ABSTRACT
Background Physical fitness is an important determinant of quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients. However, how the different physical fitness components correlate with the specific dimensions of QoL in HFpEF patients remains unknown. Objective To evaluate the association between different physical fitness components and QoL dimensions in HFpEF patients, and, assess which physical fitness components were independently associated to QoL. Methods Patients with HFpEF were assessed for physical fitness [dynamic balance and mobility (8-foot-up-and go test), upper body strength (handgrip), cardiorespiratory fitness (CRF) (6-minute-walking test) and body composition (body mass index)] and for QoL (Minnesota Living With Heart Failure Questionnaire). Partial correlation was used to verify the association between physical fitness components and QoL dimensions. The determination of independent predictors in QoL dimensions was assessed through stepwise multivariate linear regression analysis. Statistical significance was set at p<0.05. Results Both CRF and dynamic balance and mobility are significantly associated with the total score and physical dimensions of QoL (p<0.05), but only dynamic balance and mobility were concomitantly associated with the emotional dimension (r=0.597; p=0.004). Dynamic balance and mobility were independently associated with total score (ß=0.651; r2=0.424; p=0.001), physical (ß=0.570; r2=0.324; p=0.04) and emotional (ß=0.611; r2=0.373 p=0.002) dimensions of QoL. Conclusion Our data suggests that dynamic balance and mobility better assess QoL than CRF, which is commonly measured in clinical practice. Whether interventions specifically targeting dynamic balance and mobility have different impacts on QoL remains unknown. (Arq Bras Cardiol. 2020; 114(4):701-707).
Subject(s)
Heart Failure , Quality of Life , Hand Strength , Humans , Physical Fitness , Stroke VolumeABSTRACT
BACKGROUND: Decompensated heart failure patients are characterised by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, functional capacity and an increase in exercise tolerance. However, the benefits of early rehabilitation have not yet been validated. OBJECTIVE: To evaluate the safety and feasibility of an aerobic exercise training programme in functional capacity of decompensated heart failure patients. METHODOLOGY: A single centre, parallel, randomised controlled, open label trial, with 100 patients. The training group (TG, n=50) performed the training protocol and the control group (CG, n=50) performed the usual rehabilitation procedures. The London chest activity of daily living (LCADL) scale, the Barthel index (BI) and the 6 minute walking test (6MWT) at discharge were used to evaluate the efficacy of the protocol. Safety was measured by the existence of adverse events. RESULTS: The mean age of the patients was 70 years, 20% were New York Heart Association (NYHA) class IV and 80% NYHA class III at admission. The major heart failure aetiology was ischaemic (35 patients) and valvular disease (25 patients). There were no significant differences between groups at baseline in terms of sociodemographic or pathophysiological characteristics. There was a statistically significant difference of 54.2 meters for the training group (P=0.026) in the 6MWT and at LCADL 12 versus 16 (P=0.003), but the BI did not: 96 versus 92 (P=0.072). No major adverse events occurred. CONCLUSIONS: The training protocol demonstrated safety and efficacy, promoting functional capacity. This study elucidated about the benefits of a systematised implementation of physical exercise during the patient's clinical stabilisation phase, which had not yet been demonstrated.Trial registration: Clinicaltrials.gov NCT03838003, URL: https://clinicaltrials.gov/ct2/show/NCT03838003.
