1
|
Baral R, Ho JSY, Soroya AN, Hanger M, Clarke RE, Memon SF, Glatzel H, Ahmad M, Providencia R, Bray JJH, D'Ascenzo F. Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae033. [PMID: 38982996 PMCID: PMC11231943 DOI: 10.1093/ehjopen/oeae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/17/2024] [Accepted: 04/09/2024] [Indexed: 07/11/2024]
Abstract
Aims Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, and there are limited proven therapeutic strategies. Exercise has been shown to be beneficial in several studies. We aimed to evaluate the efficacy of exercise on functional, physiological, and quality-of-life measures. Methods and results A comprehensive search of Medline and Embase was performed. Randomized controlled trials (RCTs) of adult HFpEF patients with data on exercise intervention were included. Using meta-analysis, we produced pooled mean difference (MD) estimates with 95% confidence intervals (CIs) with Review Manager (RevMan) software for the peak oxygen uptake (VO2), Minnesota living with heart failure (MLWHF) and, other diastolic dysfunction scores. A total of 14 studies on 629 HFpEF patients were included (63.2% female) with a mean age of 68.1 years. Exercise was associated with a significant improvement in the peak VO2 (MD 1.96 mL/kg/min, 95% CI 1.25-2.68; P < 0.00001) and MLWHF score (MD -12.06, 95% CI -17.11 to -7.01; P < 0.00001) in HFpEF. Subgroup analysis showed a small but significant improvement in peak VO2 with high-intensity interval training (HIIT) vs. medium-intensity continuous exercise (MCT; MD 1.25 mL/kg/min, 95% CI 0.41-2.08, P = 0.003). Conclusion Exercise increases the exercise capacity and quality of life in HFpEF patients, and high-intensity exercise is associated with a small but statistically significant improvement in exercise capacity than moderate intensity. Further studies with larger participant populations and longer follow-up are needed to confirm these findings and elucidate potential differences between high- and medium-intensity exercise.
Collapse
Affiliation(s)
- Ranu Baral
- Kings College Hospital NHS Trust, London, Denmark Hill, London SE5 9RS, UK
| | | | | | - Melissa Hanger
- University College London, Gower St, London WC1E 6BT, UK
| | | | | | - Hannah Glatzel
- Stoke Mandeville Hospital, Mandeville Rd, Aylesbury HP21 8AL, UK
| | - Mahmood Ahmad
- Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Rui Providencia
- University College London, Gower St, London WC1E 6BT, UK
- Barts Heart Centre, Barts Health NHS Trust, W Smithfield, London EC1A 7BE, UK
| | - Jonathan James Hyett Bray
- Institute of Life Sciences-2, Swansea Bay University Health Board and Swansea University Medical School, Swansea University, Sketty, Swansea SA2 8QA, UK
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, University of Turin, Via Verdi 8, 10124 Torino, P.I. 02099550010, Italy
| |
Collapse
|
2
|
Gomes-Neto M, Rodrigues Durães A, Roever L, Magalhães Silva C, Gonzalez Nogueira Alves I, Bernardone Saquetto M, Ellingsen Ø, Oliveira Carvalho V. Effects of Exercise Interventions on Aerobic Capacity in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction: Systematic Review and Network Meta-Analysis. Cardiol Rev 2024; 32:45-50. [PMID: 35290247 DOI: 10.1097/crd.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exercise is an important component of rehabilitation care for patients with heart failure with preserved ejection fraction (HFpEF). However, it is unclear which type of physical rehabilitation exercise is most effective. Thus, the aim of this study was to determine the relative effects of different types of exercise interventions on aerobic capacity measured by peak oxygen consumption (VO 2 peak; in mL/kg·min) in patients with HFpEF. We searched different electronic databases until December 2020 for randomized controlled trials that evaluated the effects of different types of exercise interventions on VO 2 peak of patients with HFpEF. Mean difference, standardized mean difference (SMD), and 95% confidence intervals (CIs) were calculated. Fixed and random-effects Bayesian network meta-analysis was used to compare the relative effectiveness of the different exercise interventions. Nineteen studies met the study criteria, including 720 patients. Comparing the physical rehabilitation interventions with usual care (control group), inspiratory muscle training was the highest ranked exercise intervention with an SMD of 3.6 mL/kg·min (95% CI, 2.3-4.8), followed by the group undergoing high-intensity interval training with a significant pooled improvement in VO 2 peak 3.5 (95% CI, 2.6-4.4) and combined aerobic and resistance exercise with an SMD of 3.2 (95% CI, 1.4-5.0). The inspiratory muscle training, high-intensity interval training, and combined aerobic and resistance exercise were the highest ranked physical rehabilitation intervention to improve VO 2 peak. These interventions should be considered as a component in the care of patients with HFpEF. Registration: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42021256442.
Collapse
Affiliation(s)
- Mansueto Gomes-Neto
- From the Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
- Grupo de Estudos em Atividade Física, Brazil
| | - André Rodrigues Durães
- Programa de Pós-Graduação em Medicina e Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Leonador Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Cassio Magalhães Silva
- From the Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Micheli Bernardone Saquetto
- From the Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Øyvind Ellingsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, K.G. Jebsen Center for Exercise in Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vitor Oliveira Carvalho
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
- Grupo de Estudos em Atividade Física, Brazil
- Physical Therapy Department, Federal University of Sergipe-UFS, Aracaju, Sergipe, Brazil
| |
Collapse
|
3
|
Boulmpou A, Boutou AK, Pella E, Sarafidis P, Papadopoulos CE, Vassilikos V. Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction: Technique Principles, Current Evidence, and Future Perspectives. Cardiol Rev 2023; 31:299-317. [PMID: 36723460 DOI: 10.1097/crd.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a multifactorial clinical syndrome involving a rather complex pathophysiologic substrate and quite a challenging diagnosis. Exercise intolerance is a major feature of HFpEF, and in many cases, diagnosis is suspected in subjects presenting with exertional dyspnea. Cardiopulmonary exercise testing (CPET) is a noninvasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic functions during maximal or submaximal exercise. The assessment is based on the principle that system failure typically occurs when the system is under stress, and thus, CPET is currently considered to be the gold standard for identifying exercise intolerance, allowing the differential diagnosis of underlying causes. CPET is used in observational studies and clinical trials in HFpEF; however, in most cases, only a few from a wide variety of CPET parameters are examined, while the technique is largely underused in everyday cardiology practice. This article discusses the basic principles and methodology of CPET and studies that utilized CPET in patients with HFpEF, in an effort to increase awareness of CPET capabilities among practicing cardiologists.
Collapse
Affiliation(s)
- Aristi Boulmpou
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
4
|
Wills WB, Athilingam P, Beckie TM. Exercise-based cardiac rehabilitation in women with heart failure: a review of enrollment, adherence, and outcomes. Heart Fail Rev 2023; 28:1251-1266. [PMID: 37059937 DOI: 10.1007/s10741-023-10306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/16/2023]
Abstract
Exercise-based cardiac rehabilitation (CR) is an evidence-based recommendation for patients with stable heart failure (HF). Less clear is how effective exercise-based CR is for women with HF. The aim of this review was to synthesize the evidence for the effects of exercise-based CR on mortality, hospitalizations, exercise capacity, and quality of life (QOL) among women with HF. We identified 18 studies comprising 4917 patients, of which 1714 were women. The interventions evaluated consisted of various combinations of supervised in-hospital and out-patient sessions as well as home-based programs that included aerobic (walking, treadmill, bicycle) and resistance training. The interventions ranged from 12 to 54 weeks, with a frequency of 2-7 sessions per week, lasting from 30 to 105 min per session. Because of a paucity of sex-specific analyses of the outcomes, it was not possible to draw conclusions for women. There was limited evidence for mortality benefit for men or women participating in exercise-based CR. There was more substantial evidence for reductions in hospitalizations for the participants. Generally, exercise training improved exercise capacity. The effects of exercise-based CR on QOL were mixed with most studies favoring CR at 3 months but not at 4, 5, and 12 months. Moreover, generally, the physical dimension of QOL but not the mental dimensions improved. Recommendations for future research to reduce the gap in knowledge about the effects of exercise-based CR for women are offered.
Collapse
Affiliation(s)
- Walter B Wills
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd., MDC Box 22, Tampa, FL, 33612, USA
| | - Ponrathi Athilingam
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd., MDC Box 22, Tampa, FL, 33612, USA
| | - Theresa M Beckie
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd., MDC Box 22, Tampa, FL, 33612, USA.
| |
Collapse
|
5
|
Warner B, Bruhn EJ, Olson TP, Bissen TG, Borlaug BA, Smith JR. Inspiratory muscle strength is related to exertional dyspnoea in heart failure with preserved ejection fraction. Eur J Heart Fail 2023; 25:1716-1717. [PMID: 37476916 PMCID: PMC10592281 DOI: 10.1002/ejhf.2980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Brit Warner
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric J. Bruhn
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas P. Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas G. Bissen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua R. Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
6
|
Sachdev V, Sharma K, Keteyian SJ, Alcain CF, Desvigne-Nickens P, Fleg JL, Florea VG, Franklin BA, Guglin M, Halle M, Leifer ES, Panjrath G, Tinsley EA, Wong RP, Kitzman DW. Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2023; 81:1524-1542. [PMID: 36958952 DOI: 10.1016/j.jacc.2023.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure; its prevalence is increasing, and outcomes are worsening. Affected patients often experience severe exertional dyspnea and debilitating fatigue, as well as poor quality of life, frequent hospitalizations, and a high mortality rate. Until recently, most pharmacological intervention trials for HFpEF yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life. This success may be attributed, at least in part, to the pleiotropic effects of exercise, which may favorably affect the full range of abnormalities-peripheral vascular, skeletal muscle, and cardiovascular-that contribute to exercise intolerance in HFpEF. Accordingly, this scientific statement critically examines the currently available literature on the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions. Specifically, data reviewed herein demonstrate a comparable or larger magnitude of improvement in exercise capacity from supervised exercise training in patients with chronic HFpEF compared with those with heart failure with reduced ejection fraction, although Medicare reimbursement is available only for the latter group. Finally, critical gaps in implementation of exercise-based therapies for patients with HFpEF, including exercise setting, training modalities, combinations with other strategies such as diet and medications, long-term adherence, incorporation of innovative and more accessible delivery methods, and management of recently hospitalized patients are highlighted to provide guidance for future research.
