Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial

BACKGROUND

Functional training may be an effective non-pharmacological therapy for heart failure (HF). This study aimed to compare the effects of functional training with strength training on peak VO₂ and quality of life in individuals with HF.

METHODS

A randomized, parallel-design and examiner-blinded controlled clinical trial with concealed allocation, intention-to-treat and per-protocol analyses. Twenty-seven participants with chronic HF were randomly allocated to functional or strength training group, to perform a 12-week physical training, three times per week, totalizing 36 sessions. Primary outcomes were the difference on peak VO₂ and quality of life assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire, respectively. Secondary outcomes included functionality assessed by the Duke Activity Status Index and gait speed test, peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively, endothelial function by brachial artery flow-mediated dilation, and lean body mass by arm muscle circumference.

RESULTS

Participants were aged 60 ± 7 years, with left ventricular ejection fraction 29 ± 8.5%. The functional and strength training groups showed the following results, respectively: peak VO₂ increased by 1.4 ± 3.2 (16.9 ± 2.9 to 18.6 ± 4.8 mL.kg^-1.min^-1; p time = 0.011) and 1.5 ± 2.5 mL.kg^-1.min^-1 (16.8 ± 4.0 to 18.6 ± 5.5 mL.kg^-1.min^-1; p time = 0.011), and quality of life score decreased by 14 ± 15 (25.8 ± 14.8 to 10.3 ± 7.8 points; p time = 0.001) and 12 ± 28 points (33.8 ± 23.8 to 19.0 ± 15.1 points; p time = 0.001), but no difference was observed between groups (peak VO₂: p interaction = 0.921 and quality of life: p interaction = 0.921). The functional and strength training increased the activity status index by 6.5 ± 12 and 5.2 ± 13 points (p time = 0.001), respectively, and gait speed by 0.2 ± 0.3 m/s (p  time = 0.002) in both groups.

CONCLUSIONS

Functional and strength training are equally effective in improving peak VO₂, quality of life, and functionality in individuals with HF. These findings suggest that functional training may be a promising and innovative exercise-based strategy to treat HF.

TRIAL REGISTRATION

NCT03321682. Registered date: 26/10/2017.

Association Between Physical Exercise Interventions Participation and Functional Capacity in Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Controlled Trials

Background

The prevalence of type 2 diabetes mellitus increases with age, and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Therefore, our purpose was to systematically assess the effect of different physical exercise modalities in patients with type 2 diabetes with an average age of 45 years or older on outcomes used to measure functional capacity.

Methods

A systematic review and meta-analysis of controlled trials was conducted. Seven databases were searched from January 1987 to December 2021 (PubMed, Physiotherapy Evidence Database, Cochrane Library, SPORTDiscus, and in grey literature: Open Grey and Google Scholar). Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper-limb muscle strength, lower-limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥ 45 years. The risk of bias was assessed with the Downs & Black checklist. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses.

Results

Of 18,112 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-min walk test (n = 8) [51.6 m; 95% CI 7.6% to 95.6%; I² 92%], one-repetition maximum leg-press (n = 3) [18.0 kg; 95% CI 4.0% to 31.9%; I² 0%], and maximum oxygen consumption (VO_2max) (n = 20) [2.41 mL/kg·min; 95% CI 1.89% to 2.92%; I² 100%] compared with control groups. In sensitivity and subgroup analyses using VO_2max as outcome and stratified by type of study (randomized and non-randomized controlled clinical trials), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between glycated hemoglobin (HbA1C) levels and VO_2max [p = 0.34; I² 99.6%; R² = 2.6%]. In addition, the quality of the included studies was mostly low.

Conclusion

The results indicate that structured physical exercise programs might improve functional capacity in patients with type 2 diabetes, except for the upper-limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates.

Trial registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42020162467); date of registration: 12/15/2019. The review protocol is hosted at the Open Science Framework (OSF) (Preprint https://doi.org/10.31219/osf.io/kpg2m).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00422-1.

Cardiopulmonary exercise capacity and quality of life of patients with heart failure undergoing a functional training program: study protocol for a randomized clinical trial

BACKGROUND

Exercise intolerance is a common finding in heart failure that generates a vicious cycle in which the individual starts to limit his activities even more due to progressive fatigue. Regular physical exercise can increase the cardiopulmonary exercise capacity of these individuals. A new approach to physical exercise, known as functional training, could improve the oxygen consumption and quality of life of patients with heart failure; however, there is no information about the effect of this modality of exercise in this patient population. This randomized trial will compare the effects of 36 sessions of functional training versus strength training in heart failure patients.

METHODS

This randomized parallel-design examiner-blinded clinical trial includes individuals of both sexes aged ≥40 years receiving regular follow-up at a single academic hospital. Subjects will be randomly allocated to an intervention group (for 12-week functional training) or an active comparator group (for 12-week strength training). The primary outcomes will be the difference from baseline to the 3-month time point in peak oxygen consumption on cardiopulmonary exercise testing and quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. Secondary outcome measures will include functionality assessed by the Duke Activity Status Index and gait speed test; peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively; endothelial function by brachial artery flow-mediated dilation; lean body mass by arm muscle circumference; and participant adherence to the exercise programs classified as a percentage of the prescribed exercise dose.

DISCUSSION

The functional training program aims to improve the functional capacity of the individual using exercises that relate to his specific physical activity transferring gains effectively to one's daily life. In this context, we believe that that functional training can increase the cardiopulmonary exercise capacity and quality of life of patients with heart failure. The trial has been recruiting patients since October 2017.

TRIAL REGISTRATION

NCT03321682. Registered on October 26, 2017.

Avaliação da Força de Preensão Palmar e Qualidade de Vida de Crianças com Câncer Submetidas à Quimioterapia com Vincristina

Introdução: Com a quimioterapia, os pacientes podem apresentar diversas alterações; entre elas, polineuropatia e mudança na qualidade de vida, tanto à criança como aos familiares. Objetivo: Avaliar a força de preensão palmar e a qualidade de vida de crianças e adolescentes com câncer submetidos à quimioterapia com vincristina. Método: Trata-se de um estudo, no qual os pacientes responderam aos questionários de anamnese e PedsQLTM 3.0 Câncer Module, em três momentos diferentes do tratamento. Um dos seus responsáveis foi convidado a responder ao mesmo questionário. A força de preensão palmar foi aferida por meio de um dinamômetro, nos mesmos momentos. Resultados: A amostra foi composta por sete pacientes com mediana 7 (5-15 anos); com predomínio de meninas, residentes em Porto Alegre, RS, e diagnóstico prevalente de leucemia linfoide aguda, internados na primeira semana após o diagnóstico de câncer. A força de preensão palmar apresentou redução significativa para ambos os membros (p=0,018, membro superior direito; p=0,030, membro superior esquerdo). Apesar de não apresentar resultado significativo, na maioria dos domínios do questionário de qualidade de vida, ocorreu declínio nas respostas, principalmente nas dos pais. Conclusão: A quimioterapia com vincristina reduz a força muscular periférica em pacientes com câncer, nos 30 primeiros dias. Em relação à qualidade de vida, não foi apresentada diferença significativa. Porém, dentro dos domínios, pôde-se perceber algumas alterações. Sendo assim, fica clara a importância do acompanhamento contínuo da fisioterapia junto a uma equipe preparada para esses pacientes e seus familiares.

Effects of inspiratory muscle training in hemodialysis patients

INTRODUCTION

Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function.

OBJECTIVE

To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis.

METHOD

Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40% of PImax and weekly frequency of three alternate days.

RESULTS

A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values.

CONCLUSION

The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.