Cardiac rehabilitation and improvement of chronotropic incompetence: Is it the exercise or just the beta blockers?

Pimenta, Tiago; Rocha, José Afonso

doi:10.1016/j.repce.2021.11.013

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…However, our study showed that HRR, a cardiac autonomic function index that controls the HR response during exercise, was also markedly improved by the exercise training intervention. Several intervention studies (46,47) reported that chronotropic incompetence and HRR were improved by exercise therapy alone. Therefore, we cannot exclude the possibility that exercise training had a positive effect on the HR response by improving cardiac autonomic nerve function.…”

Section: Effects Of Exercise Training Intervention On Hemodynamics An...mentioning

confidence: 99%

Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years

Sugita,

Ito,

Yoshioka

et al. 2023

Front. Cardiovasc. Med.

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IntroductionExercise training is an established intervention method for improving exercise capacity and survival rates in patients with heart failure with preserved ejection fraction (HFpEF). However, most reports have focused on European and American patients, with limited data regarding the effects of exercise training on cardiac function, hemodynamics, and exercise capacity in East Asian patients. This study investigated the effects of exercise training on cardiac function, hemodynamics, and exercise capacity in Japanese patients aged 65–80 years with HFpEF.MethodsThis single-center, open-label, non-randomized, controlled trial prospectively enrolled 99 outpatients. Eligibility criteria for HFpEF patients were an HFA score ≥5 in addition to clinical symptoms of heart failure and left ventricular diastolic dysfunction. Exercise training in the intervention group consisted of aerobic exercise and strength training thrice weekly for 5 months. Patients in the control group continued the usual treatment for 5 months. Resting cardiac function was evaluated using echocardiography. Peak oxygen uptake (peakVO2), ventilatory equivalent (VE) vs. carbon dioxide output (VCO2) slope, peak cardiac output index, and arteriovenous oxygen difference were calculated using cardiopulmonary exercise testing combined with impedance cardiography.ResultsAfter 5 months of exercise training, remarkable interactions were observed, with peakVO2 as the primary outcome. Additionally, significant interactions were observed between hemodynamic indices and some echocardiographic parameters. The mean percentage change in peakVO2 from baseline was 8.3% in the intervention group. Fifteen study participants (30.1%) in the intervention group achieved a clinically meaningful change of 3.0 ml/min/kg (10% improvement) in peakVO2 from baseline. The group with 3.0 ml/min/kg or 10% improvement in peakVO2 from baseline had a considerably lower prevalence of diabetes mellitus and VE vs. VCO2 slope and considerably higher left atrial-global longitudinal strain values than the group without any notable improvements.ConclusionsAlthough exercise training can help improve exercise intolerance in Japanese patients aged 65–80 years with HFpEF, its benefits are limited. Our results suggest that HFpEF, complicated by diabetes mellitus and decreased ventilatory efficiency during exercise, may require reconsideration of intervention strategies. This trial was registered with the University Hospital Medical Information Network, a trial registry in Japan (registration number: UMIN000045474).

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Section: Effects Of Exercise Training Intervention On Hemodynamics An...mentioning

confidence: 99%

Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years

Sugita,

Ito,

Yoshioka

et al. 2023

Front. Cardiovasc. Med.

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show abstract

“…Maximum heart rate (HRmax) is a parameter for intensity control of aerobic physical exercises, being part of the individual prescription for regular activities, therapeutic or cardiac rehabilitation programs, by using the HRmax percentual or reserve HR. 1,2 HRmax can be directly measured using the maximum effort test; 3 being defined as the highest HR reached, it remains on the plateau even with increased work intensity. 4 It can also be predicted through equations, 5,6 which are also used as a maximum effort criterion in the measurement of cardiorespiratory fitness (CRF).…”

Section: Introductionmentioning

confidence: 99%

Prediction equations for maximal heart rate in obese and nonobese children and adolescents: a systematic review and meta-analysis

Carli

Junior

Menezes-Junior

et al. 2023

Rev. paul. pediatr.

