Establishing a cardiac training group for patients with heart failure: the "HIP-in-Würzburg" study.
Cardiac training group
Heart failure
Heart failure training group
m exercise training
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
29
05
2021
accepted:
07
06
2021
pubmed:
24
6
2021
medline:
5
4
2022
entrez:
23
6
2021
Statut:
ppublish
Résumé
Exercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated "HF training groups." Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany. Twelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ). All patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.
Sections du résumé
BACKGROUND
BACKGROUND
Exercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated "HF training groups." Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany.
METHODS
METHODS
Twelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ).
RESULTS
RESULTS
All patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO
CONCLUSION
CONCLUSIONS
This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.
Identifiants
pubmed: 34159415
doi: 10.1007/s00392-021-01892-1
pii: 10.1007/s00392-021-01892-1
pmc: PMC8218974
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
406-415Subventions
Organisme : Bundesministerium für Bildung und Forschung
ID : 01EO1504
Informations de copyright
© 2021. The Author(s).
Références
Graf C, Bjarnason-Wehrens B, Löllgen H (2004) Outpatient Cardiac Rehabilitation Groups in Germany - Retrospect and Prospects. DEUTSCHE ZEITSCHRIFT FÜR SPORTMEDIZIN 55(12):339–346
Bjarnason-Wehrens B, Held K, Karoff M (2006) Heart groups in Germany-current situation and prospects. Herz 31(6):559–565. https://doi.org/10.1007/s00059-006-2870-2
doi: 10.1007/s00059-006-2870-2
pubmed: 17036187
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975. https://doi.org/10.1002/ejhf.592
Bjarnason-Wehrens B, Nebel R, Jensen K, Hackbusch M, Grilli M, Gielen S, Schwaab B, Rauch B, German Society of Cardiovascular P, Rehabilitation (2020) Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): a systematic review and meta-analysis. Eur J Prev Cardiol 27(9):929–952. https://doi.org/10.1177/2047487319854140
doi: 10.1177/2047487319854140
Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH, American Heart Association Physical Activity Committee of the Council on L, Cardiometabolic H, Council on C, Stroke N, Council on Clinical C, Stroke C (2020) Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: placing the risks into perspective-an update: a scientific statement From the American Heart Association. Circulation 141(13):e705–e736. https://doi.org/10.1161/CIR.0000000000000749
doi: 10.1161/CIR.0000000000000749
Wienbergen H, Schwaab B, Bjarnason-Wehrens B, Guha M, Laszlo R, Burgstahler C, von Haehling S, Halle M, Zahn R, Hambrecht R (2020) Position paper of the German Cardiac Society (DGK) in cooperation with the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR)—Physician support for outpatient cardiac rehabilitation groups. Kardiologe. https://doi.org/10.1007/s12181-020-00433-w
doi: 10.1007/s12181-020-00433-w
Maron BJ (2000) The paradox of exercise. N Engl J Med 343(19):1409–1411. https://doi.org/10.1056/NEJM200011093431911
doi: 10.1056/NEJM200011093431911
pubmed: 11070108
Brüggemann I, Guha M (2019) Herzgruppen für Patienten mit hohem kardiovaskulärem Ereignisrisiko––Herzinsuffizienzgruppen. Diabetes, Stoffwechsel und Herz 28(4):218–221
