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Li Y, He W, Jiang J, Zhang J, Ding M, Li G, Luo X, Ma Z, Li J, Ma Y, Shen Y, Han X. Non-Pharmacological Interventions in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:963-974. [PMID: 37499852 DOI: 10.1016/j.apmr.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection fraction (HFrEF). DATA SOURCES We searched PubMed, Embase, and the Cochrane Clinical Trials Register from the date of database inception to April 22, 2023. STUDY SELECTION Randomized controlled trials involving non-pharmacologic interventions conducted in patients with HFrEF were included. DATA EXTRACTION Data were extracted by 2 independent reviewers based on a pre-tested data extraction form. The quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation method. DATA SYNTHESIS A total of 82 eligible studies (4574 participants) were included. We performed a random-effects model within a Bayesian framework to calculate weighted mean differences (WMDs) and 95% credibility intervals. High or moderate certainty evidence indicated that high-intensity aerobic interval training (HIAIT) was best on improving 6-minute walk distance (6MWD; 68.55 m [36.41, 100.47]) and left ventricular ejection fraction (6.28% [3.88, 8.77]), while high-intensity aerobic continuous training (HIACT) is best on improving peak oxygen consumption (Peak VO2; 3.48 mL/kg•min [2.84, 4.12]), quality of life (QOL; -17.26 [-29.99, -7.80]), resting heart rate (-8.20 bpm [-13.32, -3.05]), and N-terminal pro-B-type natriuretic peptide (-600.96 pg/mL [-902.93, -404.52]). Moderate certainty evidence supported the effectiveness of inspiratory muscle training to improve peak oxygen consumption and functional electrical stimulation to improve QOL. Moderate-intensity aerobic continuous training (MIACT) plus moderate-intensity resistance training (MIRT) had additional benefits in Peak VO2, 6MWD, and QOL. This review did not provide a comprehensive evaluation of adverse events. CONCLUSIONS Both HIAIT and HIACT are the most effective single non-pharmacologic interventions for HFrEF. MIACT plus MIRT had additional benefits in improving peak oxygen consumption, 6MWD, and QOL.
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Affiliation(s)
- Yilun Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Wenbo He
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jingwen Jiang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jiawen Zhang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Mingfeng Ding
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Gaiyun Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaolei Luo
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ziyuan Ma
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jingyi Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yichen Ma
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yanfei Shen
- Office of Legal Affairs, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xuemei Han
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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Dharmavaram N, Esmaeeli A, Jacobson K, Brailovsky Y, Raza F. Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism. Interv Cardiol Clin 2023; 12:349-365. [PMID: 37290839 DOI: 10.1016/j.iccl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Long-term exercise intolerance and functional limitations are common after an episode of acute pulmonary embolism (PE), despite 3 to 6 months of anticoagulation. These persistent symptoms are reported in more than half of the patients with acute PE and are referred as "post-PE syndrome." Although these functional limitations can occur from persistent pulmonary vascular occlusion or pulmonary vascular remodeling, significant deconditioning can be a major contributing factor. Herein, the authors review the role of exercise testing to elucidate the mechanisms of exercise limitations to guide next steps in management and exercise training for musculoskeletal deconditioning.
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Affiliation(s)
- Naga Dharmavaram
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Amir Esmaeeli
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Kurt Jacobson
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Department of Medicine, Jefferson Heart Institute-Sidney Kimmel School of Medicine, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Farhan Raza
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA.
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Wang T, Zhang L, Cai M, Tian Z. Effects of different exercise modalities on inhibiting left ventricular pathological remodeling in patients with heart failure with reduced ejection fraction: A systematic review and network meta-analysis. Life Sci 2023; 319:121511. [PMID: 36822317 DOI: 10.1016/j.lfs.2023.121511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
AIMS To evaluate the effects of different exercise training modalities on inhibiting the left ventricular pathological remodeling in patients with heart failure with reduced ejection fraction (HFrEF) and screen out the optimal exercise modality. METHODS We performed a network meta-analysis based on the Frequentist model. Random-effect meta-analyses were used to estimate mean differences (MD) and 95 % confidence intervals. KEY FINDINGS 25 randomized controlled trials (1284 patients) were enrolled in this study. Results revealed that: high-intensity interval training had the best effect in improving left ventricular ejection fraction (p-score = 0.93, MD: 6.44 (3.61 to 9.28)), reducing left ventricular end-diastolic diameter (p-score = 0.97, MD: -6.73 (-10.27 to -3.19)) and left ventricular end-systolic diameter (p-score = 0.97, MD: -9.33 (-14.90 to -3.76)). Combined aerobic training with resistance training and inspiratory muscle training had the best effect in improving maximal oxygen consumption (p-score = 0.90, MD: 5.19 (3.12 to 7.25)). SIGNIFICANCE Current evidence revealed that exercise training could effectively inhibit left ventricular pathological remodeling in patients with HFrEF. For efficacy, high-intensity interval training may have greater potential.
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Affiliation(s)
- Tao Wang
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an 710119, China
| | - Lin Zhang
- School of Physical Education, Shenyang Normal University, Shenyang 110000, China
| | - Mengxin Cai
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an 710119, China
| | - Zhenjun Tian
- Institute of Sports and Exercise Biology, School of Physical Education, Shaanxi Normal University, Xi'an 710119, China.
