Cardiac Rehabilitation in Heart Failure. Part II. Does Higher Intensity Means Better Outcome?

• Authors: Agnieszka Kujawska , Radosław Perkowski , Natalia Skierkowska , Weronika Topka , Małgorzata Gajos , Joanna Androsiuk-Perkowska , Aleksandra Cieślińska , Beata Przybysz , Dobrawa Kwolik , Dominika Siekacz , Dominika Rybarczyk , Sławomir Kujawski
• Languages of publication: EN

Abstracts

EN

Heart failure (HF) due to its universality has become a huge challenge for modern medicine. Second part of the twentieth century brought significant changes in the rehabilitation, diagnostic and pharmacological procedures. There are no definitive guidelines for Cardiac Rehabilitation (CR) in HF. Based on previous studies, the article tried to describe and illustrate the mechanism of effective CR and its intensity in HF patients, which could be helpful in CR protocol development. Cardiac Rehabilitation has confirmed efficacy in increased physical level of participation in inter alia, home/work/recreational activities, improved psychosocial well-being, functional independence, prevention of disability, long-term adherence to maintaining physically active lifestyle, improved cardiopulmonary fitness, strength, muscle endurance, and flexibility, reduced cardiovascular events risk and risk of mortality. Before and after CR conduction, baseline and final aerobic capacity should be examined with an ergospirometry test to evaluate CR protocol intensity and check its effectiveness, respectively. Frequency of training-bouts in CR protocol in HF patients were from 3 to 7 days per week, intensity ranged from 40% to 80% VO2max or 9 to 14 on rating of the perceived exertion (RPE) scale or 6 to 20 on the Borg scale. Duration of single bout-exercise ranged from 20 to 60 minutes.

Keywords

EN

aerobic training; cardiac rehabilitation; heart failure; physical exercise; resistance training

Discipline

• MEDICINE: MEDICINE

• Publisher: Uniwersytet Szczeciński. Wydawnictwo Naukowe Uniwersytetu Szczecińskiego
• Journal: Central European Journal of Sport Sciences and Medicine
• Year: 2018
• Volume: 22
• Issue: 2
• Pages: 23-32

Contributors

author

Agnieszka Kujawska

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Radosław Perkowski

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Natalia Skierkowska

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Weronika Topka

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Małgorzata Gajos

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Joanna Androsiuk-Perkowska

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Aleksandra Cieślińska

• Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University

author

Beata Przybysz

• Kazimierz Wielki University, Bydgoszcz, Poland

author

Dobrawa Kwolik

• Kazimierz Wielki University, Bydgoszcz, Poland

author

Dominika Siekacz

• Kazimierz Wielki University, Bydgoszcz, Poland

author

Dominika Rybarczyk

• Kazimierz Wielki University, Bydgoszcz, Poland

author

Sławomir Kujawski

• Faculty of Health Sciences, Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Exercise Physiology, Nicolaus Copernicus University

