Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure

Taylor, Rod S; Walker, Sarah; Smart, Neil A.; Piepoli, Massimo F; Warren, Fiona C; Ciani, Oriana; Whellan, David J.; O’Connor, Christopher M.; Keteyian, Steven J.; Coats, Andrew J.S.; Davos, Constantinos H.; Dalal, Hasnain M; Dracup, Kathleen; Evangelista, Lorraine S.; Jolly, Kate; Myers, Jonathan; Nilsson, Birgitta; Passino, Claudio; Witham, Miles D.; Yeh, Gloria Y.

doi:10.1016/j.jacc.2018.12.072

Cited by 211 publications

(165 citation statements)

References 55 publications

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“…Exercise‐based cardiac rehabilitation has been strongly recommended in the management of HF patients . This intervention improves functional capacity, exercise intolerance, and quality of life in patients with HFrEF . However, it remains unclear whether exercise training impacts the risk of mortality and hospitalization in this set of patients .…”

Section: Introductionmentioning

confidence: 99%

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Antunes‐Correa

Trevizan

Bacurau

et al. 2019

J cachexia sarcopenia muscle

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Background The exercise intolerance in chronic heart failure with reduced ejection fraction (HFrEF) is mostly attributed to alterations in skeletal muscle. However, the mechanisms underlying the skeletal myopathy in patients with HFrEF are not completely understood. We hypothesized that (i) aerobic exercise training (AET) and inspiratory muscle training (IMT) would change skeletal muscle microRNA‐1 expression and downstream‐associated pathways in patients with HFrEF and (ii) AET and IMT would increase leg blood flow (LBF), functional capacity, and quality of life in these patients. Methods Patients age 35 to 70 years, left ventricular ejection fraction (LVEF) ≤40%, New York Heart Association functional classes II–III, were randomized into control, IMT, and AET groups. Skeletal muscle changes were examined by vastus lateralis biopsy. LBF was measured by venous occlusion plethysmography, functional capacity by cardiopulmonary exercise test, and quality of life by Minnesota Living with Heart Failure Questionnaire. All patients were evaluated at baseline and after 4 months. Results Thirty‐three patients finished the study protocol: control (n = 10; LVEF = 25 ± 1%; six males), IMT (n = 11; LVEF = 31 ± 2%; three males), and AET (n = 12; LVEF = 26 ± 2%; seven males). AET, but not IMT, increased the expression of microRNA‐1 (P = 0.02; percent changes = 53 ± 17%), decreased the expression of PTEN (P = 0.003; percent changes = −15 ± 0.03%), and tended to increase the p‐AKTser473/AKT ratio (P = 0.06). In addition, AET decreased HDAC4 expression (P = 0.03; percent changes = −40 ± 19%) and upregulated follistatin (P = 0.01; percent changes = 174 ± 58%), MEF2C (P = 0.05; percent changes = 34 ± 15%), and MyoD expression (P = 0.05; percent changes = 47 ± 18%). AET also increased muscle cross‐sectional area (P = 0.01). AET and IMT increased LBF, functional capacity, and quality of life. Further analyses showed a significant correlation between percent changes in microRNA‐1 and percent changes in follistatin mRNA (P = 0.001, rho = 0.58) and between percent changes in follistatin mRNA and percent changes in peak VO2 (P = 0.004, rho = 0.51). Conclusions AET upregulates microRNA‐1 levels and decreases the protein expression of PTEN, which reduces the inhibitory action on the PI3K‐AKT pathway that regulates the skeletal muscle tropism. The increased levels of microRNA‐1 also decreased HDAC4 and increased MEF2c, MyoD, and follistatin expression, improving skeletal muscle regeneration. These changes associated with the increase in muscle cross‐sectional area and LBF contribute to the attenuation in skeletal myopathy, and the improvement in functional capacity and quality of life in patients with HFrEF. IMT caused no changes in microRNA‐1 and in the downstream‐associated pathway. The increased functional capacity provoked by IMT seems to be associated with amelioration in the respiratory function instead of changes in skeletal muscle. http://ClinicalTrials.gov (Identifier: NCT01747395)

