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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.
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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
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Economidou EC, Lianopoulou B, Soteriades S, Soteriades ES. Cardiac Rehabilitation Programs: Content, Effectiveness, Limitations, and Gaps in Knowledge. Cardiol Rev 2024; 32:157-161. [PMID: 36730494 DOI: 10.1097/crd.0000000000000492] [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: 02/04/2023]
Abstract
Cardiac rehabilitation (CR) constitutes a valuable therapeutic approach for patients with a broad spectrum of cardiovascular diseases facilitating the development and maintenance of a desirable level of physical, social, and psychological functioning following the onset of cardiovascular disease. Nowadays, cardiac rehabilitation programs emphasize the use of a multidisciplinary approach. The current review aims at presenting the state-of-the-art knowledge on the indications of patients entering cardiac rehabilitation programs, including their core components, duration, and effectiveness. Following a careful review of the international literature, we conclude that there are significant differences between the most commonly cited international CR guidelines as well as additional limitations and gaps in knowledge. Despite the benefits associated with CR and despite their widespread acceptance, CR referrals and program attendance remains low, while many questions have not been so far addressed through scientific research. Overall, the findings of our study suggest a critical need for the development of robust and evidence-based standardized CR interventions to increase their use and effectiveness throughout the world.
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Affiliation(s)
- Eleftheria C Economidou
- From the Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Barbara Lianopoulou
- Management Organization Unit of Development Programs, Human Resource Management, Ministry of Development and Investments, Republic of Greece, Athens, Greece
| | - Soteris Soteriades
- Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Elpidoforos S Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
- Environmental and Occupational Medicine and Epidemiology (EOME), Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
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Kreft SB, Wehner C, Renier CM, Haller IV, Milbrandt S. Effects of Pharmacist-Led Education on Medication Knowledge and Confidence in Cardiac Rehabilitation Patients. J Cardiopulm Rehabil Prev 2023; 43:226-229. [PMID: 36857096 DOI: 10.1097/hcr.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Sierra B Kreft
- Department of Pharmacy, Essentia Health, Fargo, North Dakota (Drs Kreft and Wehner and Ms Milbrandt); Reseach Informatics, Essentia Institute of Rural Health, Duluth, Minnesota (Ms Renier); Research Operations, Essentia Institute of Rural Health, Duluth, Minnesota (Dr Haller); and North Dakota State University School of Pharmacy, Fargo (Ms Milbrandt)
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Gloc D, Nowak Z, Nowak-Lis A, Gabryś T, Szmatlan-Gabrys U, Valach P, Pilis A. Indoor cycling training in rehabilitation of patients after myocardial infarction. BMC Sports Sci Med Rehabil 2021; 13:151. [PMID: 34844646 PMCID: PMC8628460 DOI: 10.1186/s13102-021-00379-w] [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] [Received: 05/07/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standard endurance training used from the second stage of cardiac rehabilitation has many common features with indoor cycling training which is used in fitness clubs. In the study, an attempt was made to evaluate the usefulness of this form of training in a 24-day rehabilitation program for patients after myocardial infarction. The study examined a group of 64 patients (51.34 ± 8.02 years) who were divided into two groups: the IC group (32 patients aged 53.40 ± 4.31 years) with indoor cycling training instead of standard endurance training; and the ST group (32 patients aged 55.31 ± 6.45 years) performing standard training. The level of exercise tolerance (cardiopulmonary exercise testing on a treadmill-Bruce's protocol), hemodynamic indicators of the left ventricle (echocardiography) and blood lipid profile (laboratory test) were assessed. RESULTS In the IC group there was a significant increase in the test duration (9.21 ± 2.02 vs 11.24 ± 1.26 min; p < 0.001), the MET value (9.16 ± 1.30 vs 10.73 ± 1.23; p = 0.006) and VO2max (37.27 ± 3.23 vs 39.10 ± 3.17 ml/kg/min; p < 0.001). Parallel changes were observed in the ST group, where the following parameters improved: the test duration (9.41 ± 0.39 vs 10.91 ± 2.22; p < 0.001), MET value (8.65 ± 0.25 vs 9.86 ± 1.12; p = 0.002) and VO2max (36.89 ± 6.22 vs 38.76 ± 3.44; p < 0.001). No statistically significant changes were found in the hemodynamic indices of the left ventricle and the lipid profile. Also, the intergroup analysis did not show any statistical significance. CONCLUSION Based on the research results, it was found that indoor cycling training in the second phase of cardiac rehabilitation is a safe form of therapy and therefore may be an interesting alternative method to the classic bicycle ergometer exercise in the stage of early cardiac rehabilitation.
