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Functional capacity-based rehabilitation of patients with chronic stable left ventricular heart failure

Abstract

Context

Heart failure (HF) is a common and costly condition. Reduced endurance is the main limiting factor of exercise capacity in HF patients. Cardiopulmonary exercise testing (CPX) is considered the most objective method to assess exercise capacity in HF patients.

Aim

To study the degree of improvement among patients with chronic stable left ventricular HF with low and average functional capacity after functional capacity-based rehabilitation program.

Settings and design

Rehabilitation was done at department of cardiology, department of physical medicine and rehabilitation, Ain Shams university. CPX was done at the National institute of research.

Patients and methods

A total of 40 patients with chronic heart failure were randomized to either a control (received their medical treatment with no specific rehabilitation program) or a rehabilitation group. Symptom-limited CPX was performed at baseline and at discharge from the program. Rehabilitation group was further divided according to their functional capacity measures obtained from CPX into group 1 and group 2. Minnesota Living with Heart Failure Questionnaire was obtained from all participants. Group 1 received electric muscle stimulation (EMS) of both lower limbs 5 days/week for 5 weeks. Group 2 received a conventional aerobic rehabilitation program 2 or 3 times/week for ~40 sessions. VO2 peak, VO2-VT, VE/VCO2, peak load, heart rate recovery, and Minnesota Living with Heart Failure Questionnaire values were compared before and after the treatment period.

Statistical analysis used

Statistical presentation and analysis of the present study was conducted using the mean, SD, Student’s t-test, paired t-test, χ2, linear correlation coefficient, and analysis of variance tests by SPSS, version 17.

Results

EMS produced significant improvement of functional capacity measures in addition to quality of life. It was comparable to the aerobic rehabilitation in group 2. Both rehabilitation protocols caused significant improvement when compared with the control group.

Conclusion

Functional capacity and quality of life were improved after either EMS or aerobic rehabilitation protocol when applied to selected patients with chronic heart failure when compared with control patients who did not receive any rehabilitation program.

References

  1. Colucci W, Braunwald E. Pathophysiology of heart failure. Braunwald’s heart disease. A textbook of cardiovascular medicine. 7th ed. Elsevier Saunders; 2005. pp. 509–538.

  2. Pina IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, et al. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 2003; 107:1210–1225.

    Article  Google Scholar 

  3. Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman D, et al. Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure. Circ Heart Fail 2010; 3:405–4113.

    Article  Google Scholar 

  4. Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev 2008; 13:245–269.

    Article  Google Scholar 

  5. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112:e154–e235.

  6. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al. HFSA 2010 comprehensive heart failure guideline. J Card Fail 2010; 16:e1–e194.

  7. Kucio E, Kucio C. Definition. In: Katowice KC, editor Chronic heart failure. Jerzy Kukuczka Academy of Physical Education in Katowice; 2011.

  8. Laura MTN, Lawrence PC, Vinícius Z,Maldaner S,Marianne LS, Ross A, et al. Effect of chronic neuromuscular electrical stimulation on primary cardiopulmonary exercise test variables in heart failure patients: a systematic review and meta-analysis. IJC Metab Endocr 2014; 5:28–35.

    Article  Google Scholar 

  9. Banerjee P. Electrical muscle stimulation for chronic heart failure: an alternative tool for exercise training? Curr Heart Fail Rep 2010; 7:52–58.

    Article  Google Scholar 

  10. Maddocks M, Gao W, Higginson IJ, Wilcock A. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev 2013; 1:CD009419.

    Google Scholar 

  11. Dolgin M, Fox AC, Gorlin R, Levin RI. New York Heart Association. Criteria Committee. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, MA: Lippincott Williams and Wilkins.

  12. Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 1981; 64:1227–1234.

    Article  CAS  Google Scholar 

  13. Leidy N, Rentz A, Zycynsky T. Evaluating health-related quality of life outcomes in patients with congestive heart failure. Pharmacoeconomics 1999; 15:19–46.

    Article  CAS  Google Scholar 

  14. Cohen-Solal A, Beauvais F, Tabet JW. Cardiopulmonary exercise testing in chronic heart failure. Cardiovasc Prev Rehabil 2007; XX:99–109.

  15. Naughton J, Sevelius G, Balke B. Physiological responses of normal and pathologic subjects to a modified work capacity test. J Sports Med 1963; 31:201–207.