Collapse
|
7
|
The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis. Qual Life Res 2023; 32:1-26. [PMID: 35460472 PMCID: PMC9034447 DOI: 10.1007/s11136-022-03133-y] [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] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis was to evaluate the effectiveness of RMT in internal and central nervous system disorders, on pulmonary function, exercise capacity and quality of life. METHODS The inclusion criteria were (1) publications designed as Randomized Controlled Trial (RCT), with (2) participants being adults with pulmonary dysfunction caused by an internal disease or central nervous system disorder, (3) an intervention defined as RMT (either IMT or EMT) and (4) with the assessment of exercise capacity, respiratory function and quality of life. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.3 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RESULTS From a total of 2200 records, the systematic review includes 29 RCT with an overall sample size of 1155 patients. Results suggest that patients with internal and central nervous system disorders who underwent RMT had better quality of life and improved significantly their performance in exercise capacity and in respiratory function assessed with FVC and MIP when compared to control conditions (i.e. no intervention, sham training, placebo or conventional treatments). CONCLUSION Respiratory muscle training seems to be more effective than control conditions (i.e. no intervention, sham training, placebo or conventional treatment), in patients with pulmonary dysfunction due to internal and central nervous system disorders, for quality of life, exercise capacity and respiratory function assessed with MIP and FVC, but not with FEV1.
Collapse
|
8
|
The effect of exercise training and physiotherapy on left and right heart function in heart failure with preserved ejection fraction: a systematic literature review. Heart Fail Rev 2023; 28:193-206. [PMID: 35831689 PMCID: PMC9902326 DOI: 10.1007/s10741-022-10259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
The impact of exercise training and physiotherapy on heart function and pulmonary circulation parameters in heart failure with preserved ejection fraction (HFpEF) patients is uncertain. Hence, we performed a systematic review of published trials studying physical training in HFpEF population, with a focus on exercise and physiotherapy effect on left ventricular (LV), right ventricular (RV) morphological, functional, and pulmonary circulation parameters. We searched Cochrane Library and MEDLINE/PubMed for trials that evaluated the effect of exercise training and/or physiotherapy in adult HFpEF patients (defined as LVEF ≥ 45%), including publications until March 2021. Our systematic review identified eighteen articles (n = 418 trained subjects, 4 to 52 weeks of training) and covered heterogeneous trials with various populations, designs, methodologies, and interventions. Five of twelve trials revealed a significant reduction of mitral E/e' ratio after the training (- 1.2 to - 4.9). Seven studies examined left atrial volume index; three of them showed its decrease (- 3.7 to - 8 ml/m2). Findings were inconsistent regarding improvement of cardiac output, E/A ratio, and E wave DecT and uncertain for RV function and pulmonary hypertension parameters. For now, no reliable evidence about rehabilitation effect on HFpEF cardiac mechanisms is available. There are some hypotheses generating findings on potential positive effects to parameters of LV filling pressure (E/e'), left atrium size, cardiac output, and RV function. This encourages a broader and more complex assessment of parameters reflecting cardiac function in future HFpEF exercise training studies.
Collapse
|
9
|
Palau P, Domínguez E, Gonzalez C, Bondía E, Albiach C, Sastre C, Martínez ML, Núñez J, López L. Effect of a home-based inspiratory muscle training programme on functional capacity in postdischarged patients with long COVID: the InsCOVID trial. BMJ Open Respir Res 2022; 9:9/1/e001439. [PMID: 36549786 PMCID: PMC9791108 DOI: 10.1136/bmjresp-2022-001439] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fatigue and exercise intolerance are the most common symptoms in patients with long COVID. AIMS This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) programme improves maximal functional capacity in patients' long COVID after a previous admission due to SARS-CoV-2 pneumonia. METHODS This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week IMT or usual care alone (NCT05279430). The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention.The primary endpoint was the change in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints. RESULTS The mean age of the sample and time to first visit after discharge were 50.4±12.2 years and 362±105 days, respectively. A total of 11 (42.3%) were female. At baseline, the mean of peakVO2, ventilatory efficiency and CIx were 18.9±5 mL/kg/min, 29.4±5.2 and 0.64±0.19, respectively. The IMT arm improved their peakVO2 significantly compared with usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p<0.001). Similar positive findings were found when evaluating changes for CIx and some QoL dimensions. We did not find significant changes in ventilatory efficiency. CONCLUSION In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL. TRIAL REGISTRATION NUMBER NCT05279430.
Collapse
Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clinico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Eloy Domínguez
- Cardiology Department. Hospital Clínico Universitario de Valencia, Universitat Jaume I, Castellón, Spain
| | - Cruz Gonzalez
- Pneumology Department, Hospital Clínico Universitario de Valencia, Hospital Clinico Universitario, Valencia, Spain
| | - Elvira Bondía
- Pneumology Department, Hospital Clínico Universitario de Valencia, Hospital Clinico Universitario, Valencia, Spain
| | - Cristina Albiach
- Cardiology Department, Hospital Clínico Universitario de Valencia, Hospital Clínico Universitario, Valencia, Spain
| | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia. Universitat de València, INCLIVA, Valencia, Spain
| | - Maria Luz Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Hospital Clínico Universitario, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clinico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain
| | - Laura López
- Physiotherapy Department, Universitat de Valencia, Valencia, Spain
| |
Collapse
|
10
|
Edwards JJ, O’Driscoll JM. Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:76. [PMID: 35674912 PMCID: PMC9177931 DOI: 10.1186/s40798-022-00464-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
Background While exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters. Methods A comprehensive systematic search was performed to identify trials published between 1990 and May 2021. Controlled trials of adults reporting pre- and post-ET peak VO2, 6-min walk distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) and left ventricular ejection fraction (LVEF) were considered. Parameters of cardiac diastolic function, brain natriuretic peptides (BNP)/N-terminal prohormone of BNP (NTproBNP) and follow-up hospitalisation and mortality data were also analysed. Results Ninety-three studies (11 HFpEF and 82 HFrEF) were included in the final analysis, with a pooled sample size of 11,081 participants. HFpEF analysis demonstrated significant improvements in peak VO2 (weighted mean difference: 2.333 ml·min-1·kg-1, Pfixed < 0.001), 6MWD (WMD: 35.396 m, Pfixed < 0.001), MLHFQ (WMD: − 10.932, Prandom < 0.001), KCCQ (WMD: 3.709, Pfixed = 0.037) and E/e′ (WMD: − 1.709, [95% CI] = − 2.91–0.51, Prandom = 0.005). HFrEF analysis demonstrated significant improvements in peak VO2 (WMD: 3.050 ml·min-1·kg-1, Prandom < 0.001), 6MWD (WMD: 37.299 m, Prandom < 0.001), MLHFQ (WMD: − 10.932, Prandom < 0.001), LVEF (WMD: 2.677%, Prandom = 0.002) and BNP/NTproBNP (SMD: − 1.349, Prandom < 0.001). Outcome analysis was only performed in HFrEF, which found no significant changes in hospitalisation, all-cause mortality or composite end-points. Conclusion ET significantly improves exercise capacity and quality of life in both HFpEF and HFrEF patients. In HFpEF patients, ET significantly improved an important index of diastolic function, with significant improvements in LVEF and NTproBNP/BNP seen in HFrEF patients only. Such benefits did not translate into significantly reduced hospitalisation or mortality after short-term follow-up. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00464-5.
Collapse
|
11
|
Bohmke NJ, Billingsley HE, Kirkman DL, Carbone S. Nonpharmacological Strategies in Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:491-506. [PMID: 36210133 PMCID: PMC10280381 DOI: 10.1016/j.ccl.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) suffer from a high rate of cardiometabolic comorbidities with limited pharmaceutical therapies proven to improve clinical outcomes and cardiorespiratory fitness (CRF). Nonpharmacologic therapies, such as exercise training and dietary interventions, are promising strategies for this population. The aim of this narrative review is to present a summary of the literature published to date and future directions related to the efficacy of nonpharmacologic, lifestyle-related therapies in HFpEF, with a focus on exercise training and dietary interventions.