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Yakut H, Dursun H, Felekoğlu E, Başkurt AA, Alpaydın AÖ, Özalevli S. Effect of home-based high-intensity interval training versus moderate-intensity continuous training in patients with myocardial infarction: a randomized controlled trial. Ir J Med Sci 2022; 191:2539-2548. [PMID: 34993836 PMCID: PMC8736320 DOI: 10.1007/s11845-021-02867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022]
Abstract
Background Supervised high-intensity interval training (HIIT) has been proposed to be more effective than moderate-intensity continuous training (MICT) for improving exercise capacity, but there are not sufficient information effects of home-based HIIT and MICT in patients with myocardial infarction (MI). Aims To compare the effects of home-based HIIT and MICT in patients with MI. Methods Twenty-one patients with MI were randomly assigned to one of two home-based exercise modes: HIIT group and MICT group. Home-based HIIT and MICT were performed twice a week for 12 weeks with an exercise intensity of 85–95% of heart rate (HR) reserve and 70–75% HR reserve, respectively. The primary outcome measure was functional capacity. Secondary outcomes included resting blood pressure and HR, peripheral oxygen saturation, pulmonary function and respiratory muscle strength, dyspnea severity, body composition (body fat%, body mass ındex (BMI), fat free muscle), peripheral muscle strength, and health-related quality of life (HRQoL). Results Functional capacity, measured by 6-minute walk test, increased in HIIT and MICT group (p < 0.05). Resting BP and HR, body fat%, and BMI were significantly decreased, and pulmonary functions, respiratory-peripheral muscle strength, and HRQoL were significantly increased in the both groups (p < 0.05). Home-based HIIT was more effective than MICT in improving pulmonary functions and lower extremity muscle strength (p < 0.05). Conclusions This study suggests that HIIT and MICT can be applied at home-based in patients with MI and play an important role in improving functional capacity, health outcomes, and HRQoL. Trial registration Clinical Trials Number: NCT04407624.
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Affiliation(s)
- Hazal Yakut
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hüseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Elvan Felekoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Çelebi University, Izmir, Turkey
| | - Ahmet Anıl Başkurt
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Pulmonary Disease, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sevgi Özalevli
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, 35340, Inciralti, Izmir, Turkey.
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Yao Y, He L, Chen W, Zhou H, Lu G, Tao J, Wang S. Predictive Value of Diaphragmatic Ultrasonography for the Weaning Outcome in Mechanically Ventilated Children Aged 1-3 Years. Front Pediatr 2022; 10:840444. [PMID: 35433546 PMCID: PMC9005894 DOI: 10.3389/fped.2022.840444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are estimated 20% of mechanically ventilated patients having difficulty in weaning from the ventilators, and the weaning process accounts for 40% of the whole ventilation time. Reliable tools are urgently needed to estimate the weaning outcome. Diaphragmatic ultrasonography, as a relatively good predictive method for the adults, was measured in this study, assessing the value of each indicator of diaphragmatic ultrasonography to predict the outcomes of ventilator weaning from mechanically ventilated children of 1-3 years old. METHODS Between November 2018 and November 2019, children who were mechanically ventilated and ready for weaning in the pediatric intensive care unit (PICU) were enrolled in the study. Diaphragmatic ultrasonography was performed to the children to measure the right diaphragm excursion (DE), contraction velocity, thickness, and diaphragm thickening fraction (DTF), which were recorded followed by spontaneous breathing trial (SBT). The receiver operator characteristic (ROC) curves were also used to assess the value of each indicator to predict the weaning outcome. RESULTS During this study period, a total of 72 children were enrolled, and of them, 56 children passed the weaning process, while 16 children failed. There were significant differences in DE, contraction velocity, thickness, and DTF parameters between the weaning success group and the failure group. The areas under the ROC curves (AUC) and the optimal threshold of the above indicators were as follows: 0.72 and 8.08 mm for DE, 0.71 and 26.1% for right DTF (DTFR), 0.71 and 20.7% for left DTF (DTFL), 0.78 and 14.8% for minimum DTF (DTFMIN), 0.79 and 26.1% for maximum DTF (DTFMAX), 0.71 and 1.24 mm for maximum diaphragm thickness at the end of inspiration (DteiMAX), and 0.65 and 10.0 mm/s for contraction velocity. CONCLUSION Diaphragmatic ultrasonography is feasible in guiding ventilator weaning, and the indicators of DE, DTF, and DteiMAX guide the weaning more accurately. Among them, DTF may act as a more reliable predictor of weaning by avoiding the influence of diaphragm development in children.