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Objective: The aim of this study was to analyze which equation best estimates maximal heart rate (HRmax) for the pediatric population according to body mass. Data source: We performed a meta-analysis (PROSPERO No. CRD42020190196) of cross-sectional studies that aimed to validate or develop HRmax equations and that had children and adolescents as samples. The search was conducted in Scopus, Science Direct, Web of Science, PubMed, and Biblioteca Virtual em Saúde with the descriptors “prediction or equation,” “maximal heart rate,” “maximum heart rate,” “determination of heart rate,” children, and adolescent. The TRIPOD Statement tool was used to assess the methodological quality and the relevant data were extracted for analysis. The meta-analysis was conducted in the Comprehensive Meta-Analysis, adopting p<0.05 and a 95% confidence interval (CI). Data synthesis: In total, 11 studies were selected, of which 3 developed predictive equations, 10 performed external validity of the preexisting models, and 1 incremented values related to equations already developed. The results of the methodological quality analysis showed a moderate rating in most studies. The 164 + (0.270 × HRres) – (0.155 × body mass) + (1.1 × METs) + (0.258 × body fat percent) (r=0.500, 95%CI 0.426–0.567, p<0.001) and 166.7+ (0.46 × HRres) + (1.16 × maturation) (r=0.540, 95%CI 0.313–0.708, p<0.001) equations presented stronger correlations with measured HRmax in nonobese adolescents. The predictive model developed by 208 – (0.7 × age) showed a greater accuracy among the possible models for analysis (SDM=-0.183, 95%CI -0.787 to -0.422, p=0.554). No specific predictive equation was found for obese adolescents. Conclusions: Future research should explore new possibilities for developing predictive equations for this population as a tool to control exercise intensity in the therapeutic management of childhood and adolescent obesity.

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“…These findings underscore the importance of timely diagnosis and therapeutic intervention, as chronotropic incompetence not only predicts cardiovascular morbidity and mortality but may also underlie early exercise-related fatigue. Hence, targeted interventions, including cardiopulmonary rehabilitation programs, are vital, as they have shown efficacy in enhancing aerobic capacity and the quality of life for post-COVID patients with chronotropic incompetence 10 .…”

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confidence: 99%

Chronotropic incompetence is associated with reduced aerobic conditioning and sedentary behavior in patients with post-acute COVID-19 syndrome

Campos,

Brito,

Santos

et al. 2024

Rev. Inst. Med. trop. S. Paulo

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Post-acute COVID-19 syndrome, or long COVID, presents with persistent symptoms, including cough, dyspnea, and fatigue, extending beyond one month after SARS-CoV-2 infection. Cardiac complications such as chest pain and arrhythmias have raised concerns, with chronotropic incompetence (CI), an inadequate heart rate increase during exercise, emerging as a significant condition contributing to diminished exercise tolerance and quality of life. This study estimated the prevalence of CI and explored its association with aerobic capacity and physical activity levels in long COVID patients. A cross-sectional study was conducted at a private hospital in Sergipe, Brazil, involving 93 patients over 18 years old with persistent post-COVID-19 symptoms after confirmed SARS-CoV-2 infections. Exclusion criteria included beta-blocker use, inadequate respiratory exchange ratio, and inability to complete cardiopulmonary exercise testing (CPET). Clinical histories, CPET results, and chronotropic index calculation were used to identify CI, with logistic regression analyzing associated factors. Of the participants (mean age 45 years; average duration since COVID-19 diagnosis 120 days), 20.4% were diagnosed with CI. Logistic regression identified a strong association between CI and sedentary behavior (OR 11.80; 95% CI 2.54 to 54.78; p=0.001). Patients with CI showed lower predicted peak heart rates and maximal oxygen uptake. The prevalence of CI among long COVID patients in this study was approximately 20%, associated with decreased aerobic capacity and increased sedentary behavior. These findings highlight the need for timely diagnosis and therapeutic interventions, including cardiopulmonary rehabilitation, to enhance the quality of life in post-COVID patients with CI. The study's crosssectional design and its specific context have limited causality inference and generalizability, underscoring the importance of further research in diverse settings.

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Cardiac rehabilitation and improvement of chronotropic incompetence: Is it the exercise or just the beta blockers?

Cited by 3 publications

References 23 publications

Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years

Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years

Prediction equations for maximal heart rate in obese and nonobese children and adolescents: a systematic review and meta-analysis

Chronotropic incompetence is associated with reduced aerobic conditioning and sedentary behavior in patients with post-acute COVID-19 syndrome

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