ABSTRACT
BACKGROUND AND AIMS: Regular exercise is recommended to diabetic patients in addition to dietary restrictions and drug therapy. We have studied whether health related quality of life (HRQOL) can be improved by a regular physical training program. METHODS: 23 otherwise healthy patients with history of type 1 diabetes for 20 +/- 10 years were included. 15 patients (age: 41 +/- 2 years) participated in an aerobic physical training program over 4 months and 8 patients (33 +/- 11 years) served as a control group. HRQOL was assessed by a validated questionnaire (MOS SF-36). Tests were carried out at baseline and after 4 months. RESULTS: Physical training increased peak oxygen uptake (VO2max) by 27 +/- 13% after 4 months (p = 0.04) in the training group. There was no significant change in hand or leg isometric muscle strength. All HRQOL scales improved in the training group with significantly higher (p < 0.04) Social Functioning and Vitality scores, respectively. Moreover, insulin requirements decreased during physical training program (p < 0.05). CONCLUSIONS: Our data indicate that physical exercise training in patients with type I diabetes mellitus improves metabolic control and various aspects of HRQOL. Besides enhanced cardiorespiratory capacity, this is an important subjective benefit in patients with longstanding insulin dependent (type 1) diabetes mellitus.
Subject(s)
Diabetes Mellitus, Type 1/therapy , Diet, Diabetic , Exercise , Hypoglycemic Agents/therapeutic use , Physical Fitness/psychology , Quality of Life , Adult , Case-Control Studies , Combined Modality Therapy , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/psychology , Female , Humans , Male , Oxygen Consumption , Treatment OutcomeABSTRACT
Twenty percent of heart transplantation candidates have cardiac pacemakers. Application of neuromuscular electric stimulation (NMES) in patients with pacemakers is controversial because of potential electromagnetic field interference and subsequent failure of the pacemaker. We present a safety protocol as a procedure before applying NMES in pacemaker patients. In 4 patients with chronic heart failure, NMES was applied under supervised conditions for 20 minutes to evaluate the individual risk. No changes in the clinical state and no complications secondary to electromagnetic field interference were observed. A check of pacemaker function after this 20-minute stimulation revealed no changes in the pacemaker parameters. After a thorough safety protocol, NMES of knee extensor muscles in patients with pacemakers appears to be safe.
Subject(s)
Electric Stimulation , Heart Failure/physiopathology , Heart Failure/surgery , Heart Transplantation , Pacemaker, Artificial , Preoperative Care , Humans , Male , Middle Aged , Muscle, Skeletal , Peripheral Nervous SystemABSTRACT
We performed a cross-cultural adaptation of the "Minnesota Living with Heart Failure Questionnaire" (LHFQ) for use in German-speaking chronic heart failure patients. The instrument was translated and back translated, pre-tested and reviewed by a committee. The German version was tested in 114 patients with chronic heart failure. Reliability was assessed by a test-retest procedure and Cronbach's coefficient alpha of internal consistency (0.94). To assess concurrent validity, we compared the LHFQ sum scores with the New York Heart Association classification rating (r = 0.53; p < 0.0001), the 6-minute walk (r = -0.39; p < 0.0001), the left ventricular ejection fraction (r = -0.24; p = 0.011) and big-endothelin (r = 0.27; p = 0.004). Construct validity on the LHFQ scores in comparison with the Medical Outcomes Study SF-36 Health Survey (MOS SF-36) was significant (-0.41 to -0.74; all p < 0.0001). The reliability and validity of the German version of the LHFQ was proved; the questionnaire can be recommended for use in future clinical trials.
Subject(s)
Cultural Characteristics , Heart Failure , Surveys and Questionnaires , Aged , Female , Germany/ethnology , Humans , Male , Middle Aged , Minnesota , Reproducibility of Results , Translations , United StatesABSTRACT
Measurement of skeletal muscle strength gains increasing importance as outcome parameter in patients with chronic heart failure. This study aimed at establishing short-term reliability of isokinetic strength measurements of knee extensor and flexor muscles in 38 patients with chronic heart failure. Strength tests were performed on the Cybex 6000 dynamometer. Trunk fixation was restricted to pelvic fixation. Two bouts of strength testing were performed on day 1 and one on day 5. Each isokinetic bout consisted of 3 reciprocal knee extension and flexion movements with an angular speed of 60 degrees per second. Isometric strength was measured at 30 degree knee angulation. Intraclass correlations ranged between 0.96 and 0.99 for isokinetic and isometric peak torque of knee extensor muscles and 0.82-0.96 for flexor muscles. Analysis of repeated measurements showed significant differences among the values of flexor peak torque in the isokinetic mode and between all measurements in the isometric mode (p < 0.05). Pearson's correlation coefficients for isokinetic and isometric extensor peak torques ranged between 0.95 and 0.99, for flexor peak torques between 0.81 and 0.85 (all p < 0.0001). Measurement of isokinetic knee extensor and flexor peak torque is a reliable method to assess muscle strength in patients with chronic heart failure even with altered trunk fixation.