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Affiliation(s)
- Yelin Yao
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Liming He
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - Weiming Chen
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hao Zhou
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jinhao Tao
- Pediatric Emergency Critical Care Center, Children's Hospital of Fudan University, Shanghai, China
| | - SuJuan Wang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
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Scaglione A, Panzarino C, Modica M, Tavanelli M, Pezzano A, Grati P, Racca V, Toccafondi A, Bordoni B, Verde A, Cartella I, Castiglioni P. Short- and long-term effects of a cardiac rehabilitation program in patients implanted with a left ventricular assist device. PLoS One 2021; 16:e0259927. [PMID: 34851984 PMCID: PMC8635401 DOI: 10.1371/journal.pone.0259927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022] Open
Abstract
The efficacy of cardiac rehabilitation in heart-failure patients who received a left-ventricular assist device (LVAD) instead of heart transplantation (HTx) is still unclear. This study aims to evaluate whether cardiac rehabilitation is beneficial in LVAD as HTx patients in the short term and whether its effects in LVAD patients persist over time. Twenty-five LVAD patients were evaluated by functional and psychological tests at admission (T0) and discharge (T1) of a 4-week inpatient structured rehabilitation program, and follow-ups 3 (T2), 6 (T3), and 12 months (T4) after discharge. Twenty-five matched HTx patients were also studied from T0 to T1 to compare the improvements in the six-minute walk test (6MWT). The quality-of-life scores substantially improved in LVAD patients and the 6MWT showed the same functional recovery as in HTx patients from T0 to T1. After T1, numerous LVAD patients withdrew from the study. However, the 6MWT outcome increased further from T1 to T3, with a positive trend during the follow-ups. Hemoglobin and the ventilatory performance increased, and the psychological perception of heart-failure symptoms and pain further improved at T2. In conclusion, exercise-based rehabilitation programs provide similar beneficial effects in LVAD and HTx patients, without deterioration in LVAD patients up to 12 months after discharge.
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Affiliation(s)
- Anna Scaglione
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Claudia Panzarino
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Maddalena Modica
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Monica Tavanelli
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonio Pezzano
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Grati
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Vittorio Racca
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Anastasia Toccafondi
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Bruno Bordoni
- Cardiology Rehabilitation Center, Santa Maria Nascente Institute, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Alessandro Verde
- Heart Failure and Heart Transplant Program, CardioThoracic and Vascular Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Iside Cartella
- Heart Failure and Heart Transplant Program, CardioThoracic and Vascular Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Karatzanos E, Ferentinos P, Mitsiou G, Dimopoulos S, Ntalianis A, Nanas S. Acute Cardiorespiratory Responses to Different Exercise Modalities in Chronic Heart Failure Patients-A Pilot Study. J Cardiovasc Dev Dis 2021; 8:jcdd8120164. [PMID: 34940519 PMCID: PMC8708548 DOI: 10.3390/jcdd8120164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to compare the acute cardiorespiratory responses and time spent above different %VO2peak intensities between three "iso-work" protocols: (a) a high intensity interval training protocol (HIIT), (b) a higher intensity continuous protocol (CON70) and (c) a lower intensity continuous protocol (CON50) in patients with chronic heart failure (CHF). Ten male CHF patients (aged 55.1 ± 16.2 years) performed in separate days a single session of a HIIT protocol consisted of 4 sets × 4 min cycling at 80% VO2peak with 3 min of recovery at 50% VO2peak, a CON70 protocol corresponding to 70% VO2peak and a CON50 protocol corresponding to 50% VO2peak. Cardiopulmonary data were collected by an online gas analysis system. The HIIT and CON70 elicited higher cardiorespiratory responses compared to CON50 with no differences between them (p > 0.05). In HIIT and CON70, patients exercised longer at >80% and >90% VO2peak. The completion rate was 100% for the three protocols. Not any adverse events were observed in either protocol. Both HIIT and CON70 elicited a stronger physiological stimulus and required shorter time than CON50. Both HIIT and CON70 also induced comparable hemodynamic responses and ventilatory demand.
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Affiliation(s)
- Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
- Correspondence: or ; Tel.: +30-2132043385
| | | | - Georgios Mitsiou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
| | - Argyrios Ntalianis
- Heart Failure and Cardio-Oncology Unit, Alexandra Hospital, 115 28 Athens, Greece;
| | - Serafeim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
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Taylor JL, Bonikowske AR, Olson TP. Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity. Front Cardiovasc Med 2021; 8:734278. [PMID: 34540924 PMCID: PMC8446279 DOI: 10.3389/fcvm.2021.734278] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VO2peak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.
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Affiliation(s)
- Jenna L Taylor
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Amanda R Bonikowske
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Thomas P Olson
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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10
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Harwood AE, Russell S, Okwose NC, McGuire S, Jakovljevic DG, McGregor G. A systematic review of rehabilitation in chronic heart failure: evaluating the reporting of exercise interventions. ESC Heart Fail 2021; 8:3458-3471. [PMID: 34235878 PMCID: PMC8497377 DOI: 10.1002/ehf2.13498] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
A large body of research supports the use of exercise to improve symptoms, quality of life, and physical function in patients with chronic heart failure. Previous reviews have focused on reporting outcomes of exercise interventions such as cardiorespiratory fitness. However, none have critically examined exercise prescription. The aim of this review was to evaluate the reporting and application of exercise principles in randomised control trials of exercise training in patients with chronic heart failure. A systematic review of exercise intervention RCTs in patients with CHF, using the Consensus on Exercise Reporting Template (CERT), was undertaken. The Ovid Medline/PubMed, Embase, Scopus/Web of Science, and Cochrane Library and Health Technology Assessment Databases were searched from 2000 to June 2020. Prospective RCTs in which patients with CHF were randomized to a structured exercise programme were included. No limits were placed on the type or duration of exercise structured exercise programme or type of CHF (i.e. preserved or reduced ejection fraction). We included 143 studies, comprising of 181 different exercise interventions. The mean CERT score was 10 out of 19, with no study achieving a score of 19. Primarily, details were missing regarding motivational strategies, home-based exercise components, and adherence/fidelity to the intervention. Exercise intensity was the most common principle of exercise prescription missing from intervention reporting. There was no improvement in the reporting of exercise interventions with time (R2 = 0.003). Most RCTs of exercise training in CHF are reported with insufficient detail to allow for replication, limiting the translation of evidence to clinical practice. We encourage authors to provide adequate details when reporting future interventions. Where journal word counts are restrictive, we recommend using supplementary material or publishing trial protocols prior to beginning the study.