    Google Scholar 

  16. Astrand O, Rodahl K. Textbook of work physiology. New York, NY: McGraw-Hill Book Company; 1986.

  17. Ingle L, Goode K, Carroll S, Sloan R,Boyes C, Cleland JG, et al. Prognostic value of the VE/VCO2 slope calculated from different time intervals in patients with suspected heart failure. Int J Cardiol 2007; 118:350–355.

    Article  Google Scholar 

  18. Scardovi A, De Maria R, Coletta C, Aspromonte N, Perna S, Cacciatore G, et al. Multiparametric risk stratification in patients with mild to moderate chronic heart failure. J Card Fail 2007; 13:445–451.

    Article  Google Scholar 

  19. Deley G, Eicher JC, Verges B, Wolf JE, Casillas JM. Do low-frequency electrical myostimulation and aerobic training similarly improve performance in chronic heart failure patients with different exercise capacities? J Rehabil Med 2008; 40:219–224.

    Article  Google Scholar 

  20. Vera K, Thomas PO, Kent RB, Prabin T, Thomas GA, Bruce DJ. Heart rate recovery and prognosis in heart failure patients. Eur J Appl Physiol 2009; 105:37–45.

    Article  Google Scholar 

  21. Raphaela VG, Ligia MA, Thais SN, et al. Electrical muscle stimulation improves neurovascular control and exercise tolerance in hospitalized advanced heart failure patients. Circulation 2015; 132:A12286.

  22. Pozehl B, Duncan K, Hertzog M. The effects of exercise training on fatigue and dyspnea in heart failure. Eur J Cardiovasc Nurs 2007; 7:127–132.

    Article  Google Scholar 

  23. Smart N, Haluska B, Jeffriess L, Marwick TH. Exercise training in systolic and diastolic dysfunction:Effects on cardiac function, functional capacity, and quality of life. Am Heart J 2007; 153:530–536.

    Article  Google Scholar 

  24. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinician’s guide to cardiopulmonary exercise testing in adults. A scientific statement from the American Heart Association. Circulation 2010; 122:191–225.

    PubMed  Google Scholar 

  25. Fülster S, Tacke M, Sandek A, Ebner N, Tschöpe C, Doehner W, et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J 2013; 34:512–519.

    Article  Google Scholar 

  26. Van Tassell BW, Arena RA, Toldo S, Mezzaroma E, Azam T, Seropian IM, et al. Enhanced interleukin-1 activity contributes to exercise intolerance in patients with systolic heart failure. PLoS ONE 2012; 7:e33438.

  27. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14:803–869.

    CAS  PubMed  Google Scholar 

  28. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M,et al. Exercise anaerobicthreshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation 2002; 106:3079–3084.

  29. Corra U, Mezzani A, Bosimini E, Scapellato F, Imparato A, Giannuzzi P. Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. Am Heart J 2002; 143:418–426.

    Article  Google Scholar 

  30. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J 2004; 147:354e60.

    Article  Google Scholar 

  31. Nuhr MJ, Pette D, Berger R, Quittan M, Crevenna R, Huelsman M, et al. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J 2004; 25:136–143.

    Article  Google Scholar 

  32. Deley G, Kervio G,Verges B,Hannequin A, Petitdant MF, Salmi-Belmihoub S, et al. Comparison of low-frequency electrical myostimulation and conventional aerobic exercise training in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2005; 12:226–233.

    Article  Google Scholar 

  33. DobsákP,NovákováM,FiserB,SiegelováJ,BalcárkováP,SpinarováL,et al. Electrical stimulation of skeletal muscles. An alternative to aerobic exercise training in patients with chronic heart failure? Int Heart J 2006; 47:441–453.

  34. Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A, Hambrecht R, Vanhees L. Statement on cardiopulmonary exercise testing in chronic heartfailure due to left ventricular dysfunction: recommendations for performance and interpretation. Part II: How to perform cardiopulmonary exercise testing in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006; 13:300–311.

    PubMed  Google Scholar 

  35. Myers J, Hadley D, Oswald U, Bruner K, Kottman W, Hsu L, et al. Effects of exercise training on heart rate recovery in patients with chronic heart failure. Am Heart J 2007; 153:1056–1063.

