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Begrambekova YL, Arutynov GP, Glezer MG, Karanadze NA, Kolesnikova EA, Lelyavina TA, Lishuta AS, Orlova YA, Belenkov YN. [Evaluation of the Functional Reserve and Exercise Tolerance in Patients with CHF in Clinical Trials (Consent Document of the Editorial board of the Journal of Cardiology, the Board of the Society of Specialists in Heart Failure (SSHF) and Working Group "Non-drug treatment methods" of SSHF)]. KARDIOLOGIIA 2024; 64:4-26. [PMID: 39102569 DOI: 10.18087/cardio.2024.7.n2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 08/07/2024]
Abstract
Assessing the functional capacity and exercise tolerance is an important and widely used research tool in patients with heart failure. It is used not only in cardiac rehabilitation and physical therapy, but also for inclusion criteria and outcome measures in studies of drug interventions. This document outlines the scope, guidelines for the implementation and interpretation, and limitations of the methods for assessing the functional capacity and exercise tolerance in clinical trials in patients with heart failure.
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Affiliation(s)
- Yu L Begrambekova
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - G P Arutynov
- Pirogov Russian National Research Medical University
| | - M G Glezer
- Vladimirsky Moscow Regional Research Clinical Institute; Sechenov First Moscow State Medical University
| | - N A Karanadze
- Medical Research and Educational Center, Lomonosov Moscow State University
| | | | | | - A S Lishuta
- Sechenov First Moscow State Medical University
| | - Ya A Orlova
- Medical Research and Educational Center, Lomonosov Moscow State University
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Kourek C, Zachariou A, Karatzanos E, Antonopoulos M, Soulele T, Karabinis A, Nanas S, Dimopoulos S. Effects of combined aerobic, resistance and inspiratory training in patients with pulmonary hypertension: A systematic review. World J Crit Care Med 2024; 13:92585. [PMID: 38855278 PMCID: PMC11155510 DOI: 10.5492/wjccm.v13.i2.92585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a serious progressive disorder of the modern world, characterized by endothelial dysfunction and impaired vasoreactivity. Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity. Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities. However, data regarding the effects of combined exercise training programs in patients with PH still remains limited. AIM To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH. METHODS Our search included all available randomized controlled trials (RCTs) regarding combined aerobic, resistance and inspiratory training programs in patients with PH in 4 databases (Pubmed, PEDro, Embase, CINAHL) from 2012 to 2022. Five RCTs were included in the final analysis. Functional capacity, assessed by peak VO2 or 6-min walking test (6MWT), as well as quality of life, assessed by the SF-36 questionnaire, were set as the primary outcomes in our study. RESULTS Peak VO2 was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs. Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs (P < 0.05). Quality of life was measured in 4 out of 5 RCTs. Although patients improved their quality of life in each group, however, only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls. CONCLUSION By this systematic review, we have demonstrated that combined aerobic, resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH. Such exercise training regimen may be part of the therapeutic strategy of the syndrome.
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Affiliation(s)
- Christos Kourek
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Department of Cardiology, 417 Army Share Fund Hospital of Athens, Athens 11521, Greece
| | - Antonia Zachariou
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Eleftherios Karatzanos
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Michalis Antonopoulos
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery ICU, Onassis Cardiac Surgery center, Athens 17674, Attica, Greece
| | - Theodora Soulele
- Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Andreas Karabinis
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Serafim Nanas
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Stavros Dimopoulos
- Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens 17674, Greece
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Begrambekova YL, Fedotov DA, Karanadze NA, Lelyavina TA, Bortsova MA, Orlova YA. [Possibilities of Predicting Peak Oxygen Consumption in Patients With Chronic Heart Failure According to the 6‑Minute Walk Test]. KARDIOLOGIIA 2024; 64:34-42. [PMID: 38462802 DOI: 10.18087/cardio.2024.2.n2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/23/2023] [Indexed: 03/12/2024]
Abstract