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Section: Introductionmentioning

confidence: 99%

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Antunes‐Correa

Trevizan

Bacurau

et al. 2019

J cachexia sarcopenia muscle

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“…Studies have shown that exercise can reduce allcause mortality and readmission for patients with CHF; however, the effects of exercise on QoL remain uncertain [29]. A recent meta-analysis confirmed that exercise improved both exercise capacity and QoL compared with the no-exercise control group at the 12-month follow-up, but with weaker evidence for a treatment effect at the 6-month follow-up [30]. Our study demonstrated that exercise improved PRO, especially physical condition.…”

Section: Mcid and Its Interpretation To The Multilevel Modelmentioning

confidence: 48%

Influence of self-management on patient-reported outcomes for individuals with chronic heart failure: a multilevel model approach from a longitudinal study

Zhao

Zhang

Ren

et al. 2020

Preprint

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KEYWORDSpatient reported outcome, chronic heart failure, self-management, multilevel model, minimal clinically important difference 2 Abstract Purpose: Self-management is highly heterogenous in patient-reported outcomes in individuals with chronic heart failure and lacks a clinical definition. The aim of this study was to identify clinically meaningful strategies that improve patient-reported outcomes in those with chronic heart failure.Methods: A total of 555 patients with heart failure were enrolled. Self-management advice was provided in written form at discharge. Information regarding chronic heart failure in patient-reported outcomes and self-management was collected during follow-up. Multilevel models were applied to evaluate the effects of self-management strategies for patient-reported outcome of chronic heart failure (CHF-PRO) scores, as well as its physical and psychological domains. Minimal clinically important difference was introduced to further evaluate clinical significance.Results: Scores for CHF-PRO improved significantly after discharge. A regular schedule, avoidance of over-eating, and a low-sodium diet increased scores on patient-reported outcomes, including overall scores and physical and psychological scores. In addition, exercise improved patient-reported outcomes and its physical domain. The use of angiotensin-converting enzyme inhibitors also increased physical scores. Among these variables, a regular daily schedule and avoidance of overeating almost every day reached clinical significance for CHF-PRO scores, as well as its physical and psychological domains.Conclusions: Self-management, especially the avoidance of over-eating and maintenance of a regular schedule, should be implemented to improve patient-reported outcomes in those with chronic heart failure.

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“…Studies have shown that exercise can reduce all-cause mortality and readmission for patients with CHF; however, the effects of exercise on QoL remain uncertain [29]. A recent meta-analysis confirmed that exercise improved both exercise capacity and QoL compared with the no-exercise control group at the 12-month follow-up, but with weaker evidence for a treatment effect at the 6-month follow-up [30]. Our study demonstrated that exercise improved CHF-PROM, especially physical condition.…”

Section: Mcid and Its Interpretation To The Multilevel Modelmentioning

confidence: 99%

Assessment of Chronic Disease Self-management in Patients With Chronic Heart Failure Based on the MCID of Patient-reported Outcomes by the Multilevel Model

Tian

Zhao

Zhang

et al. 2020

Preprint

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Abstract Purpose:The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure - PRO measure (CHF-PROM).Methods: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from May 2017 to May 2019. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with β values of CDSM obtained from the multi-level models to further evaluate the clinical significance.Results: Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating almost every day (13.60 vs. 10.71) and maintenance of a regular schedule often (12.03 vs. 10.71) reached clinical significance for the overall summary. Avoidance of over-eating (4.56 vs. 4.14) and a regular schedule almost every day (4.76 vs. 4.14) reached clinical significance for the physical scores. Avoidance of over-eating often (5.73 vs. 5.35) and a regular schedule almost every day (6.36 vs. 5.35) demonstrated clinical significance for the psychological scores.Conclusions: This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure.Trial registration: 2018LL128, RegisteredJanuary 2, 2018-Prospective registered, http://www.sxmu.edu.cn/.

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Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure

Cited by 211 publications

References 55 publications

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

Influence of self-management on patient-reported outcomes for individuals with chronic heart failure: a multilevel model approach from a longitudinal study

Assessment of Chronic Disease Self-management in Patients With Chronic Heart Failure Based on the MCID of Patient-reported Outcomes by the Multilevel Model

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