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Affiliation(s)
- Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Sophie Russell
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Nduka C Okwose
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK
| | - Scott McGuire
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Djordje G Jakovljevic
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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11
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Righi GDA, Schuch FB, Tolves T, De Nardi AT, Righi NC, Signori LU, da Silva AMV. Combined aerobic and strength training for fitness outcomes in heart failure: meta-analysis and meta-regression. Disabil Rehabil 2021; 44:4149-4160. [PMID: 33789068 DOI: 10.1080/09638288.2021.1900411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the effects of combined training (CT) versus aerobic training (AT) or versus control on VO2 peak and quadriceps muscle strength in patients with heart failure (HF). MATERIALS AND METHODS Major electronic databases were searched, from inception to November 2020, for randomized clinical trials comparing the effects of CT against AT or control on VO2 peak and/or quadriceps muscle strength in patients with HF. Random effects meta-analyses were conducted, calculating the standardized mean difference (SMD). RESULTS Twenty-eight articles were included. An increase on VO2 peak (SMD = 0.77, 95%CI 0.39-1.14, I2=80.1%) and quadriceps muscle strength (SMD = 0.67, 95%CI 0.18-1.16, I2=0%) was found in CT compared to control. CT increased quadriceps muscle strength, versus AT (SMD = 0.44, 95%CI 0.15-0.74, I2=0%). There were no differences between CT and AT on VO2 peak (SMD=-0.01, 95%CI -0.36 to 0.34, I2=65%). Time of session and training duration moderate the effects of CT over control on VO2 peak. CONCLUSIONS CT promotes increases on quadriceps muscle strength and aerobic capacity over control and provides additional gains on quadriceps muscle strength, having the same effects on VO2 peak compared to AT. A longer time of session is associated with greater benefits to aerobic capacity.Implications for rehabilitationCombining aerobic and strength training increases the functional capacity and quadriceps muscle strength in heart failure patients.Using longer sessions of training has a greater impact on aerobic capacity.
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Affiliation(s)
| | - Felipe Barreto Schuch
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | - Tainara Tolves
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Luis Ulisses Signori
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | - Antônio Marcos Vargas da Silva
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
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12
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Jesus ICD, Menezes Junior FJD, Bento PCB, Wiens A, Mota J, Leite N. Effect of combined interval training on the cardiorespiratory fitness in heart failure patients: a systematic review and meta-analysis. Braz J Phys Ther 2020; 24:8-19. [PMID: 31047776 PMCID: PMC6994317 DOI: 10.1016/j.bjpt.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/07/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols. OBJECTIVE To evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure. METHODS We search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model. RESULTS Ten articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO2peak in favor to combined training group compared to interval training group (SMD=0.25; CI=0.04-0.46) and without intervention group (SMD=0.46; CI=0.29-0.64), respectively. CONCLUSION The combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method.
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Affiliation(s)
- Incare Correa De Jesus
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil.
| | | | - Paulo Cesar Barauce Bento
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil
| | - Astrid Wiens
- Farmacy Department, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil
| | - Jorge Mota
- Ciafel, Porto University, Porto, Portugal
| | - Neiva Leite
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil; Ciafel, Porto University, Porto, Portugal
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13
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Dun Y, Thomas RJ, Smith JR, Medina-Inojosa JR, Squires RW, Bonikowske AR, Huang H, Liu S, Olson TP. High-intensity interval training improves metabolic syndrome and body composition in outpatient cardiac rehabilitation patients with myocardial infarction. Cardiovasc Diabetol 2019; 18:104. [PMID: 31412869 PMCID: PMC6694483 DOI: 10.1186/s12933-019-0907-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To examine the effect of high-intensity interval training (HIIT) on metabolic syndrome (MetS) and body composition in cardiac rehabilitation (CR) patients with myocardial infarction (MI). METHODS We retrospectively screened 174 consecutive patients with MetS enrolled in CR following MI between 2015 and 2018. We included 56 patients who completed 36 CR sessions and pre-post dual-energy X-ray absorptiometry. Of these patients, 42 engaged in HIIT and 14 in moderate-intensity continuous training (MICT). HIIT included 4-8 intervals of high-intensity (30-60 s at RPE 15-17 [Borg 6-20]) and low-intensity (1-5 min at RPE < 14), and MICT included 20-45 min of exercise at RPE 12-14. MetS and body composition variables were compared between MICT and HIIT groups. RESULTS Compared to MICT, HIIT demonstrated greater reductions in MetS (relative risk = 0.5, 95% CI 0.33-0.75, P < .001), MetS z-score (- 3.6 ± 2.9 vs. - 0.8 ± 3.8, P < .001) and improved MetS components: waist circumference (- 3 ± 5 vs. 1 ± 5 cm, P = .01), fasting blood glucose (- 25.8 ± 34.8 vs. - 3.9 ± 25.8 mg/dl, P < .001), triglycerides (- 67.8 ± 86.7 vs. - 10.4 ± 105.3 mg/dl, P < .001), and diastolic blood pressure (- 7 ± 11 vs. 0 ± 13 mmHg, P = .001). HIIT group demonstrated greater reductions in body fat mass (- 2.1 ± 2.1 vs. 0 ± 2.2 kg, P = .002), with increased body lean mass (0.9 ± 1.9 vs. - 0.9 ± 3.2 kg, P = .01) than the MICT. After matching for exercise energy expenditure, HIIT-induced improvements persisted for MetS z-score (P < .001), MetS components (P < .05), body fat mass (P = .002), body fat (P = .01), and lean mass (P = .03). CONCLUSIONS Our data suggest that, compared to MICT, supervised HIIT results in greater improvements in MetS and body composition in MI patients with MetS undergoing CR.
