1
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Ribeiro GDS, Deresz LF, Salvioni E, Hansen D, Agostoni P, Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int J Cardiol 2022; 360:39-43. [PMID: 35623479 DOI: 10.1016/j.ijcard.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) shows a four-fold greater risk of adverse events. This study aims to analyze the sensitivity and specificity of three EOV diagnostic definitions to predict adverse outcomes at a 2-year follow-up and to compare its EOV prevalence and relations with the patient's profile. METHODS Cardiopulmonary exercise tests from 233 heart failure patients were analyzed. Two blinded reviewers used a semiautomated software to identify EOV cases pattern according to the definitions of Ben-Dov, Corrà, and Leite. Data were grouped in EOV-positive or EOV-negative according to each definition. Baseline characteristics, EOV prevalence, relative risk, sensitivity, and specificity to predict 2-years of major adverse cardiovascular outcomes were analyzed. RESULTS The Corrà definition led to the best prediction of 2-year major cardiovascular adverse outcomes (HR 2.46 [1.16 to 5.25]; p = 0.019, AUC = 0.618; p = 0.007). EOV prevalence was 17.2%, 17.2%, and 9.4% applying Ben-Dov, Corrà, and Leite definition, respectively. The main clinical differences between EOV-positive and EOV-negative patients were: MECKI score and VE/VCO2 slope (all definitions), and BNP levels (Ben-Dov and Leite). BNP levels were correlated with amplitude (rho = 0.255; p = 0.033) and cycle length (rho = 0.388; p = 0.002). CONCLUSION Corrà definition was the only one that exhibited the capacity to predict major adverse cardiovascular outcomes at a 2-year follow-up. Regardless of its definition, EOV was more often prevalent in patients with a greater MECKI score and VE/VCO2 slope values.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, Brazil
| | | | - Dominique Hansen
- Hasselt University (UHASSELT), Faculty of Rehabilitation Sciences, BIOMED/REVAL, Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, Brazil.
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2
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Ribeiro GS, Cargnin C, Dal Lago P, Hansen D, Agostoni P, Karsten M. Exercise training effects on metabolic and ventilatory changes in heart failure patients with exercise oscillatory ventilation: systematic review and meta-analysis. Eur J Prev Cardiol 2021; 29:e233-e236. [PMID: 34849706 DOI: 10.1093/eurjpc/zwab195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Gustavo S Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite 245, 90050-170 Porto Alegre, Brazil
| | - Camila Cargnin
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite 245, 90050-170 Porto Alegre, Brazil
| | - Pedro Dal Lago
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite 245, 90050-170 Porto Alegre, Brazil.,Departamento de Fisioterapia, UFCSPA, Rua Sarmento Leite 245, 90050-170 Porto Alegre, Brazil
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences, Hasselt University (UHASSELT), BIOMED/REVAL, Agoralaan, Building A, 3590 Diepenbeek, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy.,Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite 245, 90050-170 Porto Alegre, Brazil.,Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone 358, 88080-350 Florianópolis, Brazil.,Programa de Pós-Graduação em Fisioterapia, UDESC, Rua Pascoal Simone 358, 88080-350 Florianópolis, Brazil
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3
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Díaz-Jara E, Díaz HS, Rios-Gallardo A, Ortolani D, Andrade DC, Toledo C, Pereyra KV, Schwarz K, Ramirez G, Ortiz FC, Andía ME, Del Rio R. Exercise training reduces brainstem oxidative stress and restores normal breathing function in heart failure. Free Radic Biol Med 2021; 172:470-481. [PMID: 34216779 DOI: 10.1016/j.freeradbiomed.2021.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 10/21/2022]
Abstract
Enhanced central chemoreflex drive and irregular breathing are both hallmarks in heart failure (HF) and closely related to disease progression. Central chemoreceptor neurons located within the retrotrapezoid nucleus (RTN) are known to play a role in breathing alterations in HF. It has been shown that exercise (EX) effectively reduced reactive oxygen species (ROS) in HF rats. However, the link between EX and ROS, particularly at the RTN, with breathing alterations in HF has not been previously addressed. Accordingly, we aimed to determine: i) ROS levels in the RTN in HF and its association with chemoreflex drive, ii) whether EX improves chemoreflex/breathing function by reducing ROS levels, and iii) determine molecular alterations associated with ROS generation within the RTN of HF rats and study EX effects on these pathways. Adult male Sprague-Dawley rats