Rief W, Nanke A, Klaiberg A, Braehler E (2004) Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord 82(2):271–276. https://doi.org/10.1016/j.jad.2003.11.006
doi: 10.1016/j.jad.2003.11.006
pubmed: 15488257
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
doi: 10.1046/j.1525-1497.2001.016009606.x
pubmed: 11556941
pmcid: 11556941
Green CP, Porter CB, Bresnahan DR, Spertus JA (2000) Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol 35(5):1245–1255. https://doi.org/10.1016/s0735-1097(00)00531-3
doi: 10.1016/s0735-1097(00)00531-3
pubmed: 10758967
Spertus JA, Jones PG, Sandhu AT, Arnold SV (2020) Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art Review. J Am Coll Cardiol 76(20):2379–2390. https://doi.org/10.1016/j.jacc.2020.09.542
doi: 10.1016/j.jacc.2020.09.542
pubmed: 33183512
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014
doi: 10.1093/ehjci/jev014
Uszko-Lencer N, Mesquita R, Janssen E, Werter C, Brunner-La Rocca HP, Pitta F, Wouters EFM, Spruit MA (2017) Reliability, construct validity and determinants of 6-minute walk test performance in patients with chronic heart failure. Int J Cardiol 240:285–290. https://doi.org/10.1016/j.ijcard.2017.02.109
doi: 10.1016/j.ijcard.2017.02.109
pubmed: 28377186
Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132(8):919–923
pubmed: 3978515
pmcid: 1345899
Albouaini K, Egred M, Alahmar A, Wright DJ (2007) Cardiopulmonary exercise testing and its application. Heart 93(10):1285–1292. https://doi.org/10.1136/hrt.2007.121558
doi: 10.1136/hrt.2007.121558
pubmed: 17890705
pmcid: 2000933
Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381
doi: 10.1249/00005768-198205000-00012
Bortz JLG, Boehnke K (1990) Verteilungsfreie Methoden in der Biostatistik. Springer, Berlin - Heidelberg
doi: 10.1007/978-3-662-22593-6
Lautsch EL, G. A. (1993) Binärdatenanalyse für Psychologen. Psychologie Verlags Union, Weinheim, Mediziner und Sozialwissenschaftler
Bortz J, Döring N (1995) Forschungsmethoden und Evaluation. Springer, Heidelberg
Bundesärztekammer BK (2019) Nationale Versorgungsleitlinie Chronische Herzinsuffizizienz, 3.Auflage. AWMF-Register-Nr: nvl-006. https://doi.org/10.6101/AZQ/000465
Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, O’Connor C, Whellan D, Keteyian SJ, Coats A, Davos CH, Dalal HM, Dracup K, Evangelista L, Jolly K, Myers J, McKelvie RS, Nilsson BB, Passino C, Witham MD, Yeh GY, Zwisler AO, ExTra MIIC (2018) Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail 20(12):1735–1743. https://doi.org/10.1002/ejhf.1311
doi: 10.1002/ejhf.1311
pubmed: 30255969
van der Meer S, Zwerink M, van Brussel M, van der Valk P, Wajon E, van der Palen J (2012) Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review. Eur J Prev Cardiol 19(4):795–803. https://doi.org/10.1177/1741826711410516
doi: 10.1177/1741826711410516
pubmed: 22988592
Taylor RS, Long L, Mordi IR, Madsen MT, Davies EJ, Dalal H, Rees K, Singh SJ, Gluud C, Zwisler AD (2019) Exercise-Based Rehabilitation for Heart Failure: Cochrane Systematic Review, Meta-Analysis, and Trial Sequential Analysis. JACC Heart Fail 7(8):691–705. https://doi.org/10.1016/j.jchf.2019.04.023
doi: 10.1016/j.jchf.2019.04.023
pubmed: 31302050
Piepoli MF, Davos C, Francis DP, Coats AJ, ExTra MC (2004) Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 328(7433):189. https://doi.org/10.1136/bmj.37938.645220.EE
doi: 10.1136/bmj.37938.645220.EE
pubmed: 14729656