AIM To determine the correlation between the results of the 6-minute walk test (6MWT) and peak oxygen consumption (VO2peak) for populations of patients with chronic heart failure with pronounced clinical and demographic differences; to study a possibility of indirect measurement of VO2peak based on the results of 6MWT using the formulas available from the literature. MATERIAL AND METHODS Two databases were analyzed: 50 patients included in the AEROFIT study (group A), and 31 patients from the Almazov National Medical Research Center (group B). The inclusion criteria were the availability of data from the cardiopulmonary stress test and the 6MWT. The possibility of predicting VO2peak was calculated based on the results of 6MWT using the formulas reported in the literature (L. P. Cahalin et al., 1996; R. M. Ross et al., 2010; R. A. Adedoyin et al., 2010). The predictive accuracy of the models was assessed using the coefficient of determination (R2). The relationship between functional and clinical-demographic indicators was assessed using the Pearson or Spearman correlation analysis. RESULTS The study groups differed significantly in all parameters, except for the proportion of men and the mean VO2peak. Group B patients were 20 years younger than group A patients, had a lower left ventricular ejection fraction (24.06±7.75 and 41.52±10.48 %, respectively; p<0.001), and covered a 130 m shorter distance in the 6MWT. Despite the absence of a significant difference in VO2peak between groups A and B (13.6 and 13.1 ml / kg / min, respectively; p=0.6581), 61 % of group B patients and 20% of group A belonged to Weber functional class IV. In group A, the 6MWT distance correlated closely with VO2peak (R=0.78; p<0.01) and weakly with age (R=0.4) and body mass index (R=0.3). In group B, the 6MWT distance correlated only with VO2peak (R=0.77; p<0.01). For group A, the R.M. Ross et al. model demonstrated high accuracy in determining the mean VO2peak value with a 0.06% prediction error normalized to measured VO2peak. For group B, none of the models showed satisfactory predictive accuracy. The Ross and Cahalin models showed the best coefficients of determination for groups A and B: Group A, Ross et al. (R2=0.58) and Cahalin et al. (R2=0.59); Group B, Ross et al. (R2=0.59) and Cahalin et al. (R2=0.6). CONCLUSION In two groups of patients with a statistically insignificant difference in the mean values of VO2peak, the mean values of 6MWT distance were significantly different, although these indicators correlated closely. The VO2peak prediction models showed satisfactory accuracy for estimation of mean VO2, but poor accuracy for estimation of individual values. A better predictive accuracy is determined by similar clinical and demographic characteristics between the training and testing populations, and likely also by models based on larger, more diversified populations.
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Affiliation(s)
- Yu L Begrambekova
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - D A Fedotov
- Medical Research and Educational Center, Lomonosov Moscow State University
| | - N A Karanadze
- Medical Research and Educational Center, Lomonosov Moscow State University
| | | | | | - Ya A Orlova
- Medical Research and Educational Center, Lomonosov Moscow State University
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Belli-Marin JFC, Bocchi EA, Ayub-Ferreira S, Junior NC, Guimarães GV. Effects of β-blocker therapy on exercise oscillatory ventilation in reduced ejection fraction heart failure patients: A case series study. Biomed Pharmacother 2022; 152:113106. [PMID: 35665667 DOI: 10.1016/j.biopha.2022.113106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is an abnormal breathing pattern that occurs in ~20% of patients with heart failure (HF) and is associated with poor prognosis and exercise intolerance. β-blockers (βb) are prescribed for most HF patients; however, their effect on EOV remains unclear. We evaluated the effect of βb on EOV in HF patients with reduced ejection fraction (HFrEF). METHODS Fifteen patients diagnosed with HF, ejection fraction < 45%, aged from 18 to 65 years, were included before starting βb therapy. Patients underwent clinical evaluation, cardiopulmonary exercise testing, echocardiography, laboratory exams (norepinephrine levels, B type natriuretic peptide) at baseline and after βb therapy optimized for six months. Presence of exercise oscillatory breathing was determined by two experienced observers who were blinded to the moment of the test (pre or post). RESULTS Fifteen patients (1 female), aged 49.5 ± 2.5 years, with HFrEF, NYHA I-III enrolled in the study. The etiologies of the HFrEF were idiopathic (n = 8) and hypertensive (n = 7). LVEF increased after βb therapy from 25.9 ± 2.5% to 33 ± 2.6%, P = 0.02; peak VO2 did not significantly change (21.8 ± 1.7 vs 24.7 ± 1.9, P = 0.4); VE/VCO2 slope changed from 32.1 ± 10.6-27.5 ± 9.1, P = 0.03. Before βb initiation, nine patients (60%) had EOV, but only two (13%) did after optimized therapy. McNemar test was used to evaluate the significance of the association between the two moments (P = 0.02). CONCLUSION In patients with HF, medical therapy with βb can reverse EOV. This may explain why these patients experience symptom improvement after βb therapy.