were allocated into 3 experimental groups: Sham (n = 5), volume overloaded HF (n = 6) and HF (n = 8) rats that underwent EX training for 6 weeks (60 min/day, 25 m/min, 10% inclination). At 8 weeks post-HF induction, breathing patterns and chemoreflex function were analyzed by unrestrained plethysmography. ROS levels and anti/pro-oxidant enzymes gene expression were analyzed in the RTN. Our results showed that HF rats have high ROS levels in the RTN which were closely linked to the enhanced central chemoreflex and breathing disorders. Also, HF rats displayed decreased expression of antioxidant genes in the RTN compared with control rats. EX training increases antioxidant defense in the RTN, reduces ROS formation and restores normal central chemoreflex drive and breathing regularity in HF rats. This study provides evidence for a role of ROS in central chemoreception in the setting of HF and support the use of EX to reduce ROS in the brainstem of HF animals and reveal its potential as an effective mean to normalize chemoreflex and breathing function in HF.
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Affiliation(s)
- Esteban Díaz-Jara
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
| | - Hugo S Díaz
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
| | - Angélica Rios-Gallardo
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile; Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, 621-0427, Punta Arenas, Chile.
| | - Domiziana Ortolani
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile; Centro de Fisiología y Medicina de Altura, Facultad de Ciencias de la Salud, Universidad de Antofagasta, 1270300, Antofagasta, Chile.
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile; Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, 621-0427, Punta Arenas, Chile.
| | - Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
| | - Karla Schwarz
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
| | - Gigliola Ramirez
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
| | - Fernando C Ortiz
- Centro de Investigación Biomédica, Universidad Autónoma de Chile, Santiago, Chile.
| | - Marcelo E Andía
- Radiology Department & ANID - Millennium Nucleus for Cardiovascular Magnetic Resonance, 8331150, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile; Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, 621-0427, Punta Arenas, Chile; Centro de Envejecimiento y Regeneración (CARE), Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile.
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Exercise Training Enhances Angiogenesis-Related Gene Responses in Skeletal Muscle of Patients with Chronic Heart Failure. Cells 2021; 10:cells10081915. [PMID: 34440684 PMCID: PMC8392138 DOI: 10.3390/cells10081915] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/12/2021] [Accepted: 07/23/2021] [Indexed: 01/31/2023] Open
Abstract
Peripheral myopathy consists of a hallmark of heart failure (HF). Exercise enhanced skeletal muscle angiogenesis, and thus, it can be further beneficial towards the HF-induced myopathy. However, there is limited evidence regarding the exercise type that elicits optimum angiogenic responses of skeletal muscle in HF patients. This study aimed to (a) compare the effects of a high-intensity-interval-training (HIIT) or combined HIIT with strength training (COM) exercise protocol on the expression of angiogenesis-related factors in skeletal muscle of HF patients, and (b) examine the potential associations between the expression of those genes and capillarization in the trained muscles. Thirteen male patients with chronic HF (age: 51 ± 13 y; BMI: 27 ± 4 kg/m2) were randomly assigned to a 3-month exercise program that consisted of either HIIT (N = 6) or COM training (N = 7). Vastus lateralis muscle biopsies were performed pre- and post-training. RT-PCR was used to quantify the fold changes in mRNA expression of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 2 (VEGFR-2), hypoxia-inducible factor 1 alpha (HIF-1α), angiopoietin 1 (Ang-1), angiopoietin 2 (Ang-2), angiopoietin receptor (Tie2), and matrix metallopeptidase 9 (MMP-9), and immunohistochemistry to assess capillarization in skeletal muscle post-training. There was an overall increase in the expression levels of VEGF, VEGFR-2, HIF-1α, Ang2, and MMP9 post-training, while these changes were not different among groups. Changes in capillary-to-fibre ratio were found to be strongly associated with Tie2 and HIF-1α expression. This was the first study demonstrating that both HIIT and combined HIIT with strength training enhanced similarly the expression profile of angiogenic factors in skeletal muscle of HF patients, possibly driving the angiogenic program in the trained muscles, although those gene expression increases were found to be only partially related with muscle capillarization.