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Affiliation(s)
- Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Randal J Thomas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joshua R Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jose R Medina-Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ray W Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amanda R Bonikowske
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hsuhang Huang
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China.
| | - Thomas P Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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14
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Dun Y, Smith JR, Liu S, Olson TP. High-Intensity Interval Training in Cardiac Rehabilitation. Clin Geriatr Med 2019; 35:469-487. [PMID: 31543179 DOI: 10.1016/j.cger.2019.07.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recently, high-intensity interval training (HIIT) has been recognized as a safe and effective alternative to moderate-intensity continuous training for older patients with cardiovascular disease (CVD) in cardiac rehabilitation settings in an effort to improve health outcomes. This brief review considers general principles and suggestions for prescription of HIIT for older patients with CVD, specific challenges pertaining to older adults, the physiologic mechanisms by which HIIT contributes to improvements in peak Vo2, and the effects of HIIT on cardiovascular health in older patients with coronary artery disease and heart failure.
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Affiliation(s)
- Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, P.R. China; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Joshua R Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, P.R. China.
| | - Thomas P Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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15
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Yang X, Xu PF, Shan L, Lang LG, DU L, Jia FY. [Advances in respiratory assessment and treatment in children undergoing invasive mechanical ventilation]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:94-99. [PMID: 30675871 PMCID: PMC7390170 DOI: 10.7499/j.issn.1008-8830.2019.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
The widespread use of mechanical ventilation technology has contributed to the successful treatment of many children with respiratory failure. At the same time, forced ventilation and changes in normal respiratory physiology and mechanics may lead to respiratory dysfunction and decreased airway clearance ability. Therefore, how to perform a comprehensive and accurate respiratory function assessment, conduct appropriate respiratory function rehabilitation, perform extubation as soon as possible, and shorten the duration of mechanical ventilation based on the children's own physiological characteristics, is a focus of the research on effective weaning from mechanical ventilation in children with severe conditions. This article reviews the advances in the respiratory function assessment and treatment methods in children undergoing invasive mechanical ventilation.
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Affiliation(s)
- Xue Yang
- Department of Developmental and Behavioral Pediatrics, First Hospital of Jilin University, Changchun 130021, China.
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16
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Abstract
We critically appraised all available evidence regarding exercise interventions for improving patient survival and reducing hospital admissions in adults with chronic heart failure (HF). We searched 4 databases up to April 2018 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. We reviewed 7 meta-analyses and the publications of 48 randomized controlled trials (RCTs). In HF with reduced ejection fraction, low-quality evidence suggests that exercise prevents all-cause hospitalizations [Relative risk (RR), 0.77; 95% confidence interval (CI), 0.63 to 0.93; 1328 patients in 15 RCTs] and hospitalizations due to HF (RR, 0.57; 95% CI, 0.37 to 0.88; 1073 patients in 13 RCTs) and improves quality of life (standardized mean difference, -0.37; 95% CI, -0.60 to -0.14; 1270 patients in 25 RCTs) but has no effect on mortality. In HF with preserved ejection fraction, low-quality evidence suggests that exercise improves peak oxygen uptake (mean difference, 2.36; 95% CI, 1.16 to 3.57; 171 patients in 3 RCTs) and quality of life (mean difference, -4.65; 95% CI, -8.46 to -0.83; 203 patients in 4 RCTs). In patients after heart transplantation, low-quality evidence suggests that exercise improves peak oxygen uptake (standardized mean difference, 0.68; 95% CI, 0.43 to 0.93; 284 patients in 9 RCTs) but does not improve quality of life. In order to reduce hospitalization and improve quality of life for adults with HF and reduced ejection fraction, clinicians should recommend exercise interventions. For adults with HF and preserved ejection fraction and in those undergoing heart transplantation, clinicians may recommend exercise interventions in order to improve peak oxygen uptake.