Collapse
Affiliation(s)
- Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
| |
Collapse
|
12
|
Li H, Tao L, Huang Y, Li Z, Zhao J. Inspiratory muscle training in patients with heart failure: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:993846. [PMID: 36337890 PMCID: PMC9626810 DOI: 10.3389/fcvm.2022.993846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the effect of inspiratory muscle training (IMT) on patients with heart failure and further explore the impact of IMT on patients with heart failure with preserved ejection fraction. Methods PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP databases were systematically searched. Randomized controlled trials of inspiratory muscle training in patients with heart failure were included. Revman 5.3 software was used to calculate the weighted mean difference (MD) of the combined effect size. The effects of IMT on the maximum oxygen uptake (peakVO2), maximum inspiratory pressure (PImax), ventilation efficiency (VE/VCO2), six-minute walking distance (6MWD), forced expiratory volume (FEV1), forced vital capacity (FVC) and quality of life in patients with heart failure were compared and analyzed. Results After systematic retrieval and screening, 17 studies were included in this study, and the quality of the included studies was good. The results showed that IMT could increase peakVO2 (MD 2.53; 95% CI 1. 54, 3. 51; P < 0.0001) and PImax (MD 17.25; 95% CI 13. 75, 20. 75; P < 0.00001); improve the VE/VCO2 (MD −4.22; 95% CI −6.78, −1.66; P = 0.001) and significantly improve the quality of life in patients with heart failure (MD −13.34; 95% CI −20.42, −6.26; P = 0.0002). However, the effect of IMT on 6MWD in patients with heart failure was not statistically significant (MD 74.45; 95% CI −12.88,161.79; P = 0.09), and the effect on lung function (FEV1 and FVC) was also not statistically significant (P = 0.08; P = 0.86). IMT had a more significant positive effect on peakVO2 (MD 2.98; 95% CI 1.63, 4.34; P < 0.0001) and quality of life (MD −14.52; 95% CI −18.53, −10.52; P < 0.00001) in patients with heart failure with preserved ejection fraction. Descriptive analysis suggested that IMT may positively affect dyspnoea in patients with heart failure. In addition, the choice of evaluation scale may affect the evaluation results of quality of life and dyspnoea. Conclusion IMT has a significant positive effect on respiratory status in patients with heart failure, but different dyspnoea and quality of life evaluation scales can affect the final evaluation results.
Collapse
Affiliation(s)
- Hui Li
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuewi Huang
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyang Li
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ziyang Li
| | - Jianrong Zhao
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jianrong Zhao
| |
Collapse
|
13
|
Katayıfçı N, Boşnak Güçlü M, Şen F. A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: A randomized study. Heart Lung 2022; 55:49-58. [PMID: 35472660 DOI: 10.1016/j.hrtlng.2022.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies have widely investigated the effects of inspiratory muscle strength training in patients with heart failure (HF). The effects of inspiratory muscle strength or endurance training on outcomes in patients with pacemakers have not been adequately studied. OBJECTIVES The aim was to compare the effects of inspiratory muscle strength and endurance training on exercise capacity, quality of life (QoL), peripheral and respiratory muscle strength, respiratory muscle endurance, pulmonary function, dyspnea, fatigue, and physical activity levels in pacemaker patients with HF. METHODS A randomized, controlled, double-blind study was conducted. Fourteen pacemaker patients with HF received inspiratory muscle strength training (IMST) at 50% of maximal inspiratory pressure (MIP), and 18 patients received endurance training (IMET) at 30% of MIP 7 days/8 weeks. Exercise capacity [6 min. walking test (6MWT) and the Incremental Shuttle Walking Test (ISWT)], pulmonary function, respiratory muscle strength [MIP, maximal expiratory pressure (MEP)], endurance, peripheral muscle strength, dyspnea, fatigue, QoL, and physical activity level were evaluated before and after. RESULTS Demographic characteristics were similar in IMST (3F/11M, 56.92 ± 7.61y, EF: 25%, ICD/CRT:11/3) and IMET (4F/14M, 56 ± 10.77y, EF: 30%, ICD/CRT:16/2) groups (p > 0.05). Significant improvements were present in MIP, MEP, respiratory muscle endurance, peripheral muscle strength, 6MWT and ISWT walking distances, dyspnea, QoL, physical activity level, fatigue scores within groups (p ≤ 0.05). However, there were no significant differences between the groups (p > 0.05). There were no significant improvements in FEV1%, FVC%, FEV1/FVC%, and FEF25-75 within and between the groups (p > 0.05). CONCLUSIONS Inspiratory muscle strength and endurance training similarly improves respiratory and peripheral muscle strength, exercise capacity, QoL, physical activity level, and decreases dyspnea and fatigue and are safe and effective in pacemaker patients with HF. TRIAL REGISTRATION www. CLINICALTRIALS gov; study number: NCT03501355.
Collapse
Affiliation(s)
- Nihan Katayıfçı
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay 31060, Turkey.
| | - Meral Boşnak Güçlü
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Fatih Şen
- Tayfur Ata Sökmen Faculty of Medicine, Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
| |
Collapse
|
14
|
Effects of Inspiratory Muscle Training in Patients With Class III and IV Heart Failure. Curr Probl Cardiol 2022; 47:101307. [PMID: 35810844 DOI: 10.1016/j.cpcardiol.2022.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/22/2022]
Abstract
The effects of inspiratory muscle training on functional capacity and quality of life in functional class III and IV heart failure patients were evaluated. The inspiratory muscle training protocol was applied to 20 patients with heart disease, over a period of 6 weeks, 3 times a week, for 30 minutes, with a load of 40% of the maximum inspiratory pressure and 5 sets of 10 repetitions, with an interval of 1-2 minutes. The Minnesota Quality of Life Questionnaire, the 6-minute walk test, vital data and manovacuometry (pre- and post-intervention) were used. Pre- and post-test comparisons revealed significant differences in the 6-minute walk test, heart rate, respiratory rate, Borg scale, respiratory muscle strength, and systolic and diastolic blood pressure, and an increase in quality of life was also observed (P < 0.01). Inspiratory muscle training improved functional capacity and quality of life, suggesting that inspiratory muscle training should be included in Class III and IV cardiac rehabilitation.
Collapse
|
15
|
Palau P, Domínguez E, Sastre C, Martínez ML, Gonzalez C, Bondía E, Albiach C, Núñez J, López L. Effect of a home-based inspiratory muscular training programme on functional capacity in patients with chronic COVID-19 after a hospital discharge: protocol for a randomised control trial (InsCOVID trial). BMJ Open Respir Res 2022; 9:9/1/e001255. [PMID: 35790316 PMCID: PMC9257865 DOI: 10.1136/bmjresp-2022-001255] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Exercise intolerance and fatigue are the most common symptoms in patients with chronic COVID-19 after hospital discharge. Supervised exercise training programmes improve symptoms, but scarce research has been done on home-based exercise programmes on the maximal functional capacity for discharged symptomatic COVID-19 patients. This study evaluates whether a home-based inspiratory muscle training (IMT) programme improves maximal functional capacity in chronic COVID-19 after hospital admission. Methods and analysis This single-centre, assessor-blinded randomised controlled trial, powered for superiority, seeks to evaluate maximal functional capacity as the primary endpoint. A total of 26 eligible patients with a previous admission for acute respiratory syndrome coronavirus 2 pneumonia (>3 months after hospital discharge) will be randomised (1:1) to receive a 12-week programme of IMT versus usual care alone. A blinded assessor will measure outcomes at baseline and after the intervention (12 weeks). An analysis of variance will be used to compare continuous outcomes among the two-intervention groups. As of 21 March 2022, eight patients have been enrolled. Ethics and dissemination The research ethics committee (Comité Ético de Investigación con Medicamentos de l'Hospital Clínic Universitari de València) approved the protocol following the principles of the Declaration of Helsinki and national regulations (Approval Number: 021/226). Findings will be published in peer-reviewed journals and conference publications. Trial registration number NCT05279430.
Collapse
Affiliation(s)
- Patricia Palau
- Cardiology Department. Hospital Clínico Universitario de Valencia, INCLIVA. Universitat de València, Valencia, Spain
| | | | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia, INCLIVA. Universitat de València, Valencia, Spain
| | - M Luz Martínez
- Cardiology Deparment, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Cruz Gonzalez
- Pneumology Department, Hospital Clínico Universitario de Valencia. Universitat de València, Valencia, Spain
| | - Elvira Bondía
- Pneumology Department, Hospital Clínico Universitario de Valencia. Universitat de València, Valencia, Spain
| | - Crtstina Albiach
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julio Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia, INCLIVA. Universitat de València, Valencia, Spain
| | - Laura López
- Physiotherapy Department, Universitat de València, Valencia, Spain
| |
Collapse
|
16
|
Guo Y, Xiao C, Zhao K, He Z, Liu S, Wu X, Shi S, Chen Z, Shi R. Physical Exercise Modalities for the Management of Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. J Cardiovasc Pharmacol 2022; 79:698-710. [PMID: 35522702 PMCID: PMC9067087 DOI: 10.1097/fjc.0000000000001254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/01/2022] [Indexed: 01/11/2023]
Abstract
ABSTRACT Different physical exercise modalities have been widely studied in patients having heart failure with preserved ejection fraction (HFpEF) but with variably reported findings. We, therefore, conducted a systematic review and meta-analysis to evaluate whether the efficacy of physical activity in the management of HFpEF is related to exercise modalities. PubMed and Embase were searched up to July 2021. The eligible studies included randomized controlled trials that identified effects of physical exercise on patients with HFpEF. Sixteen studies were included to evaluate the efficiency of physical exercise in HFpEF. A pooled analysis showed that exercise training significantly improved peak oxygen uptake (VO2), ventilatory anaerobic threshold, distance covered in the 6-minute walking test, the ratio of early diastolic mitral inflow to annular velocities, the Short Form 36 physical component score, and the Minnesota Living with Heart Failure Questionnaire total score. However, the changes in other echocardiographic parameters including the ratio of peak early to late diastolic mitral inflow velocities, early diastolic mitral annular velocity, and left atrial volume index were not significant. Both high-intensity and moderate-intensity training significantly improved exercise capacity (as defined by peak VO2), with moderate-intensity exercise having a superior effect. Furthermore, exercise-induced improvement in peak VO2 was partially correlated with exercise duration. Physical exercise could substantially improve exercise capacity, quality of life, and some indicators of cardiac diastolic function in patients with HFpEF. A protocol of moderate-intensity exercise training lasting a longer duration might be more beneficial compared with high-intensity training for patients with HFpEF.