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5
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Exercise oscillatory ventilation during autonomic blockade in young athletes and healthy controls. Eur J Appl Physiol 2021; 121:2499-2507. [PMID: 34031723 DOI: 10.1007/s00421-021-04720-6] [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: 01/07/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Exercise oscillatory ventilation (EOV) is a form of periodic breathing that is associated with a poor prognosis in heart failure patients, but little is known about EOV in other populations. We sought to provide insights into the phenomenon of EOV after it was observed in young healthy subjects, including athletes, after the administration of dual autonomic blockade (DAB). METHODS From 29 participants who completed cardiopulmonary exercise testing (CPET) with and without DAB (0.04 mg/kg atropine and 0.2 mg/kg metoprolol), 5 subjects developed EOV (age = 29 ± 5 years; 3/5 were athletes) according to American Heart Association criteria. For each case, we identified 2 non-EOV healthy controls (age = 34.2 ± 8.3; 7/10 were athletes) that were subsequently age- and sex-matched. RESULTS No participants had EOV during exercise without DAB. The 5 participants (4 male, 1 female) who demonstrated EOV with DAB had lower mean tidal volume (1.7 ± 0.5 L/min vs. 1.8 ± 0.5 L/min; p = 0.04) compared to participants in the non-EOV group and a decrease in peak tidal volume (2.9 ± 0.6 L/min to 2.2 ± 0.7 L/min; p = 0.004) with DAB. There were few other differences in CPET measures between EOV and non-EOV participants, although the PETCO2 tended to be higher in the EOV group (p = 0.07). CONCLUSION EOV can be elucidated in young healthy subjects, including athletes, during cardiopulmonary exercise testing, suggesting that it may not be an ominous sign in all populations.
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6
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Elpida K, Constantinos PH, Ioannis V, Athena K, Sotirios K, Eleftherios K, Serafeim N. A constructivist approach to teaching patients with heart failure: results from an intervention study. Eur J Cardiovasc Nurs 2021; 20:331-341. [PMID: 33620499 DOI: 10.1093/eurjcn/zvaa003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/08/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022]
Abstract
AIMS Despite published guidelines emphasizing the importance of education in the management of heart failure (HF), the most effective method of education remains unknown. The aim of this study was to test the efficacy of constructivist teaching method (CTM) on the patients with HF. METHODS AND RESULTS This is a single-centre, randomized controlled trial. Patients in the intervention group were educated using the CTM in five phases: orientation, elicitation, restructuring, application, and review. The duration of intervention was 6 months. For the study outcome measures, five questionnaires were used: Atlanta Heart Failure Knowledge Test (AHFK), Minnesota Living with Heart Failure (HMLHFQ), Self-Efficacy for Appropriate Medication Use Scale (SEAMS), European Heart Failure Self-care Behaviour Scale (EHFScBS-9), and Duke Activity Status Index (DASI). A total of 122 adults (83.6% male, mean age ± standard deviation 67.1 ± 12.3 years) were enrolled in the study; 61 in the intervention group and 61 in the control group. At 6 months, the knowledge, the quality of life, the self-efficacy for appropriate medication use, the self-care behaviour, and the activity were improved in both groups but the degree of change was greater in the intervention group as indicated from the results of repeated measurements analysis of variance (P < 0.001). Significantly lower proportion of readmission at hospital at 1 month (8.2% vs. 23%, P = 0.025), and 6 months (13.1% vs. 36.1%, P = 0.003) were found for the intervention group. CONCLUSIONS Training of HF patients through the CTM helps effectively manage the disease while significantly reducing hospital readmissions due to decompensation.