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17
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Panagopoulou N, Karatzanos E, Dimopoulos S, Tasoulis A, Tachliabouris I, Vakrou S, Sideris A, Gratziou C, Nanas S. Exercise training improves characteristics of exercise oscillatory ventilation in chronic heart failure. Eur J Prev Cardiol 2017; 24:825-832. [PMID: 28436722 DOI: 10.1177/2047487317695627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Exercise oscillatory ventilation in chronic heart failure has been suggested as a factor related to adverse cardiac events, aggravated prognosis and higher mortality. Exercise training is well known to affect exercise capacity and mechanisms of pathophysiology beneficially in chronic heart failure. Little is known, however, about the exercise training effects on characteristics of exercise oscillatory ventilation in chronic heart failure patients. Design and methods Twenty (out of 38) stable chronic heart failure patients exhibited exercise oscillatory ventilation (age 54 ± 11 years, peak oxygen uptake 15.0 ± 5.0 ml/kg per minute). Patients attended 36 sessions of high intensity interval exercise. All patients underwent cardiopulmonary exercise testing before and after the programme. Assessment of exercise oscillatory ventilation was based on the amplitude of cyclic fluctuations in breathing during rest and exercise. All values are mean ± SD. Results Exercise training reduced ( P < 0.05) the percentage of exercise oscillatory ventilation duration (79.0 ± 13.0 to 50.0 ± 25.0%), while average amplitude (5.2 ± 2.0 to 4.9 ± 1.6 L/minute) and length (44.0 ± 10.9 to 41.0 ± 6.7 seconds) did not change ( P > 0.05). Exercise oscillatory ventilation patients also increased exercise capacity ( P < 0.05). Conclusions A rehabilitation programme based on high intensity interval training improved exercise oscillatory ventilation observed in chronic heart failure patients, as well as cardiopulmonary efficiency and functional capacity.
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Affiliation(s)
- Niki Panagopoulou
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleftherios Karatzanos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Stavros Dimopoulos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios Tasoulis
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Ioannis Tachliabouris
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Styliani Vakrou
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Antonios Sideris
- 3 Second Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
| | - Christina Gratziou
- 4 Pulmonary and Critical Care University Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
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18
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Cornelis J, Beckers P, Taeymans J, Vrints C, Vissers D. Comparing exercise training modalities in heart failure: A systematic review and meta-analysis. Int J Cardiol 2016; 221:867-76. [PMID: 27434363 DOI: 10.1016/j.ijcard.2016.07.105] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/01/2016] [Accepted: 07/07/2016] [Indexed: 01/15/2023]
Abstract
Exercise training (ET) is suggested to improve exercise capacity, prognosis, quality of life (QOL) and functional modifications of the heart in patients with heart failure (HF). However, it is not clear which modality is best. In order to assess the effectiveness of different ET modalities on prognostic cardiopulmonary exercise test (CPET) parameters, QOL and left ventricular remodeling, a systematic review and meta-analysis was performed. Randomized clinical trials (RCTs) were selected in three databases. The primary outcome data were peak oxygen uptake, ventilation over carbon dioxide slope, oxygen uptake efficiency slope, exercise oscillatory ventilation, rest and peak pulmonary end-tidal CO2. Secondary variables were QOL, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Twenty RCTs (n=811) met the a priori stated inclusion criteria. Studies were categorized into four different groups: "interval training (IT1) versus combined interval and strength training (IT1S)" (n=156), "continuous training (CT1) versus combined continuous and strength training (CT1S)" (n=130), "interval training (IT2) versus continuous training (CT2)" (n=501) and "continuous training (CT3) versus strength training (S3)" (n=24). No significant random effects of exercise modality were revealed assessing the CPET parameters. There was a significant improvement in QOL applying CT1S (P<0.001). Comparing IT2 with CT2, LVEDD and LVEF were significantly improved favoring IT2 (P<0.001). There is some evidence to support that interval training is more effective to improve LVEF and LVEDD. The fact that patients with HF are actively involved in any kind of ET program seems sufficient to improve the prognosis, QOL and anatomic function.
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Affiliation(s)
- Justien Cornelis
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.
| | - Paul Beckers
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Jan Taeymans
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; Vrije Universiteit Brussel, Faculty of Physical Education and Physical Therapy, Pleinlaan 2, B-1050 Elsene, Belgium; Bern University of Applied Sciences (Health), Murtenstrasse 10, CH-3008 Bern, Switzerland
| | - Christiaan Vrints
- Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Dirk Vissers
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium
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Georgantas A, Dimopoulos S, Tasoulis A, Karatzanos E, Pantsios C, Agapitou V, Ntalianis A, Roditis P, Terrovitis J, Nanas S. Beneficial effects of combined exercise training on early recovery cardiopulmonary exercise testing indices in patients with chronic heart failure. J Cardiopulm Rehabil Prev 2014; 34:378-85. [PMID: 24983706 DOI: 10.1097/hcr.0000000000000068] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Exercise training induces several beneficial effects in patients with chronic heart failure (CHF). This study investigated the effects of high-intensity aerobic interval training (AIT) compared with combined AIT and strength training (COM) on early ventilatory and metabolic recovery pattern after symptom-limited cardiopulmonary exercise testing (CPET) in CHF patients. METHODS Stable CHF patients (N = 42; 54 ± 10 years [mean ± SD], 35 males) participated in an exercise training program for 12 weeks, 3 times per week. Participants were randomly assigned to either AIT (n = 20) or COM group (n = 22). Cardiopulmonary exercise testing was performed before and after completion of the program. Primary measurements included absolute and percentage difference of oxygen uptake, carbon dioxide output, minute ventilation ((Equation is included in full-text article.)E), tidal volume (VT), respiratory rate, and the first-degree slope of oxygen uptake ((Equation is included in full-text article.)O2/t slope) and carbon dioxide output ((Equation is included in full-text article.)CO2/t slope) during the first minute of recovery after maximal exercise. RESULTS The COM group had a greater improvement in the absolute and the percentage difference of (Equation is included in full-text article.)E (P = .03 and P = .04, respectively) and respiratory rate (P = .02 and P = .01, respectively) during the first minute of recovery period after exercise compared with the AIT group alone. No significant changes were noted for VT measurements. A significant increase in (Equation is included in full-text article.)CO2/t slope was observed in COM compared with the AIT group (P = .01). There was a trend for a greater increase in (Equation is included in full-text article.)O2/t slope in the COM group (P = .07). CONCLUSIONS The addition of strength training to AIT induces significant beneficial effects in terms of ventilatory and metabolic recovery kinetics than AIT alone in CHF patients, possibly indicating greater ventilatory efficiency and metabolic improvement.
