Impact of a home-based walking and resistance training program on quality of life in patients with heart failure.

Patients with heart failure (HF) often have profound activity limitations and diminished quality of life (QOL) due to symptoms of dyspnea and fatigue. Although recent studies demonstrate positive physiologic and psychological benefits of low to moderate intensity, supervised, aerobic exercise training performed 3 to 5 days/ week for 20 to 40 minutes' duration, in a monitored setting, the efficacy of a home-based exercise program combining endurance and resistance exercise on symptoms and QOL, are unknown. This randomized controlled study examined the efficacy, safety, and adherence rates of a 3-month home-based combined walking and resistance exercise program on symptoms and QOL in 40 women and men aged 30 to 76 years with New York Heart Association class II to III HF. Baseline and 3-month evaluations consisted of a chronic HF questionnaire to assess symptoms and QOL and exercise capacity by symptom-limited treadmill exercise test with respiratory gas analysis. The exercise intervention improved fatigue (p = 0.02), emotional function (p = 0.01), and mastery (p = 0.04). Overall exercise adherence was excellent (90%) and there were no reported adverse events. A moderate intensity home-based combined walking and resistance program for patients with class II to III HF is safe and effective in reducing symptoms and improving QOL.

The Telelab personal blood pressure transmitter: accurate and reliable home monitoring for hypertensive patients.

We compared Telelab Personal Blood Pressure Transmitters to mercury sphygmomanometers on a random sample of 63 patients in an office setting and on 29 different patients in a home trial. Each patient was tested with the sphygmomanometer by one of two observers. Three consecutive measurements of each patient were averaged for each method. Although some differences between observers were statistically significant, they were not clinically significant. Differences between the two methods were well within the Association for the Advancement of Medical Instrumentation's accepted range for comparable medical equipment. The 29 hypertensive outpatients used the Telelab transmitter for periods ranging from 2 to 55 weeks during a clinical validation phase. The reliability and accuracy of the monitor were again demonstrated by frequent comparisons with office mercury sphygmomanometer measurements. The high degree of patient acceptance of the monitor for repeated readings over prolonged periods clearly adds to its usefulness.

Effects of daily activities and social behavior on blood-pressure elevation.

This study examined the effects of daily activities and social behavior on the blood-pressure elevation in 21 normotensives, 20 borderline hypertensives, and 20 sustained essential hypertensives. Blood pressures were recorded over a 24-hr period using an ambulatory monitor while subjects recorded their daily activities and social involvement at each cuff inflation. Results indicated that only a moderate proportion of the blood pressure readings of the two clinical groups exceeded 140/90 mm Hg. Results also suggested that the blood pressures of normotensives were more responsive to changes in physical activity, while the blood pressures of sustained hypertensives were more responsive to social involvement. When group differences emerged on mean blood-pressure elevation, analyses indicated that the two hypertensive groups frequently differed from the normotensive group but rarely from each other. The results suggest that differences in blood-pressure elevation cannot be fully understood without considering behavior and support its continued inclusion in the study of blood pressure.

Behavioral predictors of blood pressure variation in hypertensives and normotensives.

This study examined the relative impact of five behavioral factors--activity, posture, location, social involvement, and tension--on the 24-hr blood pressure (BP) variability of 21 normotensives, 18 borderline hypertensives, and 18 sustained essential hypertensives. Multiple-regression analyses indicated that within each diagnostic group, activity accounted for more variance in BP variability than any other behavioral dimension. For each behavioral dimension examined, the magnitude of the relationship with BP was generally greater for the normotensives than for both hypertensive groups. In contrast, variation due to individuals was a better predictor of BP variability for the two hypertensive groups than for the normotensive group. Number of months hypertensive and use of antihypertensive medication were related to BP variability for the sustained hypertensive group. Findings have implications for the use of ambulatory BP monitors and interpretation of resulting data.