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Affiliation(s)
- Kroustalli Elpida
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
| | | | - Vasileiadis Ioannis
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
| | - Kalokairinou Athena
- Department of Nursing, National and Kapodistrian of University of Athens, Athens 11527, Greece
| | - Kiokas Sotirios
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece.,Cardiology Department, "Korgialenio-Benakio Hellenic Red Cross" General Hospital, Athens 11526, Greece
| | - Karatzanos Eleftherios
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
| | - Nanas Serafeim
- Clinical Ergospirometry Laboratory, Exercise, Advanced Technology and Rehabilitation, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Athens 11527, Greece
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7
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Liang B, Zhao YX, Zhang XX, Liao HL, Gu N. Reappraisal on pharmacological and mechanical treatments of heart failure. Cardiovasc Diabetol 2020; 19:55. [PMID: 32375806 PMCID: PMC7202267 DOI: 10.1186/s12933-020-01024-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a highly frequent disorder with considerable morbidity, hospitalization, and mortality; thus, it invariably places pressure on clinical and public health systems in the modern world. There have been notable advances in the definition, diagnosis, and treatment of HF, and newly developed agents and devices have been widely adopted in clinical practice. Here, this review first summarizes the current emerging therapeutic agents, including pharmacotherapy, device-based therapy, and the treatment of some common comorbidities, to improve the prognosis of HF patients. Then, we discuss and point out the commonalities and areas for improvement in current clinical studies of HF. Finally, we highlight the gaps in HF research. We are looking forward to a bright future with reduced morbidity and mortality from HF.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu-Xiu Zhao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
| | | | - Hui-Ling Liao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China.,College of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
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8
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Abstract
This document reflects the key points of a consensus meeting of the Heart Failure Association of European Society of Cardiology (ESC) held to provide an overview the role of physiological monitoring in the complex multimorbid heart failure (HF) patient. This article reviews assessments of the functional ability of patients with HF. The gold standard measurement of cardiovascular functional capacity is peak oxygen consumption obtained from a cardiopulmonary exercise test. The 6-min walk test provides an indirect measure of cardiovascular functional capacity. Muscular functional capacity is assessed using either a 1−repetition maximum test of the upper and lower body or other methods, such as handgrip measurement. The short physical performance battery may provide a helpful, indirect indication of muscular functional capacity.
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Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, Cantone del Cristo, 29121 Piacenza, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Giuseppe Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
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9
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Jesus ICD, Menezes Junior FJD, Bento PCB, Wiens A, Mota J, Leite N. Effect of combined interval training on the cardiorespiratory fitness in heart failure patients: a systematic review and meta-analysis. Braz J Phys Ther 2020; 24:8-19. [PMID: 31047776 PMCID: PMC6994317 DOI: 10.1016/j.bjpt.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/07/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols. OBJECTIVE To evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure. METHODS We search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model. RESULTS Ten articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO2peak in favor to combined training group compared to interval training group (SMD=0.25; CI=0.04-0.46) and without intervention group (SMD=0.46; CI=0.29-0.64), respectively. CONCLUSION The combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method.