Collapse
Affiliation(s)
- Yuan Guo
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiovascular Medicine, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China; and
| | - Changhu Xiao
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Kaixuan Zhao
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Ziyu He
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sha Liu
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Xuemei Wu
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Shuting Shi
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Zhu Chen
- Hunan Key Laboratory of Biomedical Nanomaterials and Devices, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
17
|
Aleksova A, Janjusevic M, Gagno G, Pierri A, Padoan L, Fluca AL, Carriere C, Beltrami AP, Sinagra G. The Role of Exercise-Induced Molecular Processes and Vitamin D in Improving Cardiorespiratory Fitness and Cardiac Rehabilitation in Patients With Heart Failure. Front Physiol 2022; 12:794641. [PMID: 35087418 PMCID: PMC8787056 DOI: 10.3389/fphys.2021.794641] [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: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Remarkably, unlike pathological hypertrophy, exercise leads to beneficial cardiac hypertrophy characterized by normal or enhanced contractile function. Exercise-based cardiac rehabilitation improves cardiorespiratory fitness and, as a consequence, ameliorates the quality of life of patients with HF. Particularly, multiple studies demonstrated the improvement in left ventricular ejection fraction (LVEF) among patients with HF due to the various processes in the myocardium triggered by exercise. Exercise stimulates IGF-1/PI3K/Akt pathway activation involved in muscle growth in both the myocardium and skeletal muscle by regulating protein synthesis and catabolism. Also, physical activity stimulates the activation of the mitogen-activated protein kinase (MAPK) pathway which regulates cellular proliferation, differentiation and apoptosis. In addition, emerging data pointed out the anti-inflammatory effects of exercises as well. Therefore, it is of utmost importance for clinicians to accurately evaluate the patient’s condition by performing a cardiopulmonary exercise test and/or a 6-min walking test. Portable devices with the possibility to measure exercise capacity proved to be very useful in this setting as well. The aim of this review is to gather together the molecular processes triggered by the exercise and available therapies in HF settings that could ameliorate heart performance, with a special focus on strategies such as exercise-based cardiac rehabilitation.
Collapse
Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Laura Padoan
- Cardiology and Cardiovascular Physiopathology, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Perugia, Italy
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Cosimo Carriere
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Antonio Paolo Beltrami
- Department of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), University of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| |
Collapse
|
18
|
Selección de lo mejor del año 2021 en riesgo vascular y rehabilitación cardiaca. REC: CARDIOCLINICS 2022. [PMCID: PMC8610374 DOI: 10.1016/j.rccl.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Saraiva RM, Mediano MFF, Mendes FSNS, Sperandio da Silva GM, Veloso HH, Sangenis LHC, Silva PSD, Mazzoli-Rocha F, Sousa AS, Holanda MT, Hasslocher-Moreno AM. Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care. World J Cardiol 2021; 13:654-675. [PMID: 35070110 PMCID: PMC8716970 DOI: 10.4330/wjc.v13.i12.654] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi. CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.
Collapse
Affiliation(s)
- Roberto M Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Mauro Felippe F Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Fernanda SNS Mendes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | | | - Henrique H Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Luiz Henrique C Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Andréa S Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Marcelo T Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Alejandro M Hasslocher-Moreno
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| |
Collapse
|
20
|
Effects of different exercise programs on cardiorespiratory reserve in HFpEF: a systematic review and meta-analysis. Hellenic J Cardiol 2021; 64:58-66. [PMID: 34861401 DOI: 10.1016/j.hjc.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/09/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022] Open
Abstract
HFpEF represents an heterogeneous syndrome with complex pathophysiologic substrate and multiple clinical manifestations. Much attention has been recently focused on cardiac rehabilitation programs for HFpEF patients and studies have examined the effects of exercise training on this specific population. This systematic review and meta-analysis included studies of adult patients with HFpEF and evaluated the impact of exercise on cardiorespiratory fitness variables measured during CPET. The primary outcome was the difference between groups in the change of peak oxygen uptake (Δpeak VO2). Literature search involved PubMed/MEDLINE, Cochrane/CENTRAL and Scopus databases. From an initial 5,143 literature records, we identified 18 studies fulfilling inclusion criteria; 11 studies with 515 patients were finally included in primary outcome analysis. Δpeak VO2 between baseline and study-end was significantly higher in the groups of exercise training versus control (WMD 2.25 ml/kg/min, 95%CI 1.81-2.70). Exercise training resulted in greater change in the 6MWT distance (WMD 2.25 meters, 95%CI 1.81-2.70). Health related quality of life (WMD: -3.36, 95%CI -9.42-2.70, I2=14%, p=0.33) and echocardiographic indexes of diastolic function showed no differences between exercise and control groups at study end. In subgroup analysis, no difference between resistance versus aerobic exercise was noted on Δpeak VO2, but high intensity interval training showed greater increase in peak VO2 versus aerobic exercise (WMD 1.62 ml/kg/min, 95%CI 0.96-2.29, I2=0%, p=0.82). Exercise training in HFpEF results in significant improvements in peak VO2 and 6MWT distance compared to controls. High intensity interval training may offer greater enhancement of exercise capacity of these patients than standard aerobic exercise.
Collapse
|
21
|
Chaveles I, Papazachou O, Shamari MA, Delis D, Ntalianis A, Panagopoulou N, Nanas S, Karatzanos E. Effects of exercise training on diastolic and systolic dysfunction in patients with chronic heart failure. World J Cardiol 2021; 13:514-525. [PMID: 34621496 PMCID: PMC8462045 DOI: 10.4330/wjc.v13.i9.514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/26/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is a complex syndrome characterized by a progressive reduction of the left ventricular (LV) contractility, low exercise tolerance, and increased mortality and morbidity. Diastolic dysfunction (DD) of the LV, is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases. Also, it is well estimated that exercise training induces several beneficial effects on patients with CHF.
AIM To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction (EF) in patients with CHF.
METHODS Thirty-two stable patients with CHF (age: 56 ± 10 years, EF: 32% ± 8%, 88% men) participated in an exercise rehabilitation program. They were randomly assigned to aerobic exercise (AER) or combined aerobic and strength training (COM), based on age and peak oxygen uptake, as stratified randomization criteria. Before and after the program, they underwent a symptom-limited maximal cardiopulmonary exercise testing (CPET) and serial echocardiography evaluation to evaluate peak oxygen uptake (VO2peak), peak workload (Wpeak), DD grade, right ventricular systolic pressure (RVSP), and EF.
RESULTS The whole cohort improved VO2peak, and Wpeak, as well as DD grade (P < 0.05). Overall, 9 patients (28.1%) improved DD grade, while 23 (71.9%) remained at the same DD grade; this was a significant difference, considering DD grade at baseline (P < 0.05). In addition, the whole cohort improved RVSP and EF (P < 0.05). Not any between-group differences were observed in the variables assessed (P > 0.05).
CONCLUSION Exercise rehabilitation improves indices of diastolic and systolic dysfunction. Exercise protocol was not observed to affect outcomes. These results need to be further investigated in larger samples.
Collapse
Affiliation(s)
- Ioannis Chaveles
- 1st Department of Cardiology - Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, “Evaggelismos” Hospital, Athens 10676, Greece
| | - Ourania Papazachou
- Department of Cardiology, ”Helena Venizelou” Hospital, Athens 10676, Greece
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Manal al Shamari
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Dimitrios Delis
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Argirios Ntalianis
- Heart Failure Unit, Department of Clinical Therapeutics, ”Alexandra” Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Niki Panagopoulou
- Department of Cardiology, ”Helena Venizelou” Hospital, Athens 10676, Greece
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
| |
Collapse
|
22
|
Amjad A, Brubaker PH, Upadhya B. Exercise training for prevention and treatment of older adults with heart failure with preserved ejection fraction. Exp Gerontol 2021; 155:111559. [PMID: 34547406 DOI: 10.1016/j.exger.2021.111559] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. In the highest age decile (≥90 years old), nearly all patients with HFpEF. As our understanding of the disease has grown in the last few years, we now know that HFpEF is a systemic disorder influenced by aging processes. The involvement of this broad collection of abnormalities in HFpEF, the recognition of the high frequency and impact of noncardiac comorbidities, and systemic, multiorgan involvement, and its nearly exclusive existence in older persons, has led to the recognition of HFpEF as a true geriatric syndrome. Most of the conventional therapeutics used in other cardiac diseases have failed to improve HFpEF patient outcomes significantly. Several recent studies have evaluated exercise training (ET) as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical endpoints, such as HF hospitalizations and mortality, they have shown that ET is a safe and effective intervention to improve peak oxygen consumption, physical function, and quality of life in clinically stable HF patients. Recently, a progressive, multidomain physical rehabilitation study among older adults showed that it is feasible in older patients with acute decompensated HF who have high frailty and comorbidities and showed improvement in physical function. However, the lack of Centers for Medicare and Medicaid Services coverage can be a major barrier to formal cardiac rehabilitation in older HFpEF patients. Unfortunately, insistence upon demonstration of mortality improvement before approving reimbursement overlooks the valuable and demonstrated benefits of physical function and life quality.