References

• Ades, P.A., Keteyian, S.J., Balady, G.J., Houston-Miller, N., Kitzman, D.W., Mancini, D.M., Rich, M.W. (2013). Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC: Heart failure, 1 (6), 540–547.
• Adsett, J., Mullins, R. (2010). Evidence based guidelines for exercise and chronic heart failure. Quenssland.
• Alves, A.J., Ribeiro, F., Goldhammer, E., Rivlin, Y., Rosenschein, U., Viana, J.L., ..., Oliveira, J. (2012). Exercise training improves diastolic function in heart failure patients. Medicine & Science in Sports & Exercise, 44 (5), 776–785.
• Anderson, L., Oldridge, N., Thompson, D.R., Zwisler, A.D., Rees, K., Martin, N., Taylor, R.S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology, 67 (1), 1–12.
• Balady, G.J., Ades, P.A., Bittner, V.A., Franklin, B.A., Gordon, N.F., Thomas, R.J., ..., Yancy, C.W. (2011). Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond. Circulation, 124 (25), 2951–2960.
• Belardinelli, R., Georgiou, D., Cianci, G., Purcaro, A. (1999). Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Circulation, 99 (9), 1173–1182.
• Belardinelli, R., Georgiou, D., Scocco, V., Barstow, T.J., Purcaro, A. (1995). Low intensity exercise training in patients with chronic heart failure. Journal of the American College of Cardiology, 26 (4), 975–982.
• Benito, B., Nattel, S. (2009). Exercise training as a treatment for heart failure: potential mechanisms and clinical implications. The Journal of physiology, 587 (21), 5011–5013.
• Blumenthal, J.A., Sherwood, A., Smith, P.J., Watkins, L., Mabe, S., Kraus, W.E., ..., Hinderliter, A. (2016). Enhancing cardiac rehabilitation with stress management training: a randomized clinical efficacy trial. Circulation, 115.
• Braith, R.W., Welsch, M.A., Feigenbaum, M.S., Kluess, H.A., Pepine, C.J. (1999). Neuroendocrine activation in heart failure is modified by endurance exercise training. Journal of the American College of Cardiology, 34 (4), 1170–1175.
• Coats, A.J., Adamopoulos, S., Radaelli, A., McCance, A., Meyer, T.E., Bernardi, L., ..., Forfar, C.O.N.W.A.Y. (1992). Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation, 85 (6), 2119–2131.
• Corra, U., Mezzani, A., Bosimini, E., Giannuzzi, P. (2004). Cardiopulmonary exercise testing and prognosis in chronic heart failure*: a prognosticating algorithm for the individual patient. CHEST Journal, 126 (3), 942–950.
• Edelmann, F., Gelbrich, G., Düngen, H.D., Fröhling, S., Wachter, R., Stahrenberg, R., ..., Herrmann-Lingen, C. (2011). Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the ExDHF (Exercise training in Diastolic Heart Failure) pilot study. Journal of the American College of Cardiology, 58 (17), 1780–1791.
• Francis, D.P., Shamim, W., Davies, L.C., Piepoli, M.F., Ponikowski, P., Anker, S.D., Coats, A.J.S. (2000). Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2slope and peak VO2. European Heart Journal, 21 (2), 154–161.
• Giannuzzi, P., Tavazzi, L., Meyer, K., Perk, J., Drexler, H., Dubach, P., ..., Meyers, J. (2001). Recommendations for exercise training in chronic heart failure patients. European Heart Journal, 22 (2), 125–135.
• Gunstad, J., MacGregor, K.L., Paul, R.H., Poppas, A., Jefferson, A.L., Todaro, J.F., Cohen, R.A. (2005). Cardiac rehabilitation improves cognitive performance in older adults with cardiovascular disease. Journal of cardiopulmonary rehabilitation, 25 (3), 173.
• Hambrecht, R., Gielen, S., Linke, A., Fiehn, E., Yu, J., Walther, C., ..., Schuler, G. (2000). Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial. Jama, 283 (23), 3095–3101.
• Keast, M.L., D’Angelo, M.E.S., Nelson, C.R., Turcotte, S.E., McDonnell, L.A., Nadler, R.E., ..., Reid, R.D. (2013). Randomized trial of Nordic walking in patients with moderate to severe heart failure. Canadian journal of cardiology, 29 (11), 1470–1476.
• Legallois, D., Belin, A., Nesterov, S.V., Milliez, P., Parienti, J.J., Knuuti, J., ..., Manrique, A. (2016). Cardiac rehabilitation improves coronary endothelial function in patients with heart failure due to dilated cardiomyopathy: A positron emission tomography study. European journal of preventive cardiology, 23 (2), 129–136.
• Lipkin, D.P., Scriven, A.J., Crake, T., Poole-Wilson, P.A. (1986). Six minute walking test for assessing exercise capacity in chronic heart failure. Br Med J (Clin Res Ed), 292 (6521), 653–655.
• Montemezzo, D., Fregonezi, G.A., Pereira, D.A., Britto, R.R., Reid, W.D. (2014). Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 95 (7), 1398–1407.
• O’Connor, C.M., Whellan, D.J., Lee, K.L., Keteyian, S.J., Cooper, L.S., Ellis, S.J., ..., Rendall, D.S. (2009). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. Jama, 301 (14), 1439–1450.
• Osman, A.F., Mehra, M.R., Lavie, C.J., Nunez, E., Milani, R.V. (2000). The incremental prognostic importance of body fat adjusted peak oxygen consumption in chronic heart failure. Journal of the American College of Cardiology, 36 (7), 2126–2131.
• Piepoli, M.F., Conraads, V., Corra, U., Dickstein, K., Francis, D.P., Jaarsma, T., ..., Anker, S.D. (2011). Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. European journal of heart failure, 13 (4), 347–357.
• Piepoli, M., Davos, C., Francis, D.P., Coats, A.J. (2004). Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH).
• Piña, I.L., Apstein, C.S., Balady, G.J., Belardinelli, R., Chaitman, B.R., Duscha, B.D., ..., Sullivan, M.J. (2003). Exercise and heart failure. Circulation, 107 (8), 1210–1225.
• Roomi, J., Johnson, M.M., Waters, K., Yohannes, A., Helm, A., Connolly, M.J. (1996). Respiratory rehabilitation, exercise capacity and quality of life in chronic airways disease in old age. Age and Ageing, 25 (1), 12–16.
• Rostagno, C., Olivo, G., Comeglio, M., Boddi, V., Banchelli, M., Galanti, G., Gensini, G.F. (2003). Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. European journal of heart failure, 5 (3), 247–252.
• Selig, S.E., Levinger, I., Williams, A.D., Smart, N., Holland, D.J., Maiorana, A., ..., Hare, D.L. (2010). Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure. Journal of Science and Medicine in Sport, 13 (3), 288–294.
• Shimiaie, J., Sherez, J., Aviram, G., Megidish, R., Viskin, S., Halkin, A., ..., Topilsky, Y. (2015). Determinants of effort intolerance in patients with heart failure: combined echocardiography and cardiopulmonary stress protocol. JACC: Heart Failure, 3 (10), 803–814.
• Smarż, K. (2008). Cardiac rehabilitation in various clinical situation–phases, indications, contraindications, risks and safety issues. Postępy Nauk Medycznych.
• Troosters, T., Gosselink, R., Decramer, M. (1999). Six minute walking distance in healthy elderly subjects. European Respiratory Journal, 14 (2), 270–274.
• Uddin, J., Zwisler, A.D., Lewinter, C., Moniruzzaman, M., Lund, K., Tang, L.H., Taylor, R.S. (2016). Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: a meta-regression analysis. European journal of preventive cardiology, 23 (7), 683–693.
• Weber, K.T., Janicki, J.S. (1985). Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. The American journal of cardiology, 55 (2), A22–A31.
• Wisløff, U., Støylen, A., Loennechen, J.P., Bruvold, M., Rognmo, Ø., Haram, P.M., ..., Videm, V. (2007). Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients. Circulation, 115 (24), 3086–3094.

• Document Type: article