Physical Rehabilitation for Older Patients Hospitalized for Heart Failure

Kitzman, Dalane W.; Whellan, David J.; Duncan, Pamela W.; Pastva, Amy M.; Mentz, Robert J.; Reeves, Gordon R.; Nelson, M. Benjamin; Chen, Haiying; Upadhya, Bharathi; Reed, Shelby D.; Espeland, Mark A.; Hewston, LeighAnn; O’Connor, Christopher M.

doi:10.1056/nejmoa2026141

Cited by 300 publications

(274 citation statements)

References 42 publications

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“…Older adults are particularly prone to hospitalisation hazards, including immobility, delirium, and functional decline, which are often associated with increased length of hospital stay, institutionalisation, and mortality (261). Exercise and early rehabilitation programmes are among the interventions through which functional decline is likely to be best prevented in hospitalised older patients (142,(262)(263)(264)(265).…”

Section: Exercise For Acute Hospitalised Older Patientsmentioning

confidence: 99%

“…The benefits of exercise have been clinically, biologically, and even economically confirmed (113,267), making exercise a valuable addition to the therapeutic arsenal. Although only a few RCTs have examined the potential benefits of exercise training for acutely hospitalised older adult patients, the effects of in-hospital exercise interventions on functional outcomes are promising even in the oldest-old people with frailty (113,264,267,268). Martínez-Velilla et al (113) and Saez de Asteasu et al (268) showed that an individualised multicomponent exercise training programme for oldest-old individuals with frailty improved their overall functional capacity and cognition during acute hospitalisation when compared with usual care.…”

Section: Exercise For Acute Hospitalised Older Patientsmentioning

confidence: 99%

“…Once discharged, however, progression to moderate-high intensity resistance training is required to achieve the benefits shown in many of the randomised controlled trials described earlier (5,68,158,210,272,273), given the well-described dose-response effects related to intensity and adaptations to anabolic exercise. More recently, Kitzman et al (264) in a diverse population of older patients hospitalised for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care.…”

Section: Exercise For Acute Hospitalised Older Patientsmentioning

confidence: 99%

See 2 more Smart Citations

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

Izquierdo

Merchant

Morley

et al. 2021

The Journal of nutrition, health and aging

438

328

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The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.

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Section: Exercise For Acute Hospitalised Older Patientsmentioning

confidence: 99%

Section: Exercise For Acute Hospitalised Older Patientsmentioning

confidence: 99%

Section: Exercise For Acute Hospitalised Older Patientsmentioning

confidence: 99%

See 1 more Smart Citation

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

Izquierdo

Merchant

Morley

et al. 2021

The Journal of nutrition, health and aging

438

328

View full text Add to dashboard Cite

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“…Homebased targeted rehabilitation such in the REACH-HFpEF pilot study [26] may improve patient and carer outcomes and be key to ensuring patient participation. The Rehab-HF trial demonstrated that recently hospitalised and very frail patients with HF benefit from rehabilitation [31].…”

Section: Implications For Practicementioning

confidence: 99%

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

et al. 2021

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BackgroundMany patients with heart failure with preserved ejection fraction (HFpEF) are undiagnosed, and UK general practice registers do not typically record HF sub-type. Improvements in management of HFpEF is dependent on improved identification and characterisation of patients in primary care.AimsTo describe a cohort of patients recruited from primary care with suspected HFpEF and compare patients in whom HFpEF was confirmed and refuted.Design and SettingBaseline data from a longitudinal cohort study of patients with suspected HFpEF recruited from primary care in two areas of England.MethodsA screening algorithm and review were used to find patients on HF registers without a record of reduced ejection fraction. Baseline evaluation included cardiac, mental and physical function, clinical characteristics and patient reported outcomes. Confirmation of HFpEF was clinically adjudicated by a cardiologist.ResultsNinety-three (61%) of 152 patients were confirmed HFpEF. The mean age of patients with HFpEF was 79.3, 46% were female, 80% had hypertension, and 37% took 10 or more medications. Patients with HFpEF were more likely to be obese, pre-frail/frail, report more dyspnoea and fatigue, were more functionally impaired, and less active than patients in whom HFpEF was refuted. Few had attended cardiac rehabilitation.ConclusionsPatients with confirmed HFpEF had frequent multimorbidity, functional impairment, frailty and polypharmacy. Although comorbid conditions were similar between people with and without HFpEF, the former had more obesity, symptoms and worse physical function. These findings highlight the potential to optimise well-being through comorbidity management, medication rationalisation, rehabilitation, and supported self-management.

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“…The Rehab study ( 82 ) explored the effect of a rehabilitative intervention in 349 older patients (mean age 72.7 ± 8 years, 52% women, 53% with HFpEF) hospitalized for acute decompensated HF. Most of patients were frail or prefrail.…”

Section: Special Populationsmentioning

confidence: 99%

The Future of Exercise-Based Cardiac Rehabilitation for Patients With Heart Failure

Passantino

Vecchia

Corrà

et al. 2021

Front. Cardiovasc. Med.

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Cardiac rehabilitation (CR) is a comprehensive program that includes exercise training, titration of medical therapy, lifestyle modification, educational support, and psychosocial assessment. All these components are safe and beneficial resulting in significant improvements in quality of life, functional capacity, mortality, and hospital readmission. Current guidelines support its use in a broad spectrum of cardiac disease. This review focuses on exercise-based CR for heart failure (HF) patients in whom CR is a recommended treatment. Exercise should be prescribed according to a personalized approach, optimizing, and tailoring the rehabilitative program to the patient's characteristics. Specific CR programs are dedicated to older patients, those with HF and preserved ejection fraction, and recipients of cardiac implantable electronic devices or left ventricular assistance device. Telemedicine may increase CR participation and overcome some of the barriers that limit its utilization.

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Physical Rehabilitation for Older Patients Hospitalized for Heart Failure

Cited by 300 publications

References 42 publications

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

The Future of Exercise-Based Cardiac Rehabilitation for Patients With Heart Failure

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