Collapse
Affiliation(s)
- Aysha Amjad
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest School of Medicine, Winston Salem, USA
| | - Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA.
| |
Collapse
|
23
|
Unraveling the Role of Respiratory Muscle Metaboloreceptors under Inspiratory Training in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041697. [PMID: 33578776 PMCID: PMC7916511 DOI: 10.3390/ijerph18041697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/15/2022]
Abstract
Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic–adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic–adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.
Collapse
|
24
|
Baral N, Changezi HU, Khan MR, Adhikari G, Adhikari P, Khan HMW, Poudyal A, Abdelazeem B, Sigdel S, Champine A. Inspiratory Muscle Training in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis. Cureus 2020; 12:e12260. [PMID: 33510978 PMCID: PMC7826245 DOI: 10.7759/cureus.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives To explore the role of inspiratory muscle training (IMT) in improving cardiorespiratory fitness of stable heart failure with preserved ejection fraction (HFpEF) patients. Background There is a paucity of data on the role of IMT in patients with HFpEF. HFpEF is a growing problem in the developed world, especially in the aging population. Methods We conducted a systematic literature search for English studies in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. We searched databases using terms relating to or describing breathing exercise, IMT, and HFpEF. RevMan 5.4 (The Cochrane Collaboration, 2020) was used for data analysis, and two independent investigators performed literature retrieval and data extraction. Results We identified three randomized controlled trials (RCTs) and one prospective study on the role of IMT in HFpEF. We calculated the pooled mean difference of peak oxygen consumption (Peak VO2) and six-min walk distance (6MWD) between the IMT and standard care (SC) groups. Our meta-analysis showed that compared with SC, IMT could significantly improve peak VO2 with a mean difference (MD) of 2.82 ml/kg/min, 95% CI [1.90, 3.74] P < 0.00001 and improve 6MWD with MD of 83.97 meters, 95% CI [59.18, 108.76] P< 0.00001 to improve cardiorespiratory fitness at 12 weeks of IMT and improve peak VO2 with MD of 2.18 ml/kg/min, 95% CI [0.38, 3.99] P < 0.00001 at 24 weeks of therapy. Conclusion IMT should be further studied as a possible treatment option to improve cardiorespiratory fitness for patients with stable HFpEF.
Collapse
Affiliation(s)
- Nischit Baral
- Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| | - Hameem U Changezi
- Cardiovascular Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| | - Mahin R Khan
- Cardiology, McLaren Flint/Michigan State University (MSU), Flint, USA
| | | | - Prakash Adhikari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | | | - Basel Abdelazeem
- Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| | - Shashi Sigdel
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Andrew Champine
- Behavioral Health/Family Medicine/Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, USA
| |
Collapse
|
25
|
Fukuta H. Effects of Exercise Training on Cardiac Function in Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2020; 6:e27. [PMID: 33133641 PMCID: PMC7592458 DOI: 10.15420/cfr.2020.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/20/2020] [Indexed: 12/29/2022] Open
Abstract
Nearly half of patients with heart failure in the community have heart failure with preserved ejection fraction (HFpEF). Patients with HFpEF are often elderly and their primary chronic symptom is severe exercise intolerance. Left ventricular diastolic dysfunction is associated with the pathophysiology of HFpEF and is an important contributor to exercise intolerance in HFpEF patients. The effects of exercise training on left ventricular diastolic function in HFpEF patients have been examined in several randomised clinical trials. Meta-analysis of the trials indicates that exercise training can provide clinically relevant improvements in exercise capacity without significant change in left ventricular structure or function in HFpEF patients. Further studies are necessary to elucidate the exact mechanisms of exercise intolerance in HFpEF patients and to develop recommendations regarding the most effective type, intensity, frequency, and duration of training in this group.
Collapse
Affiliation(s)
- Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences Nagoya, Japan
| |
Collapse
|
26
|
Fernandez-Rubio H, Becerro-de-Bengoa-Vallejo R, Rodríguez-Sanz D, Calvo-Lobo C, Vicente-Campos D, Chicharro JL. Inspiratory Muscle Training in Patients with Heart Failure. J Clin Med 2020; 9:jcm9061710. [PMID: 32498445 PMCID: PMC7356942 DOI: 10.3390/jcm9061710] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Prior systematic reviews and meta-analysis addressed that inspiratory muscle training (IMT) improved inspiratory muscle weakness, cardiorespiratory fitness and quality of life similar to conventional exercise training as a first alternative in deconditioned patients with heart failure (HF) lead to a better adaptation to posterior exercise training. The heterogeneity and variability in a wide range of new studies about this topic led to the necessity of an updated and comprehensive narrative review. The present review aimed to analyze and update the most relevant studies about IMT in patients who suffer from HF. Methods: A narrative review was carried out about IMT in HF patients including 26 experimental studies divided into 21 clinical trials and 5 quasi-experimental studies identified through database searching in PubMed, Cochrane and PEDro. Results: There is enough evidence to state that IMT produces improvements in functional capacity of patients with HF. Nevertheless, there is not enough evidence to support that IMT could improve cardiovascular parameters, blood biomarkers or quality of life in these patients. Conclusions: Thus, IMT may be recommended to improve functional capacity in patients who suffer from HF; nevertheless, more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. Furthermore, mortality or HF hospitalization was not evaluated and most studies were not longer than 3 months. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients.
Collapse
Affiliation(s)
- Hugo Fernandez-Rubio
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
- Correspondence: ; Tel.: +34-913-941-532
| | - Davinia Vicente-Campos
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - J. L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| |
Collapse
|
27
|
Physical activity and exercise training in heart failure with preserved ejection fraction: gathering evidence from clinical and pre-clinical studies. Heart Fail Rev 2020; 27:573-586. [DOI: 10.1007/s10741-020-09973-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
28
|
Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N. Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev 2020; 24:535-547. [PMID: 31032533 DOI: 10.1007/s10741-019-09774-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is associated with the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and contributes importantly to exercise intolerance that results in a reduced quality of life (QOL) in HFpEF patients. Although the effects of exercise training on LV diastolic function, exercise capacity, or QOL in HFpEF patients have been examined in randomized clinical trials (RCTs), results are inconsistent due partly to limited power with small sample sizes. We aimed to conduct a meta-analysis of RCTs examining the effects of exercise training on LV diastolic function and exercise capacity as well as QOL in HFpEF patients. The search of electronic databases identified 8 RCTs with 436 patients. The duration of exercise training ranged from 12 to 24 weeks. In the pooled analysis, exercise training improved peak exercise oxygen uptake (weighted mean difference [95% CI], 1.660 [0.973, 2.348] ml/min/kg), 6-min walk distance (33.883 [12.384 55.381] m), and Minnesota Living With Heart Failure Questionnaire total score (9.059 [3.083, 15.035] point) compared with control. In contrast, exercise training did not significantly change early diastolic mitral annular velocity (weighted mean difference [95% CI], 0.317 [- 0.952, 1.587] cm/s), the ratio of early diastolic mitral inflow to annular velocities (- 1.203 [- 4.065, 1.658]), or LV ejection fraction (0.850 [- 0.128, 1.828] %) compared with control. In conclusion, the present meta-analysis suggests that exercise training improves exercise capacity and QOL without significant change in LV systolic or diastolic function in HFpEF patients.
Collapse
Affiliation(s)
- Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Toshihiko Goto
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuaki Wakami
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
29
|
Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Phys Ther 2020; 100:14-43. [PMID: 31972027 DOI: 10.1093/ptj/pzz127] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.
Collapse
Affiliation(s)
- Michael J Shoemaker
- Department of Physical Therapy, Grand Valley State University, 301 Michigan NE, Suite 200, Grand Rapids, MI 49503 (USA). Dr Shoemaker is a board-certified clinical specialist in geriatric physical therapy
| | - Konrad J Dias
- Physical Therapy Program, Maryville University of St Louis, St Louis, Missouri. Dr Dias is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - Kristin M Lefebvre
- Department of Physical Therapy, Concordia University St Paul, St Paul, Minnesota. Dr Lefebvre is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - John D Heick
- Department of Physical Therapy, Northern Arizona University, Flagstaff, Arizona. Dr Heick is a board-certified clinical specialist in orthopaedic physical therapy, neurologic physical therapy, and sports physical therapy
| | - Sean M Collins
- Physical Therapy Program, Plymouth State University, Plymouth, New Hampshire
| |
Collapse
|
30
|
Bhanji RA, Montano-Loza AJ, Watt KD. Sarcopenia in Cirrhosis: Looking Beyond the Skeletal Muscle Loss to See the Systemic Disease. Hepatology 2019; 70:2193-2203. [PMID: 31034656 DOI: 10.1002/hep.30686] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
Abstract
Sarcopenia is a common complication of cirrhosis and is defined as a progressive and generalized loss of skeletal muscle mass, strength, and function. Sarcopenia is associated with poor prognosis and increased mortality. How sarcopenia and muscle wasting relate to such poor outcomes requires looking beyond the overt muscle loss and at this entity as a systemic disease that affects muscles of vital organs including cardiac and respiratory muscles. This review explores the pathophysiological pathways and mechanisms that culminate in poor outcomes associated with sarcopenia. This provides a launching pad to identify potential targets for therapeutic intervention and optimization to improve patient outcomes.
