram o TC6 sem intercorrências, com distância de 451,54 (88,30)m. O VO2 obtido pelo TE foi de 25,66 (8,78) ml/Kg/min, BNP=249,45 (296,05) pg/ml, fração de ejeção do ventrículo esquerdo = 51,22 (9,20 por cento), 27 pacientes (44,3 por cento) com diagnóstico de IAM anterior e 50 (83,6 por cento) com terapia de...