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Affiliation(s)
- Andreas Georgantas
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory (Drs Georgantas, Dimopoulos, Tasoulis, Karatzanos, Agapitou, Roditis, and Nanas) and 3rd Department of Cardiology, National and Kapodistrian University of Athens (Drs Pantsios, Ntalianis, and Terrovitis), Athens, Greece
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20
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Abstract
We review the substantial recent progress made in understanding the underlying mechanisms controlling breathing and the applicability of these findings to selected human diseases. Emphasis is placed on the sites of central respiratory rhythm and pattern generation as well as newly described functions of the carotid chemoreceptors, the integrative nature of the central chemoreceptors, and the interaction between peripheral and central chemoreception. Recent findings that support critical contributions from cortical central command and muscle afferent feedback to exercise hyperpnoea are also reviewed. These basic principles, and the evidence supporting chemoreceptor and ventilatory control system plasticity during and following constant and intermittent hypoxaemia and stagnant hypoxia, are applied to: 1) the pathogenesis, consequences and treatment of obstructive sleep apnoea; and 2) exercise hyperpnoea and its control and limitations with ageing, chronic obstructive pulmonary disease and congestive heart failure.
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Affiliation(s)
- Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Curtis A Smith
- John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, WI, USA
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21
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Tzanis G, Dimopoulos S, Agapitou V, Nanas S. Exercise intolerance in chronic heart failure: the role of cortisol and the catabolic state. Curr Heart Fail Rep 2014; 11:70-9. [PMID: 24293034 DOI: 10.1007/s11897-013-0177-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic heart failure (CHF) is a complex clinical syndrome leading to exercise intolerance due to muscular fatigue and dyspnea. Hemodynamics fail to explain the reduced exercise capacity, while a significant skeletal muscular pathology seems to constitute the main underlying mechanism for exercise intolerance in CHF patients. There have been proposed several metabolic, neurohormonal and immune system abnormalities leading to an anabolic/catabolic imbalance that plays a central role in the pathogenesis of the wasting process of skeletal muscle myopathy. The impairment of the anabolic axes is associated with the severity of symptoms and the poor outcome in CHF, whereas increased cortisol levels are predictive of exercise intolerance, ventilatory inefficiency and chronotropic incompetence, suggesting a significant contributing mechanism to the limited functional status. Exercise training and device therapy could have beneficial effects in preventing and treating muscle wasting in CHF. However, specific anabolic treatment needs more investigation to prove possible beneficial effects.
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Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital", National & Kapodestrian University of Athens, Papadiamantopoulou str., 20, Athens, 11528, Greece
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22
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Tasoulis A, Dimopoulos S, Repasos E, Manetos C, Tzanis G, Sousonis V, Papazachou O, Terrovitis J, Nanas S. Respiratory drive and breathing pattern abnormalities are related to exercise intolerance in chronic heart failure patients. Respir Physiol Neurobiol 2014; 192:90-4. [PMID: 24361502 DOI: 10.1016/j.resp.2013.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) are characterized by exercise intolerance and ventilatory abnormalities that are related to poor prognosis. We hypothesized that CHF patients have increased respiratory drive and abnormal breathing pattern during exercise in relation to disease severity. MATERIALS AND METHODS The study population consisted of 219 stable CHF patients and 30 healthy control subjects. All subjects underwent a symptom-limited cardiopulmonary exercise testing (CPET), pulmonary function tests, measurement of the maximal inspiratory pressure (PImax) and respiratory drive (P0.1). Measurements included peak oxygen uptake ( [Formula: see text] peak, ml/kg/min). Respiratory drive was measured by mouth occlusion pressure P0.1 and P0.1/PImax ratio at rest, and by mean inspiratory flow (VT/TI) at rest and during exercise. CHF patients were divided into 3 groups according to [Formula: see text] peak (Group A: >20, Group B: 20-16 and Group C: <16ml/kg/min). RESULTS CHF patients presented higher P0.1/PImax (4.1±3.6 vs 3.0±1.5, p=0.007) and VT/TI at rest (0.48±0.14 vs 0.41±0.10, L/s respectively, p=0.004) and lower VT/TI at peak exercise (2.17±0.66 vs 2.56±0.73, L/s, p=0.009) compared to controls. P0.1/PImax was higher in CHF Group C vs B vs A (4.9±2.9 vs 3.6±1.8 vs 3.1±1.8, respectively, p<0.001), while VT/TI at peak exercise was lower (1.71±0.43 vs 2.15±0.52 vs 2.65±0.64, L/s, respectively, p<0.001). CONCLUSIONS CHF patients present increased respiratory drive at rest and abnormal breathing pattern during exercise in relation to CHF severity.
