Home-based Training Program in Patients with Chronic Heart Failure and Reduced Ejection Fraction: a Randomized Pilot Study

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2021 Jun 16

PMID 34133657

Citations 2

Authors

Geisa Nascimento de Andrade

Iracema Ioco Kikuchi Umeda

Angela Rubia Cavalcanti Neves Fuchs

Luiz Eduardo Mastrocola

Joao Manoel Rossi-Neto

Dalmo Antonio Ribeiro Moreira

Patricia Alves de Oliveira

Carmen Diva Saldiva de Andre

Lawrence Patrick Cahalin

Naomi Kondo Nakagawa

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Home-based versus centre-based cardiac rehabilitation.

McDonagh S, Dalal H, Moore S, Clark C, Dean S, Jolly K Cochrane Database Syst Rev. 2023; 10:CD007130.

PMID: 37888805 PMC: 10604509. DOI: 10.1002/14651858.CD007130.pub5.

Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis.

Zangger G, Bricca A, Liaghat B, Juhl C, Mortensen S, Andersen R J Med Internet Res. 2023; 25:e46439.

PMID: 37410534 PMC: 10359919. DOI: 10.2196/46439.

References

Savarese G, Lund L . Global Public Health Burden of Heart Failure. Card Fail Rev. 2017; 3(1):7-11. PMC: 5494150. DOI: 10.15420/cfr.2016:25:2. View

Izawa K, Watanabe S, Osada N, Kasahara Y, Yokoyama H, Hiraki K . Handgrip strength as a predictor of prognosis in Japanese patients with congestive heart failure. Eur J Cardiovasc Prev Rehabil. 2009; 16(1):21-7. DOI: 10.1097/HJR.0b013e32831269a3. View

. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-7. DOI: 10.1164/ajrccm.166.1.at1102. View

Piepoli M, Corra U, Agostoni P, Belardinelli R, Cohen-Solal A, Hambrecht R . Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part II: How to perform cardiopulmonary exercise testing in chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2006; 13(3):300-11. DOI: 10.1097/00149831-200606000-00003. View

Karapolat H, Demir E, Bozkaya Y, Eyigor S, Nalbantgil S, Durmaz B . Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters. Clin Res Cardiol. 2009; 98(10):635-42. DOI: 10.1007/s00392-009-0049-6. View

Yeo T, Wang Y, Low T . Have a heart during the COVID-19 crisis: Making the case for cardiac rehabilitation in the face of an ongoing pandemic. Eur J Prev Cardiol. 2020; 27(9):903-905. PMC: 7717267. DOI: 10.1177/2047487320915665. View

. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009; 41(3):687-708. DOI: 10.1249/MSS.0b013e3181915670. View

. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002; 166(4):518-624. DOI: 10.1164/rccm.166.4.518. View

OConnor C, Whellan D, Lee K, Keteyian S, Cooper L, Ellis S . Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009; 301(14):1439-50. PMC: 2916661. DOI: 10.1001/jama.2009.454. View

10.

Poole D, Hirai D, Copp S, Musch T . Muscle oxygen transport and utilization in heart failure: implications for exercise (in)tolerance. Am J Physiol Heart Circ Physiol. 2011; 302(5):H1050-63. PMC: 3311454. DOI: 10.1152/ajpheart.00943.2011. View

11.

Mathiowetz V, Weber K, Volland G, Kashman N . Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984; 9(2):222-6. DOI: 10.1016/s0363-5023(84)80146-x. View

12.

Winkelmann E, Chiappa G, Lima C, Viecili P, Stein R, Ribeiro J . Addition of inspiratory muscle training to aerobic training improves cardiorespiratory responses to exercise in patients with heart failure and inspiratory muscle weakness. Am Heart J. 2009; 158(5):768.e1-7. DOI: 10.1016/j.ahj.2009.09.005. View

13.

Thomas R, Beatty A, Beckie T, Brewer L, Brown T, Forman D . Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol. 2019; 74(1):133-153. PMC: 7341112. DOI: 10.1016/j.jacc.2019.03.008. View

14.

Lans C, Cider A, Nylander E, Brudin L . Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study. ESC Heart Fail. 2017; 5(2):241-248. PMC: 5880672. DOI: 10.1002/ehf2.12230. View

15.

Taylor R, Sagar V, Davies E, Briscoe S, Coats A, Dalal H . Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014; (4):CD003331. PMC: 6485909. DOI: 10.1002/14651858.CD003331.pub4. View

16.

Dracup K, Evangelista L, Hamilton M, Erickson V, Hage A, Moriguchi J . Effects of a home-based exercise program on clinical outcomes in heart failure. Am Heart J. 2007; 154(5):877-83. DOI: 10.1016/j.ahj.2007.07.019. View

17.

Daskapan A, Arikan H, Caglar N, Tunali N, Ataman S . Comparison of supervised exercise training and home-based exercise training in chronic heart failure. Saudi Med J. 2005; 26(5):842-7. View

18.

Adamopoulos S, Schmid J, Dendale P, Poerschke D, Hansen D, Dritsas A . Combined aerobic/inspiratory muscle training vs. aerobic training in patients with chronic heart failure: The Vent-HeFT trial: a European prospective multicentre randomized trial. Eur J Heart Fail. 2014; 16(5):574-82. DOI: 10.1002/ejhf.70. View

19.

Dalal H, Wingham J, Palmer J, Taylor R, Petre C, Lewin R . Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland. BMJ Open. 2012; 2(2):e000787. PMC: 3323807. DOI: 10.1136/bmjopen-2011-000787. View

20.

Drwal K, Forman D, Wakefield B, El Accaoui R . Cardiac Rehabilitation During COVID-19 Pandemic: Highlighting the Value of Home-Based Programs. Telemed J E Health. 2020; 26(11):1322-1324. DOI: 10.1089/tmj.2020.0213. View