Safety and Efficacy of Aerobic Exercise Training Associated to Non-Invasive Ventilation in Patients with Acute Heart Failure

Abstract

BackgroundExercise training (ET) improves functional capacity in chronic heart failure (HF). However, ET effects in acute HF are unknown.ObjectiveTo investigate the effects of ET alone or combined with noninvasive ventilation (NIV) compared with standard medical treatment during hospitalization in acute HF patients.MethodsTwenty-nine patients (systolic HF) were randomized into three groups: control (Control - only standard medical treatment); ET with placebo NIV (ET+Sham) and ET+NIV (NIV with 14 and 8 cmH2O of inspiratory and expiratory pressure, respectively). The 6MWT was performed on day 1 and day 10 of hospitalization and the ET was performed on an unloaded cycle ergometer until patients' tolerance limit (20 min or less) for eight consecutive days. For all analyses, statistical significance was set at 5% (p < 0.05).ResultsNone of the patients in either exercise groups had adverse events or required exercise interruption. The 6MWT distance was greater in ET+NIV (Δ120 ± 72 m) than in ET+Sham (Δ73 ± 26 m) and Control (Δ45 ± 32 m; p < 0.05). Total exercise time was greater (128 ± 10 vs. 92 ± 8 min; p < 0.05) and dyspnea was lower (3 ± 1 vs. 4 ± 1; p < 0.05) in ET+NIV than ET+Sham. The ET+NIV group had a shorter hospital stay (17 ± 10 days) than ET+Sham (23 ± 8 days) and Control (39 ± 15 days) groups (p < 0.05). Total exercise time in ET+Sham and ET+NIV had significant correlation with length of hospital stay (r = -0.75; p = 0.01).ConclusionExercise training in acute HF was safe, had no adverse events and, when combined with NIV, improved 6MWT and reduce dyspnea and length of stay.

Diretriz Brasileira de Reabilitação Cardiovascular – 2020

“…The study evaluated patients hospitalized for acute decompensated HF, and found functional benefits and reduced length of stay. 201 Nevertheless, additional studies are needed to confirm these initial results before a stronger recommendation can be issued.…”

“…Low-intensity aerobic exercises with noninvasive ventilation during the hospital phase of HF 201 IIb B/C HF: heart failure; LVEF: left ventricular ejection fraction.…”

Review of Trials on Exercise-Based Rehabilitation Interventions Following Acute Decompensated Heart Failure

“…The literature review identified a total of 14 studies from a total of 6751 articles, of which eight were RCTs, [23][24][25][28][29][30][31][32] three retrospective studies 20,33,34 and one each of a propensity-matched trial, 35 single group pre-/post-study, 36 and case series. 37 Studies varied with time of initiation of CR (ie, during hospitalization, at discharge, or within 6 wk of discharge).…”

Feasibility and safety of 1-min sit-to-stand test in acute decompensated heart failure confirmed by lung ultrasound

“…Traditionally, this group of patients was often excluded from CR due to the presence of dyspnea at rest and the fear of acute exacerbation in symptoms and vitals after exercise. However, in recent years, as research on CR in ADHF has gradually been intensified, patients in NYHA class IV have also started to be included in some studies ( 27 ). In this study, although patients in NYHA class IV had significantly more amounts of pulmonary water than patients in class II/III at baseline, they did not show an increase after the test.…”