1
|
Clark HI, Pearson MJ, Smart NA. Rate adaptive pacing in people with chronic heart failure increases peak heart rate but not peak exercise capacity: a systematic review. Heart Fail Rev 2023; 28:21-34. [PMID: 35138522 PMCID: PMC9902309 DOI: 10.1007/s10741-022-10217-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 02/07/2023]
Abstract
Rate adaptive cardiac pacing (RAP) allows increased heart rate (HR) in response to metabolic demand in people with implantable electronic cardiac devices (IECD). The aim of this work was to conduct a systematic review to determine if RAP increases peak exercise capacity (peak VO2) in line with peak HR in people with chronic heart failure. We conducted a systematic literature search from 1980, when IECD and RAP were first introduced, until 31 July 2021. Databases searched include PubMed, Medline, EMBASE, EBSCO, and the Clinical Trials Register. A comprehensive search of the literature produced a total of 246 possible studies; of these, 14 studies were included. Studies and subsequent analyses were segregated according to comparison, specifically standard RAP (RAPON) vs fixed rate pacing (RAPOFF), and tailored RAP (TLD RAPON) vs standard RAP (RAPON). Pooled analyses were conducted for peak VO2 and peak HR for RAPON vs RAPOFF. Peak HR significantly increased by 15 bpm with RAPON compared to RAPOFF (95%CI, 7.98-21.97, P < 0.0001). There was no significant difference between pacing mode for peak VO2 0.45 ml kg-1 min-1 (95%CI, - 0.55-1.47, P = 0.38). This systematic review revealed RAP increased peak HR in people with CHF; however, there was no concomitant improvement in peak VO2. Rather RAP may provide benefits at submaximal intensities by controlling the rise in HR to optimise cardiac output at lower workloads. HR may be an important outcome of CHF management, reflecting myocardial efficiency.
Collapse
Affiliation(s)
- H. I. Clark
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| | - M. J. Pearson
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| | - N. A. Smart
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| |
Collapse
|
2
|
Impact of β-Blockers on Heart Rate and Oxygen Uptake During Exercise and Recovery in Older Patients With Heart Failure With Preserved Ejection Fraction. J Cardiopulm Rehabil Prev 2021; 40:174-177. [PMID: 31899703 DOI: 10.1097/hcr.0000000000000459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The study aimed to investigate the differences in oxygen uptake ((Equation is included in full-text article.)O2) and heart rate (HR) (at rest, submaximal exercise, peak exercise, and recovery) in patients with heart failure with preserved ejection fraction (HFpEF) with β-blockers (BB) or without BB treatment (NBB) and to analyze the relationship between HR reserve (HRresv) and peak (Equation is included in full-text article.)O2 ((Equation is included in full-text article.)O2peak) in BB and NBB. METHODS A total of 174 HFpEF patients (>65 yr; BB, n = 59; NBB, n = 115) were assessed with a cardiopulmonary exercise test to peak exertion using an incremental protocol. After 5 min of supine rest, HR and (Equation is included in full-text article.)O2 (HRrest, (Equation is included in full-text article.)O2rest) at submaximal exercise (HRsubmax, (Equation is included in full-text article.)O2submax), at peak exercise (HRpeak, (Equation is included in full-text article.)O2peak), at 1 min of passive recovery (HRrec1), HRresv (HRpeak- HRrest), and HR recovery (HRrecov = HRpeak- HRrec1) were evaluated. RESULTS Analysis showed that HRrest (66.0 ± 12.2 vs 69.7 ± 10.6 bpm), HRsubmax (91.7 ± 16.2 vs 98.6 ± 15.2 bpm), and HRrec1 (102.9 ± 18.9 vs 109.4 ± 16.9 bpm) were significantly lower (P ≤ .05) in BB than in NBB, respectively. However, there were no significant differences (P > .05) between the BB and the NBB for HRpeak, HRresv, HRrecov, (Equation is included in full-text article.)O2rest, (Equation is included in full-text article.)O2submax, and (Equation is included in full-text article.)O2peak. A significant relationship was found between HRresv and (Equation is included in full-text article.)O2peak values in both groups (BB, r = 0.52; NBB, r = 0.49, P < .001). CONCLUSIONS The nonsignificant differences in HRpeak, HRresv, HRrecov, or (Equation is included in full-text article.)O2 values between BB and NBB HFpEF patients, along with significant correlation between HRresv and (Equation is included in full-text article.)O2peak, suggest that these measures may have equal utility in prognostic and functional assessment as well as clinical applications, including the prescription of exercise, in elderly HFpEF patients.
