Feasibility of Conducting a 6-Months Long Home-based Exercise Program with Protein Supplementation in Elderly Community-dwelling Individuals with Heart Failure

Abstract

Objective Cardiac cachexia is a condition associated with heart failure, particularly in the elderly, and is characterized by loss of muscle mass with or without the loss of fat mass. Approximately 15% of elderly heart failure patients will eventually develop cardiac cachexia; such a diagnosis is closely associated with high morbidity and increased mortality. While the mechanism(s) involved in the progression of cardiac cachexia is incompletely established, certain factors appear to be contributory. Dietary deficiencies, impaired bowel perfusion, and metabolic dysfunction all contribute to reduced muscle mass, increased muscle wasting, increased protein degradation, and reduced protein synthesis. Thus slowing or preventing the progression of cardiac cachexia relies heavily on dietary and exercise-based interventions in addition to standard heart failure treatments and medications. Methods The aim of the present study was to test the feasibility of an at-home exercise and nutrition intervention program in a population of elderly with heart failure, in an effort to determine whether dietary protein supplementation and increased physical activity may slow the progression, or prevent the onset, of cardiac cachexia. Frail elderly patients over the age of 55 with symptoms of heart failure from UAMS were enrolled in one of two groups, intervention or control. To assess the effect of protein supplementation and exercise on the development of cardiac cachexia, data on various measures of muscle quality, cardiovascular health, mental status, and quality of life were collected and analyzed from the two groups at the beginning and end of the study period. Results More than 50% of those who were initially enrolled actually completed the 6-month study. While both groups showed some improvement in their study measures, the protein and exercise group showed a greater tendency to improve than the control group by the end of the six months. Conclusion These findings suggest that with a larger cohort, this intervention may show significant positive effects for elderly patients who are at risk of developing cardiac cachexia.

The effect of protein and essential amino acid supplementation on muscle strength and performance in patients with chronic heart failure: a systematic review

“…Fourteen full-text articles were retrieved after screening of titles and abstracts. Eight articles, including the five studies identified in the hand search, were excluded (Online Resource 4) and six articles were retained for review [27][28][29][30][31][32]. Data reported within these manuscripts was heterogeneous and there was insufficient data to perform meta-analysis or quantitative synthesis due to the risk of generating misleading findings [33].…”

“…Study characteristics are reported in Table 2. One cohort study [32] and five RCTs [27][28][29][30][31] were identified. One-hundred and three (n = 103) patients were recruited to intervention groups and 64 patients were recruited to control groups, providing a total population of 167 patients from six studies.…”

“…All five RCTs had a high risk of bias (Table 3) [27][28][29][30][31]. Randomised controlled trials had between two and six domains that were considered to be at a high risk of bias.…”

“…Five out of six studies increased daily dietary protein and/ or EAA intake with supplementation. Among these five studies, two administered dietary protein; one used 1.5 g/ kg per day of whey protein powder [31] and one used a 300 kcal of twice daily multi-macronutrient supplement containing 20 g of protein [28]. Three of the five studies administered an EAA supplement without further alteration to the patient's habitual macro, or micro nutrient intake.…”

Nutritional interventions for heart failure patients who are malnourished or at risk of malnutrition or cachexia: a systematic review and meta-analysis

“…The remainder 16 articles were selected to be screened for eligibility. Of those 16 articles screened, 11 were rejected, as one did not have a suitable comparator [25], six did not have a relevant outcome [26][27][28][29][30][31], one was a protocol paper [32], one was reporting secondary outcomes of studies already selected to be included in the review [33], and one was rejected as the full-text English version was not available [34]. One further paper was found to be relevant, but it was excluded because the study population was mixed including patients with heart failure, acute myocardial infarction, pneumonia and chronic obstructive pulmonary disease (COPD), and the results were presented for the whole patient population without subgroup analysis for HF only [35].…”