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Affiliation(s)
- Incare Correa De Jesus
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil.
| | | | - Paulo Cesar Barauce Bento
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil
| | - Astrid Wiens
- Farmacy Department, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil
| | - Jorge Mota
- Ciafel, Porto University, Porto, Portugal
| | - Neiva Leite
- Physical Education Department, Research Nucleus of Quality of Life, Universidade Federal Paraná (UFPR), Curitiba, PR, Brazil; Ciafel, Porto University, Porto, Portugal
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10
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Bjarnason-Wehrens B, Nebel R, Jensen K, Hackbusch M, Grilli M, Gielen S, Schwaab B, Rauch B. Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 27:929-952. [PMID: 31177833 PMCID: PMC7272131 DOI: 10.1177/2047487319854140] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background In heart failure with reduced left ventricular ejection fraction (HFrEF)
patients the effects of exercise-based cardiac rehabilitation on top of
state-of-the-art pharmacological and device therapy on mortality,
hospitalization, exercise capacity and quality-of-life are not well
established. Design The design of this study involved a structured review and meta-analysis. Methods Evaluation of randomised controlled trials of exercise-based cardiac
rehabilitation in HFrEF-patients with left ventricular ejection fraction
≤40% of any aetiology with a follow-up of ≥6 months published in 1999 or
later. Results Out of 12,229 abstracts, 25 randomised controlled trials including 4481
HFrEF-patients were included in the final evaluation. Heterogeneity in study
population, study design and exercise-based cardiac
rehabilitation-intervention was evident. No significant difference in the
effect of exercise-based cardiac rehabilitation on mortality compared to
control-group was found (hazard ratio 0.75, 95% confidence interval
0.39–1.41, four studies; 12-months follow-up: relative risk 1.29, 95%
confidence interval 0.66–2.49, eight studies; six-months follow-up: relative
risk 0.91, 95% confidence interval 0.26–3.16, seven studies). In addition
there was no significant difference between the groups with respect to
‘hospitalization-for-any-reason’ (12-months follow-up: relative risk 0.79,
95% confidence interval 0.41–1.53, four studies), or
‘hospitalization-due-to-heart-failure’ (12-months follow-up: relative risk
0.59, 95% confidence interval 0.12–2.91, four studies; six-months follow-up:
relative risk 0.84, 95% confidence interval 0.07–9.71, three studies). All
studies show improvement of exercise capacity. Participation in
exercise-based cardiac rehabilitation significantly improved quality-of-life
as evaluated with the Kansas City Cardiomyopathy Questionnaire: (six-months
follow-up: mean difference 1.94, 95% confidence interval 0.35–3.56, two
studies), but no significant results emerged for quality-of-life measured by
the Minnesota Living with Heart Failure Questionnaire (nine-months or more
follow-up: mean difference –4.19, 95% confidence interval –10.51–2.12, seven
studies; six-months follow-up: mean difference –5.97, 95% confidence
interval –16.17–4.23, four studies). Conclusion No association between exercise-based cardiac rehabilitation and mortality or
hospitalisation could be observed in HFrEF patients but exercise-based
cardiac rehabilitation is likely to improve exercise capacity and quality of
life.
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Affiliation(s)
| | - R Nebel
- Hermann-Albrecht-Klinik Mettnau, Germany
| | - K Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - M Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - M Grilli
- Medical Faculty University Library, University of Mannheim-Heidelberg, Germany
| | - S Gielen
- Department of Cardiology, Angiology and Intensive Care, Klinikum Lippe, Detmold, Germany.,Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - B Schwaab
- Curschmann Klinik, Timmendorfer Strand, Germany
| | - B Rauch
- Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
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11
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Piepoli MF. Editor’s presentation. Eur J Prev Cardiol 2018; 25:1683-1685. [DOI: 10.1177/2047487318806722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Emilia, Romagna, Italy
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12
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Bjarnason-Wehrens B, Predel HG. Inspiratory muscle training – an inspiration for more effective cardiac rehabilitation in heart failure patients? Eur J Prev Cardiol 2018; 25:1687-1690. [DOI: 10.1177/2047487318798917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Germany
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Germany
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13
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Yamaoka-Tojo M. Is It Possible to Distinguish Patients with Terminal Stage of Heart Failure by Analyzing Their Breathing Patterns? Int Heart J 2018; 59:674-676. [PMID: 30068834 DOI: 10.1536/ihj.18-295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
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14
