A randomized trial of the effects of exercise training in Chagas cardiomyopathy

Abstract

AimsThe effects of exercise training in chronic heart failure are well established, however, they have not been evaluated in Chagas cardiomyopathy (ChC). We sought to determine the effects of exercise training on functional capacity, health-related quality of life (HQoL), and brain natriuretic peptide (BNP) levels in patients with ChC. Methods and resultsThis randomized, controlled, single-blind trial included 40 patients with ChC (age 49.5 + 7.8 years, 57.5% male) who did not practice regular exercise. All patients were assessed, at baseline and at the end of the study, by exercise test (VO 2 and exercise time), six-minute walk test (6MWT), Goldman Specific Activity Scale (SAS), HQoL, and BNP levels. Patients were randomized to inactive control group (ICG ¼ 19) or exercise training group (ETG ¼ 21). Exercise training group patients underwent 12 weeks of exercise training: walking for up to 30 min (intensity 50-70% HR reserve + HR at rest) and warm-up and cooling-down exercising, three times a week. The data were analysed for delta values (D¼ end 2 baseline). After intervention, compared with the ICG, the ETG had significant increases in functional parameters including, DVO 2 (6.5 vs. 2.8 mL/kg/min, P ¼ 0.001), D exercise time (2.9 vs.1.1 min, P , 0.001), D6MWT distance (83.5 vs. 2.0 m, P ¼ 0.001) improved DSAS (8 vs. 1 patient, P ¼ 0.008), and HQoL: D domains vitality (7.5 vs. 0 points, P ¼ 0.013), D emotional aspects (16.7 vs. 0 points, P ¼ 0.012), and D mental health (16.1 vs. 0 points, P ¼ 0.031). There was no difference in BNP levels. ConclusionIn patients with ChC, exercise training was associated with a major improvement in functional capacity and HQoL without any adverse effects.--

Health-related quality of life in patients with Chagas disease: a review of the evidence

“…Of these, 10 were published in international journals, and 2 were published in Brazilian journals. Six cross-sectional studies evaluated HRQoL in ChD patients (Table 1) (5) (10) (14) (15) (16) (17) , two verifi ed the effect of non-surgical conservative treatments on HRQoL in Chagas dilated cardiomyopathy patients (Table 2) (18) (19) , and 4 correlated HRQoL with functional capacity in ChD patients (Table 3) (20) (21) (22) (23) . The studies found in our literature search showed heterogeneity in the patient samples: one article included patients presenting with all clinical forms of ChD (8.3%), two (16.7%) included patients with pacemakers, two (16.7%) did not mention the presence of cardiopathy, and 7 (58.3%) included patients with cardiopathy.…”

Effects of an exercise program on the functional capacity of patients with chronic Chagas' heart disease, evaluated by cardiopulmonary testing

“…In the literature reviewed, only 1 study correlated the effects of regular physical training with CHD 18 .…”

“…The study by Lima et al correlated the effect of regular physical training with CHD 18 . The article was published in the European Journal of Heart Failure in June 2010 and reported the improvement of functional capacity in patients with Chagas' cardiomyopathy undergoing a 12-week exercise program.…”

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

“…Lima et al (16) conducted a study with the aim of evaluating the effects of exercise training in Chagas cardiomyopathy. A total of 40 patients were randomized to inactive control or exercise training groups, and followed up over 3 months.…”

“…However, the majority of studies that have evaluated CR in HF have failed to include patients with Chagas disease, and the few studies evaluating the effects of exercise training on patients with Chagas disease have been limited by short-term followup (≤ 6 months), the lack of echocardiographic evaluation, and the inclusion of patients in the early stages of Chagas cardiomyopathy or even those without evidence of cardiac disease (16) (17) (18) (19) (20) . Therefore, the safety and efficacy of CR among patients with CHF remains unknown.…”