Subject(s)
Cardiac Rehabilitation/methods , Exercise Therapy/methods , Exercise Tolerance/physiology , Exercise/psychology , Heart Failure/rehabilitation , Quality of Life/psychology , Aged , Female , Heart Failure/diagnosis , Humans , Male , Middle AgedABSTRACT
Resumo Fundamento A aptidão física é um importante determinante da qualidade de vida (QV) em pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP). No entanto, ainda não se sabe como os diferentes componentes da aptidão física se relacionam com as dimensões específicas da QV em pacientes com ICFEP. Objetivo Avaliar a associação entre diferentes componentes da aptidão física e dimensões da QV em pacientes com ICFEP, e examinar quais componentes da aptidão física foram independentemente associados à QV. Métodos Os pacientes com ICFEP foram avaliados quanto à aptidão física [equilíbrio dinâmico e mobilidade ("teste 8-feet Up-and-go "), força da parte superior do corpo (Teste de força de preensão manual), aptidão cardiorrespiratória (ACR) (teste de caminhada de 6 minutos) e composição corporal (índice de massa corporal)] e para QV ( Minnesota Living With Heart Failure Questionnaire ). Uma correlação parcial foi utilizada para verificar a associação entre os componentes da aptidão física e as dimensões da QV. A análise das dimensões dos preditores independentes de QV foi realizada através da análise de regressão linear multivariada stepwise . A significância estatística foi estabelecida em p <0,05. Resultados Tanto a ACR quanto o equilíbrio dinâmico e a mobilidade estão significativamente associados ao escore total e às dimensões físicas da QV (p <0,05), mas apenas o equilíbrio dinâmico e a mobilidade foram concomitantemente associados à dimensão emocional (r = 0,597; p = 0,004). O equilíbrio dinâmico e a mobilidade foram associados de forma independente ao escore total (β = 0,651; r2 = 0,424; p = 0,001), e as dimensões física (β = 0,570; r2 = 0,324; p = 0,04) e emocional (β = 0,611; r2 = 0,337 p = 0,002) da QV. Conclusão Nossos dados sugerem que o equilíbrio dinâmico e a mobilidade avaliam melhor a QV do que a ACR, comumente medida na prática clínica. Ainda não se sabe se as intervenções direcionadas especificamente ao equilíbrio dinâmico e à mobilidade têm diferentes impactos na QV. (Arq Bras Cardiol. 2020; 114(4):701-707)
Abstract Background Physical fitness is an important determinant of quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients. However, how the different physical fitness components correlate with the specific dimensions of QoL in HFpEF patients remains unknown. Objective To evaluate the association between different physical fitness components and QoL dimensions in HFpEF patients, and, assess which physical fitness components were independently associated to QoL. Methods Patients with HFpEF were assessed for physical fitness [dynamic balance and mobility (8-foot-up-and go test), upper body strength (handgrip), cardiorespiratory fitness (CRF) (6-minute-walking test) and body composition (body mass index)] and for QoL (Minnesota Living With Heart Failure Questionnaire). Partial correlation was used to verify the association between physical fitness components and QoL dimensions. The determination of independent predictors in QoL dimensions was assessed through stepwise multivariate linear regression analysis. Statistical significance was set at p<0.05. Results Both CRF and dynamic balance and mobility are significantly associated with the total score and physical dimensions of QoL (p<0.05), but only dynamic balance and mobility were concomitantly associated with the emotional dimension (r=0.597; p=0.004). Dynamic balance and mobility were independently associated with total score (β=0.651; r2=0.424; p=0.001), physical (β=0.570; r2=0.324; p=0.04) and emotional (β=0.611; r2=0.373 p=0.002) dimensions of QoL. Conclusion Our data suggests that dynamic balance and mobility better assess QoL than CRF, which is commonly measured in clinical practice. Whether interventions specifically targeting dynamic balance and mobility have different impacts on QoL remains unknown. (Arq Bras Cardiol. 2020; 114(4):701-707)
Subject(s)
Humans , Quality of Life , Heart Failure , Stroke Volume , Physical Fitness , Hand StrengthABSTRACT
Objective. (i) To compare daily physical activity (PA) levels evaluated by the International Physical Activity Questionnaire (IPAQ) and by triaxial accelerometry in heart failure with preserved ejection fraction (HFpEF) patients; (ii) to describe daily PA patterns based in objective measurements; and (iii) to observe the association between prognostic indicators and PA measurements. Design. This is a cross-sectional study with 24 stable HFpEF patients. PA was assessed through the IPAQ short version and triaxial accelerometer. Time spent in moderate-to-vigorous PA (MVPA) from IPAQ was computed as self-reported walking and MVPA. Prognostic indicators were: distance on the 6-minute-walking test (6MWT), oxygen consumption (VO2) during the test, quality of life (QoL), BNP plasma level, and E/e' ratio. Results. Compared to accelerometry, IPAQ underestimated sedentary time (253 ± 156 vs. 392 ± 104 min/day, p = .001) and overestimated MVPA (44 ± 56 vs. 19.3 ± 26 min/day, p < .001). Accelerometer-derived data showed that HFpEF patients spent 50% of their waking time in sedentary behaviours and 2.5% in MVPA. Of measured surrogate prognostic markers, functional capacity (6MWT, r = 0.652, p = .04; VO2, r = 0.512, p = .02) and QoL (r=-0.490, p = .04) were correlated with MVPA. Conclusions. The IPAQ underestimated sedentary time and over-estimated MVPA in HFpEF patients. Using accelerometer-derived data, HFpEF patients spent only a minority of their time involved in MVPA, which was the only PA pattern positively associated with prognostic indicators.