Collapse
Affiliation(s)
- Rahima A Bhanji
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.,Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada
| | - Aldo J Montano-Loza
- Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
31
|
Craighead DH, Heinbockel TC, Hamilton MN, Bailey EF, MacDonald MJ, Gibala MJ, Seals DR. Time-efficient physical training for enhancing cardiovascular function in midlife and older adults: promise and current research gaps. J Appl Physiol (1985) 2019; 127:1427-1440. [PMID: 31556835 PMCID: PMC10205162 DOI: 10.1152/japplphysiol.00381.2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed societies, and "midlife" (50-64 yr) and older (65+) men and women bear the great majority of the burden of CVD. Much of the increased risk of CVD in this population is attributable to CV dysfunction, including adverse changes in the structure and function of the heart, increased systolic blood pressure, and arterial dysfunction. The latter is characterized by increased arterial stiffness and vascular endothelial dysfunction. Conventional aerobic exercise training, as generally recommended in public health guidelines, is an effective strategy to preserve or improve CV function with aging. However, <40% of midlife and older adults meet aerobic exercise guidelines, due in part to time availability-related barriers. As such, there is a need to develop evidence-based time-efficient exercise interventions that promote adherence and optimize CV function in these groups. Two promising interventions that may meet these criteria are interval training and inspiratory muscle strength training (IMST). Limited research suggests these modes of training may improve CV function with time commitments of ≤60 min/wk. This review will summarize the current evidence for interval training and IMST to improve CV function in midlife/older adults and identify key research gaps and future directions.
Collapse
Affiliation(s)
- Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Thomas C Heinbockel
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Makinzie N Hamilton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Martin J Gibala
- Department of Kinesiology, McMaster University, Ontario, Canada
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| |
Collapse
|
32
|
Wang MH, Yeh ML. Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials. World J Clin Cases 2019; 7:2760-2775. [PMID: 31616691 PMCID: PMC6789387 DOI: 10.12998/wjcc.v7.i18.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.
AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.
METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.
RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.
CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
Collapse
Affiliation(s)
- Mei-Hua Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| |
Collapse
|
33
|
Hossein Pour AH, Gholami M, Saki M, Birjandi M. The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial. Jpn J Nurs Sci 2019; 17:e12290. [PMID: 31429207 DOI: 10.1111/jjns.12290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 04/18/2019] [Accepted: 06/27/2019] [Indexed: 12/30/2022]
Abstract
AIM Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. METHODS In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II-III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6-week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). RESULTS The between-group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within-group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. CONCLUSIONS The 6-week home-based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.
Collapse
Affiliation(s)
| | - Mohammad Gholami
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mandana Saki
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Birjandi
- Department of Biostatistics and Epidemiology, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
34
|
Palau P, Domínguez E, Ramón JM, López L, Briatore AE, Tormo JP, Ventura B, Chorro FJ, Núñez J. Home-based inspiratory muscle training for management of older patients with heart failure with preserved ejection fraction: does baseline inspiratory muscle pressure matter? Eur J Cardiovasc Nurs 2019; 18:621-627. [PMID: 31148459 DOI: 10.1177/1474515119855183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is a clinical syndrome characterised by reduced exercise capacity. Some evidence has shown that a simple and home-based programme of inspiratory muscle training offers promising results in terms of aerobic capacity improvement in patients with heart failure with preserved ejection fraction. This study aimed to investigate whether the baseline inspiratory muscle function predicts the changes in aerobic capacity (measured as peak oxygen uptake; peak VO2) after a 12-week home-based programme of inspiratory muscle training in patients with heart failure with preserved ejection fraction. METHODS A total of 45 stable symptomatic patients with heart failure with preserved ejection fraction and New York Heart Association II-III received a 12-week home-based programme of inspiratory muscle training between June 2015 and December 2016. They underwent cardiopulmonary exercise testing and measurements of maximum inspiratory pressure pre and post-inspiratory muscle training. Maximum inspiratory pressure and peak VO2 were registered in both visits. Multivariate linear regression analysis was used to assess the association between changes in peak VO2 (Δ-peakVO2) and baseline predicted maximum inspiratory pressure (pp-MIP). RESULTS The median (interquartile range) age was 73 (68-77) years, 47% were women and 35.6% displayed New York Heart Association III. The mean peak VO2 at baseline and Δ-peakVO2 post-training were 10.4±2.8 ml/min/kg and +2.2±1.3 ml/min/kg (+21.3%), respectively. The median (interquartile range) of pp-MIP and Δ-MIP were 71% (64-92) and 39.2 (26.7-80.4) cmH2O, respectively. After a multivariate analysis, baseline pp-MIP was not associated with Δ-peakVO2 (β coefficient 0.005, 95% confidence interval -0.009-0.019, P=0.452). CONCLUSIONS In symptomatic and deconditioned older patients with heart failure with preserved ejection fraction, a home-based inspiratory muscle training programme improves aerobic capacity regardless of the baseline maximum inspiratory pressure.
Collapse
Affiliation(s)
- Patricia Palau
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - Eloy Domínguez
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - José María Ramón
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de València. Spain
| | - Laura López
- Departamento de Fisioterapia, Universitat de València, Spain
| | - Antonio Ernesto Briatore
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - J Pablo Tormo
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - Bruno Ventura
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de València. Spain.,Servicio de Cardiología, Hospital Clínico Universitario, CIBERCV, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de València. Spain.,Servicio de Cardiología, Hospital Clínico Universitario, CIBERCV, Spain
| |
Collapse
|
35
|
Palau P, Domínguez E, López L, Ramón JM, Heredia R, González J, Santas E, Bodí V, Miñana G, Valero E, Mollar A, Bertomeu González V, Chorro FJ, Sanchis J, Lupón J, Bayés-Genís A, Núñez J. Entrenamiento de la musculatura inspiratoria y la electroestimulación muscular funcional en el tratamiento de la insuficiencia cardiaca con función sistólica conservada: estudio TRAINING-HF. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
36
|
[Prevention of frailty and cognitive impairment in elderly patients with heart failure]. Nihon Ronen Igakkai Zasshi 2019; 56:107-114. [PMID: 31092774 DOI: 10.3143/geriatrics.56.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
37
|
Ntelios D, Giannakoulas G, Dimopoulos K. Strength training in congenital heart disease: A way to boost respiratory function? Eur J Prev Cardiol 2018; 26:489-491. [PMID: 30426770 DOI: 10.1177/2047487318812505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dimitrios Ntelios
- 1 Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - George Giannakoulas
- 1 Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Konstantinos Dimopoulos
- 2 Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, National Heart and Lung Institute, Royal Brompton Hospital, Imperial College London, UK
| |
Collapse
|
38
|
Pearson MJ, King N, Smart NA. Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis. Open Heart 2018; 5:e000819. [PMID: 30018779 PMCID: PMC6045761 DOI: 10.1136/openhrt-2018-000819] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022] Open
Abstract
Background Biomarkers are important in the diagnosis, risk stratification and management of patients with heart failure (HF). The established biomarkers of myocardial stretch, brain natriuretic peptide (BNP) and amino (N) portion of BNP (NT-proBNP) have been extensively studied, and early analyses have demonstrated response to exercise training. Several other biomarkers have been identified over the last decade and may provide valuable and complementary information which may guide treatment strategies, including exercise therapy. Methods A systematic search of PubMed, EMBASE and Cochrane Trials Register to 31 October 2017 was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported biomarkers, BNP, NT-proBNP, soluble ST2, galectin-3, mid-regional atrial natriuretic peptide, mid-regional adrenomedullin and copeptin, were included. Results Forty-three studies were included in the systematic review, with 27 studies suitable for meta-analyses. Data pooling was only possible for NT-proBNP and BNP. Meta-analyses of conventional training studies demonstrated a statistically significant improvement in NT-proBNP (pmol/L); mean difference (MD) −32.80 (95% CI −56.19 to −9.42), p=0.006 and in BNP (pmol/L); MD −17.17 (95% CI −29.56 to −4.78), p=0.007. Pooled data of non-conventional training failed to demonstrate any statistically significant improvements. Conclusion Pooled data indicated a favourable effect of conventional exercise therapy on the established biomarkers, NT-proBNP and BNP; however, this was in contrast to a number of studies that could not be pooled. Limited evidence exists as to the effect of exercise training on emerging biomarkers.