Mediano MFF, Leifer ES, Cooper LS, Keteyian SJ, Kraus WE, Mentz RJ, Fleg JL (2018) Influence of baseline physical activity level on exercise training response and clinical outcomes in heart failure: the HF-ACTION Trial. JACC Heart Fail 6(12):1011–1019. https://doi.org/10.1016/j.jchf.2018.09.012
doi: 10.1016/j.jchf.2018.09.012
pubmed: 30497641
pmcid: 6317714
Patti A, Merlo L, Ambrosetti M, Sarto P (2021) Exercise-Based Cardiac Rehabilitation Programs in Heart Failure Patients. Heart Fail Clin 17(2):263–271. https://doi.org/10.1016/j.hfc.2021.01.007
doi: 10.1016/j.hfc.2021.01.007
pubmed: 33673950
Tenenbaum A, Freimark D, Ahron E, Koren-Morag N, Schwamenthal E, Fisman EZ, Shechter M, Tanne D, Kachlon D, Motro M, Adler Y (2006) Long-term versus intermediate-term supervised exercise training in advanced heart failure: effects on exercise tolerance and mortality. Int J Cardiol 113(3):364–370. https://doi.org/10.1016/j.ijcard.2005.11.098
doi: 10.1016/j.ijcard.2005.11.098
pubmed: 16707174
Bui AL, Horwich TB, Fonarow GC (2011) Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8(1):30–41. https://doi.org/10.1038/nrcardio.2010.165
doi: 10.1038/nrcardio.2010.165
pubmed: 21060326
Cornelis J, Beckers P, Taeymans J, Vrints C, Vissers D (2016) Comparing exercise training modalities in heart failure: a systematic review and meta-analysis. Int J Cardiol 221:867–876. https://doi.org/10.1016/j.ijcard.2016.07.105
doi: 10.1016/j.ijcard.2016.07.105
pubmed: 27434363
Gomes-Neto M, Duraes AR, Conceicao LSR, Roever L, Silva CM, Alves IGN, Ellingsen O, Carvalho VO (2019) Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis. Int J Cardiol 293:165–175. https://doi.org/10.1016/j.ijcard.2019.02.050
doi: 10.1016/j.ijcard.2019.02.050
pubmed: 31345646
Miche E, Roelleke E, Wirtz U, Zoller B, Tietz M, Huerst M, Radzewitz A (2008) Combined endurance and muscle strength training in female and male patients with chronic heart failure. Clin Res Cardiol 97(9):615–622. https://doi.org/10.1007/s00392-008-0660-y
doi: 10.1007/s00392-008-0660-y
pubmed: 18432395
Williams MA, Pozehl B (2015) Reasonable expectations: how much aerobic capacity, muscle strength, and quality of life can improve with exercise training in heart failure. Heart Fail Clin 11(1):37–57. https://doi.org/10.1016/j.hfc.2014.08.003
doi: 10.1016/j.hfc.2014.08.003
pubmed: 25432473
Tucker WJ, Beaudry RI, Liang Y, Clark AM, Tomczak CR, Nelson MD, Ellingsen O, Haykowsky MJ (2019) Meta-analysis of exercise training on left ventricular ejection fraction in heart failure with reduced ejection fraction: a 10-year update. Prog Cardiovasc Dis 62(2):163–171. https://doi.org/10.1016/j.pcad.2018.08.006
doi: 10.1016/j.pcad.2018.08.006
pubmed: 30227187
Flynn KE, Pina IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O’Connor CM, Weinfurt KP, Investigators H-A (2009) Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301(14):1451–1459. https://doi.org/10.1001/jama.2009.457
doi: 10.1001/jama.2009.457
pubmed: 19351942
pmcid: 2690699
Spertus J, Peterson E, Conard MW, Heidenreich PA, Krumholz HM, Jones P, McCullough PA, Pina I, Tooley J, Weintraub WS, Rumsfeld JS, Cardiovascular Outcomes Research C (2005) Monitoring clinical changes in patients with heart failure: a comparison of methods. Am Heart J 150(4):707–715. https://doi.org/10.1016/j.ahj.2004.12.010
doi: 10.1016/j.ahj.2004.12.010
Stevens LA, Coresh J, Greene T, Levey AS (2006) Assessing kidney function–measured and estimated glomerular filtration rate. N Engl J Med 354(23):2473–2483. https://doi.org/10.1056/NEJMra054415
doi: 10.1056/NEJMra054415
pubmed: 16760447