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Piepoli MF. Editor's Presentation. Eur J Prev Cardiol 2017; 25:3-5. [PMID: 29212426 DOI: 10.1177/2047487317747147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Italy
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15
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Panagopoulou N, Karatzanos E, Dimopoulos S, Nanas S. The effect of exercise training on characteristics of exercise oscillatory ventilation in chronic heart failure - Reply to the Letter to the Editor. Eur J Prev Cardiol 2017; 24:1285-1286. [PMID: 28511621 DOI: 10.1177/2047487317709830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Niki Panagopoulou
- Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, School of Medicine, National & Kapodistrian University of Athens, Greece
| | - Eleftherios Karatzanos
- Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, School of Medicine, National & Kapodistrian University of Athens, Greece
| | - Stavros Dimopoulos
- Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, School of Medicine, National & Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- Cardiopulmonary Exercise Testing & Rehabilitation Laboratory, School of Medicine, National & Kapodistrian University of Athens, Greece
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16
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Di Raimondo D, Miceli G, Musiari G, Tuttolomondo A, Pinto A. New insights about the putative role of myokines in the context of cardiac rehabilitation and secondary cardiovascular prevention. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:300. [PMID: 28856140 DOI: 10.21037/atm.2017.07.30] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise training prevents the onset and the development of many chronic diseases, acting as an effective tool both for primary and for secondary prevention. Various mechanisms that may be the effectors of these beneficial effects have been proposed during the past decades: some of these are well recognized, others less. Muscular myokines, released during and after muscular contraction, have been proposed as key mediators of the systemic effects of the exercise. Nevertheless the availability of an impressive amount of evidence regarding the systemic effects of muscle-derived factors, few studies have examined key issues: (I) if skeletal muscle cells themselves are the main source of cytokine during exercise; (II) if the release of myokines into the systemic circulation reach an adequate concentration to provide significant effects in tissues far from skeletal muscle; (III) what may be the role carried out by muscular cytokine regarding the well-known benefits induced by regular exercise, first of all the anti-inflammatory effect of exercise. Furthermore, a greater part of our knowledge regarding myokines derives from the muscle of healthy subjects. This knowledge may not necessarily be transferred per se to subjects with chronic diseases implicating a direct or indirect muscular dysfunction and/or a chronic state of inflammation with persistent immune-inflammatory activation (and therefore increased circulating levels of some cytokines): cachexia, sarcopenia due to multiple factors, disability caused by neurological damage, chronic congestive heart failure (CHF) or coronary artery disease (CAD). A key point of future studies is to ascertain how is modified the muscular release of myokines in different categories of unhealthy subjects, both at baseline and after rehabilitation. The purpose of this review is to discuss the main findings on the role of myokines as putative mediators of the therapeutic benefits obtained through regular exercise in the context of secondary cardiovascular prevention.
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Affiliation(s)
- Domenico Di Raimondo
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Giuseppe Miceli
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Gaia Musiari
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Antonino Tuttolomondo
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
| | - Antonio Pinto
- Dipartimento Biomedico di Medicina interna e Specialistica, University of PALERMO, Palermo, Italy
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17
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Cornelis J, Vrints C, Vissers D, Beckers P. The effect of exercise training on exercise oscillatory ventilation in heart failure. Eur J Prev Cardiol 2017; 24:1283-1284. [PMID: 28511622 DOI: 10.1177/2047487317709824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Justien Cornelis
- 1 University of Antwerp (Faculty of Medicine and Health), Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Christiaan Vrints
- 2 Antwerp University Hospital (Department of Cardiology), Edegem, Belgium.,3 University of Antwerp (Faculty of Medicine and Health), Department of Medicine, Wilrijk, Belgium
| | - Dirk Vissers
- 1 University of Antwerp (Faculty of Medicine and Health), Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Paul Beckers
- 1 University of Antwerp (Faculty of Medicine and Health), Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium.,2 Antwerp University Hospital (Department of Cardiology), Edegem, Belgium.,3 University of Antwerp (Faculty of Medicine and Health), Department of Medicine, Wilrijk, Belgium
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