Collapse
|
3
|
Anselmi F, Cavigli L, Pagliaro A, Valente S, Valentini F, Cameli M, Focardi M, Mochi N, Dendale P, Hansen D, Bonifazi M, Halle M, D'Ascenzi F. The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects. Scand J Med Sci Sports 2021; 31:1796-1808. [PMID: 34170582 PMCID: PMC8456830 DOI: 10.1111/sms.14007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1 ) and second ventilatory thresholds (VT2 ) in cardiac patients, sedentary subjects, and athletes comparing VT1 and VT2 with EI defined by recommendations. METHODS We prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2 , peak heart rate (HR), and HR reserve were obtained at VT1 and VT2 and compared with the EI definition proposed by the recommendations. RESULTS VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively). CONCLUSIONS EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable to define an appropriate level of EI.
Collapse
Affiliation(s)
- Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Clinical and Surgical Cardiology Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena, Siena, Italy
| | - Serafina Valente
- Clinical and Surgical Cardiology Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena, Siena, Italy
| | - Francesca Valentini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Mochi
- Sports Medicine Unit, USL Toscana Centro, Florence, Italy
| | - Paul Dendale
- Heartcentre Hasselt, Jessa Hospital, Hasselt University, Hasselt, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Munich, Germany
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.,Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Kalazich-Rosales M, Mautner-Molina C, König-Araya C, Fuentes-Leal F, Cárcamo-Ibaceta C, Martínez-Huenchullán S. Demographic/anthropometric factors and physiological performance-related parameters associated with the six-minute walk test in bariatric surgery candidates, from Valdivia, Chile. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/20009228032021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The six-minute walk test (6MWT) is widely used to measure functional capacity in special populations. However, the factors associated with its performance in candidates for bariatric surgery are unclear. Therefore, this study aimed to investigate the influence of anthropometric and physiological factors in the 6MWT performance in bariatric surgery candidates. This cross-sectional study included 107 candidates for bariatric surgery. Anthropometric factors considered: gender, weight, height, body mass index (BMI), waist-to-hip, and waist-to-height ratios. Along with distance covered during 6MWT, physiological factors such as ratings of perceived exertion (RPE) and heart rate reserve percentage used (%HRR) were recorded. Among the 107 patients (mean age: 39.6 years), 83 volunteers were accepted to perform the 6MWT. No gender differences were observed in terms of distance covered, %HRR, and RPE during the 6MWT. Moreover, BMI and %HRR explained 21% of the 6MWT distance covered. Furthermore, participants with BMI ≤41.5 kg/m2 walked ~50 meters more than their peers above this level (p=0.05). Interestingly, heart rate increase during the 6MWT was lower than described for healthy populations. BMI and %HRR partially explain the variability of the 6MWT performance in bariatric surgery candidates.
Collapse
|
5
|
Nakanishi M, Izumi S, Nagayoshi S, Kawaguchi H, Yoshimoto M, Shiga T, Ando T, Nakae S, Usui C, Aoyama T, Tanaka S. Estimating metabolic equivalents for activities in daily life using acceleration and heart rate in wearable devices. Biomed Eng Online 2018; 17:100. [PMID: 30055617 PMCID: PMC6064136 DOI: 10.1186/s12938-018-0532-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/21/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Herein, an algorithm that can be used in wearable health monitoring devices to estimate metabolic equivalents (METs) based on physical activity intensity data, particularly for certain activities in daily life that make MET estimation difficult. RESULTS Energy expenditure data were obtained from 42 volunteers using indirect calorimetry, triaxial accelerations and heart rates. The proposed algorithm used the percentage of heart rate reserve (%HRR) and the acceleration signal from the wearable device to divide the data into a middle-intensity group and a high-intensity group (HIG). The two groups were defined in terms of estimated METs. Evaluation results revealed that the classification accuracy for both groups was higher than 91%. To further facilitate MET estimation, five multiple-regression models using different features were evaluated via leave-one-out cross-validation. Using this approach, all models showed significant improvements in mean absolute percentage error (MAPE) of METs in the HIG, which included stair ascent, and the maximum reduction in MAPE for HIG was 24% compared to the previous model (HJA-750), which demonstrated a 70.7% improvement ratio. The most suitable model for our purpose that utilized heart rate and filtered synthetic acceleration was selected and its estimation error trend was confirmed. CONCLUSION For HIG, the MAPE recalculated by the most suitable model was 10.5%. The improvement ratio was 71.6% as compared to the previous model (HJA-750C). This result was almost identical to that obtained from leave-one-out cross-validation. This proposed algorithm revealed an improvement in estimation accuracy for activities in daily life; in particular, the results included estimated values associated with stair ascent, which has been a difficult activity to evaluate so far.