Collapse
Affiliation(s)
- Melissa J Pearson
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | - Nicola King
- School of Biomedical and Healthcare Sciences, University of Plymouth, Plymouth, UK
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| |
Collapse
|
39
|
Lage SM, Britto RR, Brandão DC, Pereira DAG, Andrade ADD, Parreira VF. Can diaphragmatic breathing modify chest wall volumes during inspiratory loaded breathing in patients with heart failure? Braz J Phys Ther 2018; 22:452-458. [PMID: 29752160 DOI: 10.1016/j.bjpt.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some inspiratory muscle training protocols for patients with heart failure report the request of diaphragmatic breathing during inspiratory loaded breathing. However, it is unclear whether this condition modifies the chest wall volumes. OBJECTIVE The primary purpose was to evaluate chest wall volumes during inspiratory loaded breathing as well as during inspiratory loaded breathing associated with diaphragmatic breathing in patients with heart failure. METHODS Sixteen men with heart failure functional class I to III, aged 50(SD=7) years were evaluated. Volumes of the pulmonary rib cage, abdominal rib cage and abdomen, as well as other breathing pattern variables, were assessed by optoelectronic plethysmography during quiet breathing, inspiratory loaded breathing, and inspiratory loaded breathing associated with diaphragmatic breathing. RESULTS Chest wall tidal volume significantly increased from quiet breathing 0.53(SD=0.14)L to inspiratory loaded breathing 1.33(SD=0.48)L and to inspiratory loaded breathing associated with diaphragmatic breathing 1.36(SD=0.48)L. A significant volume variation was observed on the three compartments (p<0.05 for all). During inspiratory loaded breathing associated with diaphragmatic breathing, patients showed increased abdominal volume compared to quiet breathing [0.28(SD=0.05) to 0.83(SD=0.47)L, p<0.001]; as well as from inspiratory loaded breathing [0.63(SD=0.23) to 0.83(SD=0.47)L, p=0.044]. No significant changes were observed between the two inspiratory loaded breathing conditions on the percentages of the contribution of each chest wall compartment for the tidal volume, respiratory rate, minute ventilation, and duty cycle. CONCLUSION When inspiratory loaded breathing was associated with diaphragmatic breathing, a higher volume in the abdominal compartment was obtained without significant changes in other breathing pattern variables.
Collapse
Affiliation(s)
- Susan Martins Lage
- Universidade Federal de Minas Gerais (UFMG), Rehabilitation Sciences Post Graduation Program, Belo Horizonte, MG, Brazil
| | - Raquel Rodrigues Britto
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil
| | - Daniella Cunha Brandão
- Universidade Federal de Pernambuco (UFPE), Department of Physical Therapy, Recife, PE, Brazil
| | | | | | - Verônica Franco Parreira
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil.
| |
Collapse
|
40
|
Abela M. Exercise training in heart failure. Postgrad Med J 2018; 94:392-397. [PMID: 29728451 DOI: 10.1136/postgradmedj-2018-135638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/04/2018] [Accepted: 04/15/2018] [Indexed: 12/28/2022]
Abstract
Exercise training (ET) in heart failure (HF) has long been established as an important part of HF care. ET is known to improve quality of life and functional capacity in a number of ways. Despite its proposed benefits, evidence supporting its routine inclusion in standard rehabilitation programme is at times conflicting, partly because of the significant heterogeneity present in available randomised controlled trials. There is lack of evidence with regard to the duration of the overall benefit, the optimal exercise regimen and whether certain types of HF aetiologies benefit more than others. The aim of this review is to provide an update to date literature review of the positive and negative evidence surrounding ET in HF, while proposing an efficient novel in-hospital exercise-based rehabilitation programme for patients with HF in addition to a pre-existing HF clinic.
Collapse
|
41
|
Palau P, Domínguez E, Núñez E, Ramón JM, López L, Melero J, Sanchis J, Bellver A, Santas E, Bayes-Genis A, Chorro FJ, Núñez J. El consumo máximo de oxígeno predice los ingresos recurrentes por insuficiencia cardiaca con fracción de eyección conservada. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
42
|
Palau P, Domínguez E, López L, Ramón JM, Heredia R, González J, Santas E, Bodí V, Miñana G, Valero E, Mollar A, Bertomeu González V, Chorro FJ, Sanchis J, Lupón J, Bayés-Genís A, Núñez J. Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial. ACTA ACUST UNITED AC 2018; 72:288-297. [PMID: 29551699 DOI: 10.1016/j.rec.2018.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. METHODS A total of 61 stable symptomatic patients (New York Heart Association II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the study was to evaluate change in peak exercise oxygen uptake at 12 and 24 weeks. Secondary endpoints were changes in quality of life, echocardiogram parameters, and prognostic biomarkers. We used a mixed-effects model for repeated-measures to compare endpoints changes. RESULTS Mean age and peak exercise oxygen uptake were 74 ± 9 years and 9.9 ± 2.5mL/min/kg, respectively. The proportion of women was 58%. At 12 weeks, the mean increase in peak exercise oxygen uptake (mL/kg/min) compared with usual care was 2.98, 2.93, and 2.47 for IMT, FES, and IMT + FES, respectively (P < .001) and this beneficial effect persisted after 6 months (1.95, 2.08, and 1.56; P < .001). Significant increases in quality of life scores were found at 12 weeks (P < .001). No other changes were found. CONCLUSIONS In HFpEF patients with low aerobic capacity, IMT and FES were associated with a significant improvement in exercise capacity and quality of life. This trial was registered at ClinicalTrials.gov (Identifier: NCT02638961)..
Collapse
Affiliation(s)
- Patricia Palau
- Servicio de Cardiología, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Eloy Domínguez
- Servicio de Cardiología, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Laura López
- Facultad de Fisioterapia, Departamento de Fisioterapia, Universitat de València, Valencia, Spain
| | - José María Ramón
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Raquel Heredia
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Jessika González
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Vicent Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Vicente Bertomeu González
- Servicio de Cardiología, Hospital Universitario de San Juan, Universidad Miguel Hernández, CIBERCV, San Juan de Alicante, Alicante, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain
| | - Josep Lupón
- Servicio de Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, CIBERCV, Barcelona, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, CIBERCV, Valencia, Spain.
| |
Collapse
|
43
|
Pearson MJ, Mungovan SF, Smart NA. Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2018; 22:229-242. [PMID: 28229273 DOI: 10.1007/s10741-017-9600-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Diastolic dysfunction contributes to the development and progression of heart failure. Conventional echocardiography and tissue Doppler imaging are widely utilised in clinical research providing a number of indices of diastolic function valuable in the diagnosis and prognosis of heart failure patients. The aim of this meta-analysis was to quantify the effect of exercise training on diastolic function in patients with heart failure. Exercise training studies that investigate different indices of diastolic function in patients with heart failure have reported that exercise training improves diastolic function in these patients. We sought to add to the current literature by quantifying, where possible, the effect of exercise training on diastolic function. We conducted database searches (PubMed, EBSCO, EMBASE, and Cochrane Trials Register to 31 July 2016) for exercise based rehabilitation trials in heart failure, using the search terms 'exercise training, diastolic function and diastolic dysfunction'. Data from six studies, with a total of 266 heart failure with reduced ejection fraction (HFrEF) participants, 144 in intervention groups and 122 in control groups, indicated a significant reduction in the ratio of early diastolic transmitral velocity (E) to early diastolic tissue velocity (E') (E/E' ratio) with exercise training, exercise vs. control mean difference (MD) of -2.85 (95% CI -3.66 to -2.04, p < 0.00001). Data from five studies in heart failure with preserved ejection fraction (HFpEF) patients, with a total of 204 participants, 115 in intervention groups and 89 in control groups, also demonstrated a significant improvement in E/E' in exercise vs. control MD of -2.38 (95% CI -3.47 to -1.28, p < 0.0001).
Collapse
Affiliation(s)
- M J Pearson
- School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia
| | - S F Mungovan
- Westmead Private Physiotherapy Services and The Clinical Research Institute, Sydney, Australia.,Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - N A Smart
- School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
| |
Collapse
|
44
|
Diaphragm abnormalities in heart failure and aging: mechanisms and integration of cardiovascular and respiratory pathophysiology. Heart Fail Rev 2018; 22:191-207. [PMID: 27000754 DOI: 10.1007/s10741-016-9549-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inspiratory function is essential for alveolar ventilation and expulsive behaviors that promote airway clearance (e.g., coughing and sneezing). Current evidence demonstrates that inspiratory dysfunction occurs during healthy aging and is accentuated by chronic heart failure (CHF). This inspiratory dysfunction contributes to key aspects of CHF and aging cardiovascular and pulmonary pathophysiology including: (1) impaired airway clearance and predisposition to pneumonia; (2) inability to sustain ventilation during physical activity; (3) shallow breathing pattern that limits alveolar ventilation and gas exchange; and (4) sympathetic activation that causes cardiac arrhythmias and tissue vasoconstriction. The diaphragm is the primary inspiratory muscle; hence, its neuromuscular integrity is a main determinant of the adequacy of inspiratory function. Mechanistic work within animal and cellular models has revealed specific factors that may be responsible for diaphragm neuromuscular abnormalities in CHF and aging. These include phrenic nerve and neuromuscular junction alterations as well as intrinsic myocyte abnormalities, such as changes in the quantity and quality of contractile proteins, accelerated fiber atrophy, and shifts in fiber type distribution. CHF, aging, or CHF in the presence of aging disturbs the dynamics of circulating factors (e.g., cytokines and angiotensin II) and cell signaling involving sphingolipids, reactive oxygen species, and proteolytic pathways, thus leading to the previously listed abnormalities. Exercise-based rehabilitation combined with pharmacological therapies targeting the pathways reviewed herein hold promise to treat diaphragm abnormalities and inspiratory muscle dysfunction in CHF and aging.
