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 .

Heart failure is often characterised by low exercise capacity and a great impairment of performance in the activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. The aims of this study are to understand the relationship of gender and pathophysiological characteristics with self-care behaviour and to evaluate the self-care behaviour in a sample of Portuguese heart failure inpatients, using the Self-Care of Heart Failure Index (SCHFI). A cross-sectional multicentre study enrolling 225 heart failure inpatients from eight hospitals from Portugal was performed. At admission, each patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. A comparison between self-care behaviour with gender was performed. The patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% had reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance, self-care management and self-care confidence, respectively. Heart failure inpatients present inadequate levels of self-care behaviour. The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

Funding Acknowledgements Type of funding sources: None. Introduction Heart failure is often characterized by low exercise capacity and great impairment on performance in activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. Self-care behaviour plays an important role on patient"s quality of life. Aim The aims of this study are to evaluate the self-care behaviour in a sample of heart failure inpatients, using the Self-Care Heart Failure Index (SCHFI) and to understand whether gender and patophisiologic characteristics does interfere on it. Methods Cross-sectional multicenter study enrolling 225 heart failure inpatients from eight hospitals. At admission, patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. Comparison between self-care behaviour with gender was performed. Also some correaltions were perfomed with the total sample of patients, aiming to understand which were the variables that may interfere with the socre of each sub-scale of the self-care HF index.  Results Patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% have reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance (SCMt), self-care management (SCMg) and self-care confidence (SCC), respectively. Heart failure inpatients present inadequate levels of self-care behaviour. No difference was found between genders on any section of the SCHFI. Among all variables, only the number of CVRFs and the left ventricular ejection fraction had significant differences. Males had better results, but not with a statistically significant difference. Association tests (ANOVA) between different variables and the score of each section of the SCHFI were perfomred. Only in the NYHA there are variables associated with a better self-care, namely in the SCMg (p = 0.011) and in SCC (p = 0.010). Correlations were made using the numeric variables age, CVRF, BI, LCADL, SCMt, SCMg and SCC, in order to understand the influence of the variables with each other. All the three dimesnions present a positive correlation, at 99% confidence interval between them (SCMt with SCMg: r = 0.365, p < 0.000; SCMt with SCC: r = 0.272, p < 0.000 and SCMg with SCC: r = 0.670, p < 0.000). In addition, SCMt presents a positive correlation with age at a 95% confidence interval (r = 0.158, p = 0.018). Negative correlations were found between 1) BI and age (r=-0.151, p = 0.023), at a 95% confidence interval and 2) BI with LCALD (r=-0.407, p < 0.000), at a 99% confidence interval. Regarding NYHA functional class and left ventricular systolic function, only NYHA class II patients present a statistically significant difference in SCMg and SCC comparing to Class III and IV patients (who do not present differences between them).  Conclusion The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

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Objective To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. Design A randomized controlled clinical trial with follow-up at discharge. Settings Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. Group Assignments Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). Main outcome Functional exercise tolerance was measured with a 6-min walking test at discharge. Results In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% ( n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders ( p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). Conclusion The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.

Introdução: A insuficiência cardíaca (IC) acarreta limitação nas atividades da vida diária e consequente perda de autonomia funcional e instrumental. Representa um dos problemas de saúde mais preocupantes devido ao seu impacte económico significativo. Objetivo: Identificar o impacte de um programa de exercício físico nos doentes com IC em fase de compensação em contexto hospitalar. Métodos: Foi implementado um estudo exploratório retrospetivo no qual participaram vinte doentes que realizaram um mínimo de 3 sessões do programa ERIC. Os sinais vitais, monitorização do ECG e da perceção subjetiva de esforço (PSE) foram avaliados antes e depois de cada sessão de treino, bem como escala LCADL e os parâmetros do exercício (número de voltas na pedaleira, o número de metros caminhados no corredor e número de degraus percorridos). O estudo apresentado decorreu num período de 3 meses. Resultados: Os doentes (idade média de 64 anos) apresentaram uma variação positiva nos parâmetros de desempenho do exercício, uma variação negativa na escala LCADL (29,9-20,9) e PSE após o exercício (4,85-3,82), o que significa que melhoram a sua capacidade funcional ao longo do programa. Nenhum dos odentes apresentou eventos adversos ou treinou fora do intervalo de frequência cardíaca de segurança (valor médio de 11,2 bpm a 12,9 bpm). Conclusões: O programa ERIC demonstra segurança e melhoria da Capacidade Funcional do doente, com base na análise estatística desta amostra, Estes resultados permitem-nos inferir que o exercício poderá ser um recurso efetivo para o tratamento coadjuvante de doentes admitidos com insuficiência cardíaca descompensada. Contudo, serão necessários mais estudos com amostras maiores e com desenho do tipo randomizado. Palavras-chave: Exercício, insuficiência cardíaca, segurança, eficácia, Enfermagem de Reabilitação