Collapse
Affiliation(s)
- Motofumi Nakanishi
- Omron Healthcare Co., Ltd., 53 Kunotsubo, Terado-cho, Muko, Kyoto 617-0002 Japan
- The Graduate School of System Informatics, Kobe University, 1-1 Rokkodai, Nada, Kobe, Hyogo 657-8501 Japan
| | - Shintaro Izumi
- The Institute of Scientific and Industrial Research Osaka University, 8-1 Mihogaoka, Ibaraki, Osaka 567-0047 Japan
| | - Sho Nagayoshi
- Omron Healthcare Co., Ltd., 53 Kunotsubo, Terado-cho, Muko, Kyoto 617-0002 Japan
| | - Hiroshi Kawaguchi
- The Graduate School of System Informatics, Kobe University, 1-1 Rokkodai, Nada, Kobe, Hyogo 657-8501 Japan
| | - Masahiko Yoshimoto
- The Graduate School of System Informatics, Kobe University, 1-1 Rokkodai, Nada, Kobe, Hyogo 657-8501 Japan
| | - Toshikazu Shiga
- Omron Healthcare Co., Ltd., 53 Kunotsubo, Terado-cho, Muko, Kyoto 617-0002 Japan
| | - Takafumi Ando
- The Section of Energy Metabolism, Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku, Tokyo 162-8636 Japan
| | - Satoshi Nakae
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka 560-8531 Japan
| | - Chiyoko Usui
- Department of Communication, Division of Human Science, Tokyo Woman’s Christian University, 2-6-1 Zempukuji, Suginami-ku, Tokyo 167-8585 Japan
| | - Tomoko Aoyama
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku, Tokyo 162-8636 Japan
| | - Shigeho Tanaka
- The Section of Energy Metabolism, Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku, Tokyo 162-8636 Japan
| |
Collapse
|
6
|
Yoshimura K, Urabe Y, Maeda N, Yuguchi S, Yoshida T. Dynamics of cardiorespiratory response during and after the six-minute walk test in patients with heart failure. Physiother Theory Pract 2018; 36:476-487. [DOI: 10.1080/09593985.2018.1489925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kae Yoshimura
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
- Department of Sports Rehabilitation, Graduate School of Biomedical & Health Sciences, Hiroshima University, Horoshima, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical & Health Sciences, Hiroshima University, Horoshima, Japan
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical & Health Sciences, Hiroshima University, Horoshima, Japan
| | - Satoshi Yuguchi
- Department of Physical Therapy, Japan University of Health Sciences, Saitama, Japan
| | - Toshinobu Yoshida
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| |
Collapse
|
7
|
Oliveira MF, Zanussi G, Sprovieri B, Lobo DML, Mastrocolla LE, Umeda IIK, Sperandio PA. Alternatives to Aerobic Exercise Prescription in Patients with Chronic Heart Failure. Arq Bras Cardiol 2016; 106:97-104. [PMID: 26815313 PMCID: PMC4765007 DOI: 10.5935/abc.20160014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/30/2015] [Indexed: 01/14/2023] Open
Abstract
Background Exercise is essential for patients with heart failure as it leads to a reduction in
morbidity and mortality as well as improved functional capacity and oxygen uptake
(⩒O2). However, the need for an experienced physiologist and the
cost of the exam may render the cardiopulmonary exercise test (CPET) unfeasible. Thus,
the six-minute walk test (6MWT) and step test (ST) may be alternatives for exercise
prescription. Objective The aim was to correlate heart rate (HR) during the 6MWT and ST with HR at the
anaerobic threshold (HRAT) and peak HR (HRP) obtained on the
CPET. Methods Eighty-three patients (58 ± 11 years) with heart failure (NYHA class II) were
included and all subjects had optimized medication for at least 3 months. Evaluations
involved CPET (⩒O2, HRAT, HRP), 6MWT
(HR6MWT) and ST (HRST). Results The participants exhibited severe ventricular dysfunction (ejection fraction: 31
± 7%) and low peak ⩒O2 (15.2 ± 3.1
mL.kg-1.min-1). HRP (113 ± 19 bpm) was higher
than HRAT (92 ± 14 bpm; p < 0.05) and HR6MWT (94
± 13 bpm; p < 0.05). No significant difference was found between
HRP and HRST. Moreover, a strong correlation was found between
HRAT and HR6MWT (r = 0.81; p < 0.0001), and between