    Article  Google Scholar 

  36. Sbruzzi G, Ribeiro RA, Schaan BD, Signori LU, Silva AM, Irigoyen MC, et al. Functional electrical stimulation in the treatment of patients with chronic heart failure: a meta-analysis of randomized controlled trials. Eur J Cardiovasc Prev Rehabil 2010; 17:254–260.

    Article  Google Scholar 

  37. Smart NA, Dieberg G, Giallauria F. Functional electrical stimulation for chronic heart failure: a meta-analysis. Int J Cardiol 2013; 167:80–86.

    Article  Google Scholar 

  38. Vladimir S, Petr D, Michal P, Lenka S, Vitovec J, Krejci J, et al. Exercise training combined with electromyostimulation in the rehabilitation of patients with chronic heart failure: a randomized trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:98–106.

    Article  Google Scholar 

  39. Banning AP, Lewis NP, Northridge DB, Hendersen AH. Perfusion/ ventilation mismatch during exercise in chronic heart failure: an investigation of circulatory determinants. Br Heart J 1995; 74:27–33.

    Article  CAS  Google Scholar 

  40. Reindl I, Wernecke KD, Opitz C, Wensel R, König D, Dengler T, et al. Impaired ventilatory efficiency in chronic heart failure: possible role of pulmonary vasoconstriction. Am Heart J 1998; 136:778–785.

    Article  CAS  Google Scholar 

  41. Ponikowski P, Francis DP, Piepoli MF, Davies LC, Chua TP, Davos CH, et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation 2001; 103:967–972.

    Article  CAS  Google Scholar 

  42. Jaussaud J, Aimable L, Douard H. The time for a new strong functional parameter in heart failure: the VE/VCO2 slope. Int J Cardiol 2011; 147:189–190.

    Article  Google Scholar 

  43. Ritt LE, Oliveira RB, Myers J, Arena R, Peberdy MA, et al. Patients with heart failure in the ‘intermediate range’ of peak oxygen uptake: additive value of heart rate recovery and the minute ventilation/carbon dioxide output slope in predicting mortality. J Cardiopulm Rehabil Prev 2012; 32:141–146.

    Article  Google Scholar 

  44. Guazzi M, Arena R. The impact of pharmacotherapy on the cardiopulmonary exercise test response in patients with heart failure: a mini review. Curr Vasc Pharmacol 2009; 7:557–569.

    Article  CAS  Google Scholar 

  45. Arena R, Guazzi M, Myers J, Peberdy MA. Prognostic value of heart rate recovery in patients with heart failure. Am Heart J 2006; 151:851.e7–851.e13.

    Article  Google Scholar 

  46. Stacey DS, Ezra AA, Charles LS. Heart rate recovery in heart failure patients after a 12-week cardiac rehabilitation program. Am J Cardiol 2006; 97:694–698.

    Article  Google Scholar 

  47. Racine N, Blanchet M, Ducharme A, Marquis J, Boucher JM, Juneau M, et al. Decreased heart rate recovery after exercise in patients with congestive heart failure: effect of [beta]-blocker therapy. J Card Fail 2003; 9:296–302.

    Article  CAS  Google Scholar 

  48. Myers J, Hadley D, Oswald U, Bruner K, Kottman W, Hsu L, et al. Effects of exercise training on heart rate recovery in patients with chronic heart failure. Am Heart J 2007; 153:1056–1063.

    Article  Google Scholar 

  49. Dimopoulos S, Anastasiou-Nana M, Sakellariou D, Drakos S, Kapsimalakou S, Maroulids G, et al. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006; 13:67–73.

    Article  Google Scholar 

  50. Karavidas A, Parissis J, Arapi S, Farmakis D, Korres D, Nikolaou M, et al. Effects of functional electrical stimulation on quality of life and emotional stress in patients with chronic heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy: a randomised, placebo controlled trial. Eur J Heart Fail 2008; 10:709–713.

    Article  Google Scholar 

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Correspondence to Youssy S. Gergius BSc, MSc.

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Gergius, Y.S., El-Sheshtawy, N.E., El-Arousi, N.H. et al. Functional capacity-based rehabilitation of patients with chronic stable left ventricular heart failure. Egypt Rheumatol Rehabil 45, 159–166 (2018). https://doi.org/10.4103/err.err_5_18

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