Home-based training program in patients with chronic heart failure and reduced ejection fraction: a randomized pilot study

Abstract

OBJECTIVES: We aimed to compare the effects of home-and center-based exercise training programs on functional capacity, inspiratory muscle strength, daily physical activity level, and quality of life (QoL) in patients with chronic heart failure (CHF) over a 12-week period. METHODS: This study included 23 patients with CHF (left ventricular ejection fraction 31±6%) randomized to a home-based (n=11) or center-based (n=12) program. Patients underwent 12 weeks of aerobic training (60%-70% heart rate reserve): walking for the home-based and supervised cycling for the center-based group, both combined with resistance training (50% of 1 maximum repetition). At baseline and after 12 weeks of training, we assessed cardiopulmonary test variables, 6-min walk test distance (6 MWD), steps/day with accelerometry, and QoL (Minnesota Living with Heart Failure questionnaire). Maximal inspiratory pressure and handgrip strength were measured at baseline and after 4, 8, and 12 weeks of training. ClinicalTrials.gov: NCT03615157. RESULTS: There were no adverse events during training in either group. The home- and center-based training groups obtained similar improvements in peak oxygen uptake, maximal ventilation, and 6 MWD. However, there were significant between-group differences: center-based training was more effective in improving maximal inspiratory pressure ( p =0.042), number of steps/day ( p =0.001), and QoL ( p =0.039). CONCLUSIONS: Home-based training is safe and can be an alternative to improve the exercise capacity of patients with stable CHF. However, center-based training was superior in improving inspiratory muscle strength, QoL, and daily physical activity.

Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study

“…Com o advento da pandemia de COVID-19, os programas de reabilitação foram forçados a operar de forma remota, na casa do paciente. (1,2) Embora progressivamente tenham surgido estudos que mostraram que é possível propiciar treinamento físico, aconselhamento sobre atividade física (AF), educação e treinamento de automanejo fora dos centros de reabilitação tradicionais, (3,4) a maioria dos testes de exercício para a avaliação inicial ainda é realizada nesses centros. No que tange aos programas domiciliares de reabilitação, a fim de avaliar a capacidade de exercício, os profissionais precisam fazer adaptações para criar condições e oportunidades de acessibilidade em diferentes contextos hospitalares e ambulatoriais.…”

Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis

“…In total, Of the included studies, 7 offered a preintervention period as run-in exercise (a period before randomization and intervention start where all participants performed exercise) or rehabilitation [63,98,108,111,120,160,183,189]. Furthermore, 13 RCTs offered rehabilitation as part of the intervention [64,75,80,82,147,149,151,152,157,160,163,169,178]. mHealth solutions (eg, telephone calls, text messages, and apps) were primarily used in 56 RCTs [53,56,57,59,63,67,69,78-80, 83-86,90,92,93,96,99,101,102,105,108,110,112-115,119, 120,124,128-130,134,136,140-142,146-148,150,155,157,161,163, 164,167,168,172,176,177,179,181,185], whereas 22 RCTs [58,60,61,65,70,81,87,111,116,117,126,133,134,145,149,151,154,156,165,171,173,174] used mHealth combined with a device (eg, wearable, pedometer, activity tracker, or Bluetooth-connected pul...…”

“…8). For objectively measured physical function, 4% (2/47) of the RCTs were classified as low risk of bias [110,158], 70% (33/47) of the RCTs had some concerns [54,55,64,71,74,79,82,87,94,96,97,102,105,108,117,118,120,121,124,133,136,147,156,159,167,171,175,178,183,185,186,190], and 26% (12/47) of the RCTs were classified as high risk of bias [57,63,91,112,126,149,[151][152][153][154]163,164,170,176] (Figure 9). The risk of bias profiles were similar for the secondary outcomes (Multimedia Ap...…”

“…objectively measured physical activity, 6% (3/51) of the RCTs were classified as low risk of bias[58,84,160], 55% (28/51) of the RCTs had some concerns[53,61,62,68,70,71,74,81,82,95,97,98,100,102,107,111,115,117,136,143,144,147,148,155,156,166,180,182,183,[188][189][190][191], and 39% (20/51) of the RCTs were classified as high risk of bias[60,65,69,81,91,94,99,104,125,[130][131][132]145,146,149,151,152,163,164,186] (Figure…”