HRP and HRST (r = 0.89; p < 0.0001). Conclusion These findings suggest that, in the absence of CPET, exercise prescription can be
performed by use of 6MWT and ST, based on HR6MWT and HRST
Collapse
Affiliation(s)
- Mayron F Oliveira
- Equipe de Fisioterapia, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Gabriela Zanussi
- Equipe de Fisioterapia, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Bianca Sprovieri
- Equipe de Fisioterapia, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Denise M L Lobo
- Equipe de Fisioterapia, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Luiz E Mastrocolla
- Equipe Médica, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Iracema I K Umeda
- Equipe de Fisioterapia, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Priscila A Sperandio
- Equipe de Fisioterapia, Setor de Reabilitação Cardiovascular, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| |
Collapse
|
8
|
Borghi-Silva A, Trimer R, Mendes RG, Arena RA, Schwartzmann PV. Rehabilitation practice patterns for patients with heart failure: the South American perspective. Heart Fail Clin 2014; 11:73-82. [PMID: 25432475 DOI: 10.1016/j.hfc.2014.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is an important public health issue in South America. Economic impacts are substantial. Chagas heart disease is a prevalent HF etiology; it is caused by the protozoan Trypanosoma cruzi. Cardiac rehabilitation (CR) is an integral component of HF care. The benefits of CR in HF patients need to be assessed. The effectiveness and safety of CR delivery, such as home-based interventions, should be explored. Strategies to improve adherence in CR are imperative. We describe past and current CR trends for HF patients and discuss the future of this important intervention.
Collapse
Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil.
| | - Renata Trimer
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis Km 235 - SP - 310, Sao Carlos, Sao Paulo 13565-90, Brazil
| | - Ross A Arena
- Integrative Physiology Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1918 West Taylor Street, Chicago, IL 60612, USA
| | - Pedro V Schwartzmann
- Clinical Hospital, Rehabilitation Institute Lucy Montoro, Ribeirao Preto School of Medicine, University of Sao Paulo, Monte Alegre, Ribeirão Preto, Sao Paulo 14048-900, Brazil
| |
Collapse
|
9
|
Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2013; 32:327-50. [PMID: 23103476 DOI: 10.1097/hcr.0b013e3182757050] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
Collapse
|
10
|
Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, Urhausen A, Williams MA. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 2012; 20:442-67. [PMID: 23104970 DOI: 10.1177/2047487312460484] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
Collapse
Affiliation(s)
- Alessandro Mezzani
- Salvatore Maugeri Foundation IRCCS, Scientific Institute of Veruno, Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Carvalho VO. Aerobic exercise prescription in patients with chronic heart failure: a review in the beta-blocker era. J Cardiovasc Med (Hagerstown) 2012; 13:570-4. [PMID: 22828773 DOI: 10.2459/jcm.0b013e328356a3b2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aerobic exercise training is a well-established nonpharmacological tool in patients with clinically stable chronic heart failure. In recent years, β-blocker therapy has become a primary pharmacologic intervention in patients with chronic heart failure. Despite the undeniable improvements in patients, the β-blocker era has aroused uncertainties about aerobic exercise intensity prescription. It is well known that aerobic exercise prescription is performed by a percentage of the patient's heart rate reserve and the use of β-blockers could interfere in this method. For this reason, the aim of this review is to provide an update about aerobic exercise prescription in patients with chronic heart failure who are using β-blockers.