Introdução: Os doentes com insuficiência cardíaca descompensada caracterizam-se por apresentar elevada intolerância à atividade, associada a dispneia e edemas. O treino de exercício físico permite promover um aumento da tolerância ao esforço, assim como melhoria da função cardíaca. Objetivo: Identificar sinais de modulação cardíaca e consequente melhoria da capacidade funcional após a implementação de um plano de exercício físico estruturado. Método: Relato de caso de abordagem quantitativa. Pessoa com insuficiência cardíaca descompensada de etiologia isquémica e valvular, manifestando elevado grau de intolerância à atividade assim como descompensação hemodinâmica. Foram avaliados parâmetros fisiológicos como FC, TA, PSE pela escala de Borg e a sua tolerância à atividade, no momento da admissão e ao longo das sessões de treino. O T6MM foi aplicado em 2 momentos distintos: ao 4º dia de internamento e à data da alta, como forma de avaliar a evolução da capacidade funcional. O doente em questão encontra-se inserido num ensaio clínico randomizado onde se pretende avaliar a eficácia e segurança do exercício físico, sendo utilizados como instrumentos de avaliação a escala de LCADL, o Índice de Barthel, assim como do T6MM. Resultados: Verificou-se uma melhoria da capacidade funcional da pessoa, avaliada pelo teste dos 6 minutos de marcha (T1: 210m, T2: 295m), assim como uma redução da frequência cardíaca em repouso (85 bpm vs 68 bpm) e de treino (145bpm vs 94bpm). Não foram verificados eventos adversos durante as sessões de treino. Conclusões: A intervenção implementada nesta situação clínica revelou-se segura, sendo igualmente eficaz na melhoria da capacidade funcional e modulação da frequência cardíaca em repouso e durante o treino. Descritores: Treino Aeróbio, insuficiência cardíaca, reabilitação cardíaca; Enfermagem de Reabilitação

Funding Acknowledgements Type of funding sources: None. Introduction Heart Failure patients often present impairment on their functional capacity. Exercise training is the key component of cardiac rehabilitation and must be early implemented. Knowing the characteristics that lead a patient to be a good responder to an exercise intervention would be useful to identify the ones that could benefit from this same intervention. Purpose Identify the characteristics of good responses to an aerobic exercise training in decompensated heart failure (HF) patients and understand if there are gender differences.  Methods Cross sectional study with 76 inpatients who performed an aerobic exercise training program (AET). Functional capacity was evaluated at admission and discharge using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). Multivariate linear regression was performed by gender to understand which variables lead a patient to have better performance. Since it is known that men and women have different responses to exercise training, the results and analysis of the data collected were performed by gender. Results Seventy-six patients (52 men) were included. The mean age was 67 ± 10 years, 15.8% were New York Heart Association (NYHA) class IV and 76.3% had reduced ejection fraction. The major etiology of HF was ischemic disease (35.5%). Six predictive equations were obtained, one for each functional capacity (FC) tool divided by gender. NYHA class III patients do not differ from class IV in terms of FC at discharge. However, HFreduced ejection fraction patients presented higher 6MWT distance (309,6m vs 231m) and lower LCADL score (11 vs 15) compared to non-reduced. Gender analysis showed that women had an average of 4 days longer in-hospital stay and a considerable difference in the 6MWT. At admission women walked 15 meters less than man and at discharge 69 meters less, presenting also lower score at BI and higher at LCADL. However, only the discharge 6MWT distance presents a statistical significant difference (69 meters; p = 0.01). Traditionally women are more sedentary and present less fitness level than men. The linear regression model shows that gender is a independent variable that contributes to the change in the 6MWT - favouring men.  Conclusions The AET program appears to be more effective in younger patients, with low FC at admission and who are less impaired. Those with left systolic ventricular function apparently interfered with progression during the program. Gender influences the performance of patients undergoing exercise training. Men present higher FC at discharge but the predictive models are stronger for women. These results are consistent with the idea that gender plays an important role in determine the performance of patients in exercise training programs.