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Affiliation(s)
| | - Edimar Alcides Bocchi
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Silvia Ayub-Ferreira
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Nelson Carvas Junior
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Guilherme Veiga Guimarães
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Guimarães GV, Carvalho VO, Bocchi EA, d’Avila VM. Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial. Cardiovasc Ther 2012; 30:351-356. [DOI: 10.1111/j.1755-5922.2011.00285.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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de Araújo CJS, Gonçalves FS, Bittencourt HS, dos Santos NG, Junior SVM, Neves JLB, Fernandes AMS, Junior RA, dos Reis F, Guimarães AC, Junior E, Carvalho VO. Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward. J Cardiothorac Surg 2012; 7:124. [PMID: 23153062 PMCID: PMC3544690 DOI: 10.1186/1749-8090-7-124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 11/03/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Neuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay. METHODS This is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us) two times a day for consecutive days until hospital discharge. RESULTS The walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p<0.001). On the other hand, the walked distance in the control group did not change. CONCLUSION The neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.
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Affiliation(s)
- Carlos José Soares de Araújo
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | - Fernanda Souza Gonçalves
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | - Hugo Souza Bittencourt
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | - Noélia Gonçalves dos Santos
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | - Sérgio Vitor Mecca Junior
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | - Júlio Leal Bandeira Neves
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | | | - Roque Aras Junior
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
- Faculdade de Medicina da Universidade Federal da Bahia (UFBa), Salvador-BA, Brazil
| | | | - Armênio Costa Guimarães
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
| | - ErenaldodeSouzaRodrigues Junior
- Hospital Ana Neri, Universidade Federal da Bahia, Avenida Saldanha Marinho s/n, Salvador Bahia, CEP:40320-010, Brazil
- Faculdade de Medicina da Universidade Federal da Bahia (UFBa), Salvador-BA, Brazil
- The GREAT Group (GRupo de Estudos em Atividade física), São Paulo, Brazil
| | - Vitor Oliveira Carvalho
- Unidade de Cirurgia Cardíaca Pediátrica do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
- The GREAT Group (GRupo de Estudos em Atividade física), São Paulo, Brazil
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Corrà U, Mezzani A, Giordano A, Caruso R, Giannuzzi P. A new cardiopulmonary exercise testing prognosticating algorithm for heart failure patients treated with beta-blockers. Eur J Prev Cardiol 2011; 19:185-91. [DOI: 10.1177/1741826710396625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ugo Corrà
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy
| | - Alessandro Mezzani
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy
| | - Andrea Giordano
- Bioengineering Department, Salvatore Maugeri Foundation, IRCCS, Via per Revislate 13, 28010 Veruno, Italy
| | - Roberto Caruso
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy
| | - Pantaleo Giannuzzi
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Italy
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Guimarães GV, D'Avila V, Bocchi EA, Carvalho VO. Norepinephrine remains increased in the six-minute walking test after heart transplantation. Clinics (Sao Paulo) 2010; 65:587-91. [PMID: 20613934 PMCID: PMC2898555 DOI: 10.1590/s1807-59322010000600005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 02/17/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test. INTRODUCTION Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described. METHODS Twenty heart transplantation (18 men, 49+/-11 years and 8.5+/-3.3 years after transplantation), 11 heart failure (8 men, 43+/-10 years), and 7 healthy subjects (5 men 39+/-8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise. RESULTS During rest, patients' norepinephrine plasma level (659+/-225 pg/mL) was higher in heart transplant recipients (463+/-167 pg/mL) and healthy subjects (512+/-132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248+/-692 pg/mL) was not different from that of heart failure patients (1174+/-653 pg/mL). Both these groups had a higher level than healthy subjects had (545+/-95 pg/mL), p<0.05. CONCLUSION Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.
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Carvalho VO, Guimarães GV. Is the 6-min walking test a sub-maximal exercise test in heart failure patients? Eur J Appl Physiol 2009; 107:623-4. [DOI: 10.1007/s00421-009-1173-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2009] [Indexed: 11/30/2022]
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Carvalho VO, Bocchi EA, Guimarães GV. The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy. Circ J 2009; 73:1871-6. [DOI: 10.1253/circj.cj-09-0333] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Edimar Alcides Bocchi
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Guilherme Veiga Guimarães
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
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