Collapse
Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade de Cirurgia Cardíaca Pediátrica - Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP), São Paulo, Brazil.
| |
Collapse
|
12
|
Cunha FAD, Farinatti PDTV, Midgley AW. Methodological and practical application issues in exercise prescription using the heart rate reserve and oxygen uptake reserve methods. J Sci Med Sport 2011; 14:46-57. [DOI: 10.1016/j.jsams.2010.07.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 02/11/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
|
13
|
A cutoff point for peak oxygen consumption in the prognosis of heart failure patients with beta-blocker therapy. Int J Cardiol 2010; 145:75-7. [DOI: 10.1016/j.ijcard.2009.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 05/01/2009] [Indexed: 11/19/2022]
|
14
|
Carvalho VO, Bocchi EA, Pascoalino LN, Guimarães GV. The relationship between heart rate and oxygen consumption in heart transplant recipients during a cardiopulmonary exercise test. Int J Cardiol 2010; 145:158-60. [DOI: 10.1016/j.ijcard.2009.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 07/25/2009] [Indexed: 11/25/2022]
|
15
|
Carvalho VO, Bocchi EA, Guimarães GV. The carvedilol's beta-blockade in heart failure and exercise training's sympathetic blockade in healthy athletes during the rest and peak effort. Cardiovasc Ther 2010; 28:87-92. [PMID: 20398097 DOI: 10.1111/j.1755-5922.2009.00113.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In recent years, beta-blocker therapy has become a primary pharmacologic intervention in patients with heart failure by blocking the sympathetic activity. To compare the exercise training's sympathetic blockade in healthy subjects (athletes) and the carvedilol's sympathetic blockade in sedentary heart failure patients by the evaluation of the heart rate dynamic during an exercise test. A total of 26 optimized and 49 nonoptimized heart failure patients in a stable condition (for, at least, 3 months), 15 healthy athletes and 17 sedentary healthy subjects were recruited to perform a cardiopulmonary exercise test. The heart rate dynamic (rest, reserve, peak and the peak heart rate in relation to the maximum predicted for age) was analyzed and compared between the four groups. The heart rate reserve was the same between optimized (48 +/- 15) and nonoptimized (49 +/- 18) heart failure patients (P < 0.0001). The athletes (188 +/- 9) showed a larger heart rate reserve compared to sedentary healthy subjects (92 +/- 10, P < 0.0001). Athletes and healthy sedentary reached the maximum age-predicted heart ratefor their age, but none of the heart failure patients did. The carvedilol's sympathetic blockade occurred during the rest and during the peak effort in the same proportion, but the exercise training's sympathetic blockade in healthy subjects occurred mainly in the rest.
Collapse
Affiliation(s)
- Vitor Oliveira Carvalho
- Laboratório de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP), São Paulo, Brazil.
| | | | | |
Collapse
|
16
|
Carvalho VO, Bocchi EA, Guimarães GV. Aerobic Exercise Prescription in Adult Heart Transplant Recipients: A Review. Cardiovasc Ther 2010; 29:322-6. [DOI: 10.1111/j.1755-5922.2010.00175.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|
17
|
Guimarães GV, D'Avila V, Bocchi EA, Carvalho VO. Norepinephrine remains increased in the six-minute walking test after heart transplantation. Clinics (Sao Paulo) 2010; 65:587-91. [PMID: 20613934 PMCID: PMC2898555 DOI: 10.1590/s1807-59322010000600005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 02/17/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test. INTRODUCTION Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described. METHODS Twenty heart transplantation (18 men, 49+/-11 years and 8.5+/-3.3 years after transplantation), 11 heart failure (8 men, 43+/-10 years), and 7 healthy subjects (5 men 39+/-8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise. RESULTS During rest, patients' norepinephrine plasma level (659+/-225 pg/mL) was higher in heart transplant recipients (463+/-167 pg/mL) and healthy subjects (512+/-132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248+/-692 pg/mL) was not different from that of heart failure patients (1174+/-653 pg/mL). Both these groups had a higher level than healthy subjects had (545+/-95 pg/mL), p<0.05. CONCLUSION Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.
Collapse
|
18
|
Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. ACTA ACUST UNITED AC 2010; 18:5-14. [DOI: 10.1097/hjr.0b013e32833a9c63] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP) - São Paulo/SP, Brazil
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (LATIS-CEPEUSP) - São Paulo/SP, Brazil.
| | - Edimar Alcides Bocchi
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP) - São Paulo/SP, Brazil
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (LATIS-CEPEUSP) - São Paulo/SP, Brazil.
| | - Guilherme Veiga Guimarães
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP) - São Paulo/SP, Brazil
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (LATIS-CEPEUSP) - São Paulo/SP, Brazil.
| |
Collapse
|
20
|
Carvalho VO, Bocchi EA, Guimarães GV. The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy. Circ J 2009; 73:1871-6. [DOI: 10.1253/circj.cj-09-0333] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Edimar Alcides Bocchi
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Guilherme Veiga Guimarães
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| |
Collapse
|