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Affiliation(s)
- Athanasios Tasoulis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece
| | - Stavros Dimopoulos
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece
| | | | - Christos Manetos
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece
| | - Giorgos Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece
| | | | - Ourania Papazachou
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece
| | - John Terrovitis
- 3rd Cardiology Department, "Laiko" Hospital, NKUA, Athens, Greece
| | - Serafim Nanas
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece.
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23
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Abstract
Aerobic exercise training is strongly recommended in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF) to improve symptoms and quality of life. Moderate-intensity aerobic continuous exercise (MICE) is the best established training modality in HF patients. For about a decade, however, another training modality, high-intensity aerobic interval exercise (HIIE), has aroused considerable interest in cardiac rehabilitation. Originally used by athletes, HIIE consists of repeated bouts of high-intensity exercise interspersed with recovery periods. The rationale for its use is to increase exercise time spent in high-intensity zones, thereby increasing the training stimulus. Several studies have demonstrated that HIIE is more effective than MICE, notably for improving exercise capacity in patients with HF. The aim of the present review is to describe the general principles of HIIE prescription, the acute physiological effects, the longer-term training effects, and finally the future perspectives of HIIE in patients with HF.
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Johnson BD, Joyner MJ. Carotid body denervation: too soon to get breathless about heart failure? J Am Coll Cardiol 2013; 62:2431-2432. [PMID: 24013054 DOI: 10.1016/j.jacc.2013.08.718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/05/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Blair D Johnson
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
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Arena R, Myers J, Forman DE, Lavie CJ, Guazzi M. Should high-intensity-aerobic interval training become the clinical standard in heart failure? Heart Fail Rev 2013; 18:95-105. [PMID: 22791516 DOI: 10.1007/s10741-012-9333-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aerobic exercise training in the heart failure (HF) population is supported by an extensive body of literature. The clinically accepted model for exercise prescription is currently moderate-intensity-aerobic continuous training (MI-ACT). Documented benefits from the literature include improvements in various aspects of physiologic function, aerobic exercise capacity and quality of life while the impact on morbidity and mortality is promising but requires further investigation. Recently, however, a body of evidence has begun to emerge demonstrating high-intensity-aerobic interval training (HI-AIT) can be performed safely with impressive improvements in physiology, functional capacity and quality of life. These initial findings have led some to question the long-standing clinical approach to aerobic exercise training in patients with HF (i.e., MI-ACT), implying it should perhaps be replaced with a HI-AIT model. This is a potentially controversial paradigm shift given the potential increase in adverse event risk associated with exercising at higher intensities, particularly in the HF population where the likelihood of an untoward episode is already at a heightened state relative to the apparently healthy population. The present review therefore addresses key issues related to HI-AIT in the HF population and makes recommendations for future research and current clinical practice.
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Affiliation(s)
- Ross Arena
- Physical Therapy Program, Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA.
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Intermittent versus continuous exercise training in chronic heart failure: a meta-analysis. Int J Cardiol 2011; 166:352-8. [PMID: 22100179 DOI: 10.1016/j.ijcard.2011.10.075] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/18/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We conducted a meta-analysis of randomized, controlled trials of combined strength and intermittent aerobic training, intermittent aerobic training only and continuous exercise training in heart failure patients. METHODS A systematic search was conducted of Medline (Ovid) (1950-September 2011), Embase.com (1974-September 2011), Cochrane Central Register of Controlled Trials and CINAHL (1981-September 19 2011). The search strategy included a mix of MeSH and free text terms for the key concepts heart failure, exercise training, interval training and intermittent exercise training. RESULTS The included studies contained an aggregate of 446 patients, 212 completed intermittent exercise training, 66 only continuous exercise training, 59 completed combined intermittent and strength training and 109 sedentary controls. Weighted mean difference (MD) in Peak VO2 was 1.04mlkg(-1)min(-1) and (95% C.I.) was 0.42-1.66 (p=0.0009) in intermittent versus continuous exercise training respectively. Weighted mean difference in Peak VO2 was -1.10mlkg(-1)min(-1) (95% C.I.) was -1.83-0.37 p=0.003 for intermittent only versus intermittent and strength (combined) training respectively. In studies reporting VE/VCO2 for intermittent versus control groups, MD was -1.50 [(95% C.I. -2.64, -0.37), p=0.01] and for intermittent versus continuous exercise training MD was -1.35 [(95% C.I. -2.15, -0.55), p=0.001]. Change in peak VO2 was positively correlated with weekly exercise energy expenditure for intermittent exercise groups (r=0.48, p=0.05). CONCLUSIONS Combined strength and intermittent exercise appears superior for peak VO2 changes when compared to intermittent exercise of similar exercise energy expenditure.
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