Establishing a cardiac training group for patients with heart failure: the “HIP-in-Würzburg” study

Abstract

Background Exercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated “HF training groups.” Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany. Methods Twelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ). Results All patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO2% predicted, from 66.5 [49; 77] to 67 [52; 78]; p for trend = 0.03. The physical function and social limitation domains of the KCCQ improved from 60 [54; 82] to 71 [58; 95, and from 63 [39; 83] to 78 [64; 92]; p for trend = 0.04 and = 0.01, respectively. Positive trends were further seen for the clinical and overall summary scores. Conclusion This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.

Habitual physical activity levels of adults with heart failure: systematic review and meta-analysis

“…Therefore, we converted the median and IQR to mean and SD assuming a log-normal distribution. 22 In one instance in Guder et al , 23 this process resulted in an estimated mean smaller than the stated median. Therefore, for this study, we assumed a normal distribution, with the mean equal to the median and the SD approximated using the formula IQR/1.35 (Cochrane Collaboration Handbook Section 6.5.2.5).…”

Utility of Kansas City Cardiomyopathy Questionnaire (KCCQ) in Assessing Quality of Life among Patients with Heart Failure Undergoing Exercise Training Rehabilitation: A Systematic Review

“…The systematic review analyzed a total of nine studies [21][22][23][24][25][26][27][28][29], detailed in Table 1, spanning various countries including the United States [21][22][23]25,27], Germany [24,26], Taiwan [28], and Japan [29], conducted between 2012 and 2022. This diverse collection of research emphasizes a widespread interest in the application of the KCCQ to assess the QoL in patients with HF undergoing exercise training rehabilitation.…”

Multidisziplinärer Teamansatz in der Versorgung von Patienten mit Herzinsuffizienz

“…Auch die Indikation zur Teilnahme an einer Herzinsuffizienz-Sportgruppe sollte regelmäßig im ambulanten Bereich geprüft werden [17,18]. Seit Jahrzehnten sind die positiven Auswirkungen von Sport bei Herzinsuffizienz bekannt.…”