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Affiliation(s)
- Dagmara Gloc
- Silesian Center for Rehabilitation and Prevention, 43-450 Ustron, Poland
| | - Zbigniew Nowak
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Agata Nowak-Lis
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Tomasz Gabryś
- Sport Centrum Faculty of Pedagogy, University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - Urszula Szmatlan-Gabrys
- Department of Anatomy, Faculty of Rehabilitation, University of Physical Education, 31-571 Kraków, Poland
| | - Peter Valach
- Sport Centrum Faculty of Pedagogy, University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - Anna Pilis
- Faculty of Health Science, Jan Dlugosz University, 42-200 Czestochowa, Poland
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Piotrowska M, Okrzymowska P, Kucharski W, Rożek-Piechura K. Application of Inspiratory Muscle Training to Improve Physical Tolerance in Older Patients with Ischemic Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312441. [PMID: 34886168 PMCID: PMC8657106 DOI: 10.3390/ijerph182312441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022]
Abstract
Regardless of the management regime for heart failure (HF), there is strong evidence supporting the early implementation of exercise-based cardiac rehabilitation (CR). Respiratory therapy is considered to be an integral part of such secondary prevention protocols. The aim of the study was to evaluate the effect of inspiratory muscle training (IMT) on exercise tolerance and the functional parameters of the respiratory system in patients with heart failure involved in cardiac rehabilitation. The study included 90 patients with HF who took part in the second-stage 8-week cycle of cardiac rehabilitation (CR). They were randomly divided into three groups: Group I underwent CR and IMT; Group II only CR; and patients in Group III underwent only the IMT. Before and after the 8-week cycle, participants were assessed for exercise tolerance and the functional parameters of respiratory muscle strength. Significant statistical improvement concerned the majority of the hemodynamic parameters, lung function parameters, and respiratory muscle strength in the first group. Moreover, the enhancement in the exercise tolerance in the CR + IMT group was accompanied by a negligible change in the HRpeak. The results confirm that the addition of IMT to the standard rehabilitation process of patients with heart failure can increase the therapeutic effect while influencing some of the parameters measured by exercise electrocardiography and respiratory function.
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Affiliation(s)
- Monika Piotrowska
- Department of Physiotherapy in Internal Disease, Wroclaw University of Health and Sport, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland; (M.P.); (K.R.-P.)
| | - Paulina Okrzymowska
- Department of Physiotherapy in Internal Disease, Wroclaw University of Health and Sport, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland; (M.P.); (K.R.-P.)
- Correspondence:
| | - Wojciech Kucharski
- Department of Human Biology, Wroclaw University of Health and Sport Sciences, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland;
- Cardiac Rehabilitation Unit, Hospital of Vratislavia Medica, Saint John Paul II, ul. Lekarska 1, 51-134 Wrocław, Poland
| | - Krystyna Rożek-Piechura
- Department of Physiotherapy in Internal Disease, Wroclaw University of Health and Sport, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland; (M.P.); (K.R.-P.)
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The Use of Artificial Hypoxia in Endurance Training in Patients after Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041633. [PMID: 33572082 PMCID: PMC7915043 DOI: 10.3390/ijerph18041633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
The presence of a well-developed collateral circulation in the area of the artery responsible for the infarction improves the prognosis of patients and leads to a smaller area of infarction. One of the factors influencing the formation of collateral circulation is hypoxia, which induces angiogenesis and arteriogenesis, which in turn cause the formation of new vessels. The aim of this study was to assess the effect of endurance training conducted under normobaric hypoxia in patients after myocardial infarction at the level of exercise tolerance and hemodynamic parameters of the left ventricle. Thirty-five patients aged 43–74 (60.48 ± 4.36) years who underwent angioplasty with stent implantation were examined. The program included 21 training units lasting about 90 min. A statistically significant improvement in exercise tolerance assessed with the cardiopulmonary exercise test (CPET) was observed: test duration (p < 0.001), distance covered (p < 0.001), HRmax (p = 0.039), maximal systolic blood pressure (SBPmax) (p = 0.044), peak minute ventilation (VE) (p = 0.004) and breathing frequency (BF) (p = 0.044). Favorable changes in left ventricular hemodynamic parameters were found for left ventricular end-diastolic dimension LVEDD (p = 0.002), left ventricular end-systolic dimension LVESD (p = 0.015), left ventricular ejection fraction (LVEF) (p = 0.021), lateral e’ (p < 0.001), septal e’ (p = 0.001), and E/A (p = 0.047). Endurance training conducted in hypoxic conditions has a positive effect on exercise tolerance and the hemodynamic indicators of the left ventricle.
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