Collapse
|
45
|
Wu J, Kuang L, Fu L. Effects of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysis. CONGENIT HEART DIS 2018; 13:194-202. [PMID: 29423938 DOI: 10.1111/chd.12586] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of inspiratory muscle training (IMT) in chronic heart failure (CHF) patients. DESIGN We searched MEDLINE, EMBASE, Cochrane Library, CINHAL, and CBMdisc to collect controlled trials on the application of inspiratory muscle training in CHF patients from the establishment of these databases to November 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of literature. Meta-analysis was conducted by software RevMan5.3. RESULTS Eight studies involving 302 patients were identified. Meta-analysis indicated that IMT significantly improved PImax , VE /VCO2 slope and dyspnea (weighted mean difference [WMD] = 16.52, 95% CI: 13.87-19.17, P < .01; WMD = -5.78, 95% CI: -7.72 to -3.85, P < .01; SMD = -0.95, 95% CI: -1.5 to -0.39, P < .01), and descriptive results showed that long-term IMT (≥6 weeks) can improve the quality of life of CHF patients, and patients in IMT group also have a significant improvement in 6-minute walking distance test (6-MWD). CONCLUSION IMT can improve pulmonary function, exercise tolerance, and quality of life of CHF patients and relieve the symptom of dyspnea.
Collapse
Affiliation(s)
- Jing Wu
- Shanghai Jiao Tong University School of Nursing, Shanghai, People's Republic of China
| | - Li Kuang
- Shanghai Jiao Tong University School of Nursing, Shanghai, People's Republic of China
| | - Lijuan Fu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
46
|
Laohachai K, Winlaw D, Selvadurai H, Gnanappa GK, d'Udekem Y, Celermajer D, Ayer J. Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation. J Am Heart Assoc 2017; 6:JAHA.117.005750. [PMID: 28862962 PMCID: PMC5586429 DOI: 10.1161/jaha.117.005750] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation. METHODS AND RESULTS Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily. Respiratory muscle strength (maximal inspiratory pressure and expiratory pressure), lung function, and exercise capacity (cardiopulmonary exercise testing) were assessed. Fourteen of 23 participants also underwent exercise cardiac magnetic resonance imaging to examine the effects of IMT on cardiac output and systemic and pulmonary blood flow. Six weeks of IMT improved maximal inspiratory pressure by 36±24 cm H2O (61±46%) with no change in maximal expiratory pressure. Ventilatory efficiency of exercise improved after 6 weeks of IMT (from 34.2±7.8 to 32.2±5.6, P=0.04). In those who underwent exercise cardiac magnetic resonance imaging, IMT increased resting cardiac output (from 4.2±1.2 to 4.5±1.0 L/min, P=0.03) and ejection fraction (from 50.1±4.3 to 52.8±6.1%, P=0.03). CONCLUSIONS Six weeks of IMT is associated with improved inspiratory muscle strength, ventilatory efficiency of exercise, and resting cardiac output in young Fontan patients. IMT may be a simple beneficial addition to the current management of Fontan patients, potentially reducing exercise intolerance and long-term morbidity and mortality.
Collapse
Affiliation(s)
- Karina Laohachai
- The Children's Hospital at Westmead, Sydney, NSW, Australia .,The University of Sydney, Sydney, NSW, Australia
| | - David Winlaw
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | | | - Yves d'Udekem
- The Royal Children's Hospital, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - David Celermajer
- The University of Sydney, Sydney, NSW, Australia.,The Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Julian Ayer
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
47
|
Peak Exercise Oxygen Uptake Predicts Recurrent Admissions in Heart Failure With Preserved Ejection Fraction. ACTA ACUST UNITED AC 2017; 71:250-256. [PMID: 28666951 DOI: 10.1016/j.rec.2017.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO2) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO2 and the risk of recurrent hospitalizations in patients with HFpEF. METHODS A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO2 (pp-peak VO2) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. RESULTS The mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO2 and median pp-peak VO2 were 10 ± 2.8mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). CONCLUSIONS In symptomatic elderly patients with HFpEF, pp-peak VO2 predicts all-cause recurrent admission.
Collapse
|
48
|
Palau P, Domínguez E, Núñez E, Ramón JM, López L, Melero J, Bellver A, Chorro FJ, Bodí V, Bayés-Genis A, Sanchis J, Núñez J. Inspiratory Muscle Function and Exercise Capacity in Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail 2017; 23:480-484. [PMID: 28449951 DOI: 10.1016/j.cardfail.2017.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired exercise capacity resulting from dyspnea and fatigue. The pathophysiological mechanisms underlying the exercise intolerance in HFpEF are not well established. We sought to evaluate the effects of inspiratory muscle function on exercise tolerance in symptomatic patients with HFpEF. METHODS AND RESULTS A total of 74 stable symptomatic patients with HFpEF and New York Heart Association class II-III underwent a cardiopulmonary exercise test between June 2012 and May 2016. Inspiratory muscle weakness was defined as maximum inspiratory pressure (MIP) <70% of normal predicted values. Pearson correlation coefficient and multivariate linear regression analysis were used to assess the association between percent of predicted MIP (pp-MIP) and maximal exercise capacity [measured by peak oxygen uptake (peak VO2) and percent of predicted peak VO2 (pp-peak VO2)]. Thirty-one patients (42%) displayed inspiratory muscle weakness. Mean (standard deviation) age was 72.5 ± 9.1 years, 53% were women, and 35.1% displayed New York Heart Association class III. Mean peak VO2 and pp-peak VO2 were 10 ± 2.8 mL•min•kg and 57.3 ± 13.8%, respectively. The median (interquartile range) of pp-MIP was 72% (58%-90%). pp-MIP was not correlated with peak VO2 (r = -0.047, P = .689) nor pp-peak VO2 (r = -0.078, P = .509). Furthermore, in multivariable analysis, pp-MIP showed no association with peak VO2 (β coefficient = 0.01, 95% confidence interval -0.01 to 0.03, P = .241) and pp-peak VO2 (β coefficient = -0.00, 95% confidence interval -0.10 to 0.10, P = .975). CONCLUSIONS In symptomatic elderly patients with HFpEF, we found that pp-MIP was not associated with either peak VO2 or pp-peak VO2.
Collapse
Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Eloy Domínguez
- Cardiology Department, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Jose María Ramón
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Laura López
- Facultat de Fisioteràpia, Universitat de València, Spain
| | - Joana Melero
- Cardiology Department, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Alejandro Bellver
- Cardiology Department, Hospital General Universitario de Castellón, Universitat Jaume I, Castellón, Spain
| | - Francisco J Chorro
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Antoni Bayés-Genis
- Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
| |
Collapse
|
49
|
Ding R. Exercise-Based Rehabilitation for Heart Failure: Clinical Evidence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1000:31-49. [PMID: 29098614 DOI: 10.1007/978-981-10-4304-8_3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
People with heart failure experience marked reduction in their exercise capacity which has detrimental effects on their activities of daily living, health-related quality of life, and ultimately their hospital ad-mission rate and mortality. Numerous cardiac rehabilitation studies have demonstrated functional benefits, improvement in quality of life and clinical outcomes from exercise training in patients with HFrEF. Based on evidences, the American College of Cardiology/American Heart Association, European Society of Cardiology, and National Institute for Health and Care Excellence(NICE) consistently recommend exercise-based cardiac rehabilitation(CR) as an effective and safe adjunct for patients with stable class II to III heart failure (HF) who do not have advanced arrhythmias and who do not have other limitations to exercise. This recommendation applies to patients with HFrEF as well as to patients with HFpEF besides patients with class IV HF, although the data are not as robust for patients with HFpEF. In this article, the clinical evidence on effects of exercise for HFrEF and HFpEF as well as end-stage heart failure were separately reviewed.
Collapse
Affiliation(s)
- Rongjing Ding
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, People's Republic of China.
| |
Collapse
|
50
|
Kinugasa Y, Yamamoto K. The challenge of frailty and sarcopenia in heart failure with preserved ejection fraction. Heart 2016; 103:184-189. [PMID: 27940967 DOI: 10.1136/heartjnl-2016-309995] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 01/09/2023] Open
Abstract
Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to stressors. Frailty is often accompanied by heart failure with preserved ejection fraction (HFpEF), and frailty is likely to affect its clinical features and outcomes. Frail patients with HFpEF are frequently associated with sarcopenia (ie, muscle loss and weakness), which is a major component of the pathophysiology of frailty. Sarcopenia is a systemic skeletal muscle disease that impairs the function of limb skeletal muscles, as well as respiratory muscles, and this results in further functional decline. In addition, sarcopenia may contribute to cardiovascular remodelling and dysfunction, leading to the development of HFpEF through several metabolic and endocrine abnormalities. Although there is no established strategy for frail patients with HFpEF, a multidisciplinary approach, including various types of muscular training and nutritional intervention, may provide beneficial effects for these patients.
Collapse
Affiliation(s)
- Yoshiharu Kinugasa
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| |
Collapse
|