Aquatic Exercise Is Effective in Improving Exercise Performance in Patients with Heart Failure and Type 2 Diabetes Mellitus

Background. Peak oxygen uptake (VO2peak) and muscle function are more decreased in patients with a combination of chronic heart failure (CHF) and type 2 diabetes mellitus (2DM) compared to patients with only one of the conditions. Further, patients with 2DM have peripheral complications that hamper many types of conventional exercises. Aim. To evaluate the efficacy and applicability of eight-week aquatic exercise in patients with the combination of CHF and 2DM. Methods. Twenty patients (four women) with both CHF and 2DM (age 67.4 ± 7.1, NYHA II-III) were randomly assigned to either aquatic exercise or a control group. The patients exercised for 45 minutes 3 times/week in 33–34°C, swimming pool. Results. The training programme was well tolerated. Work rate (+11.7 ± 6.6 versus −6.4 ± 8.1 watt, P < 0.001) and VO2peak (+2.1 ± 0.8 versus −0.9 ± 1.4 mL·kg−1·min−1, P < 0.001) and walking capacity (P = 0.01) increased significantly in the training group. Muscle function was also significantly improved and Hba1c decreased significantly (P < 0.01) during training, while fasting glucose, insulin, c-peptide, and lipids were unchanged . Training also increased vitality measured by SF-36 significantly (P = 0.05). Conclusion. Aquatic exercise could be used to improve exercise capacity and muscle function in patients with the combination of CHF and 2DM

Exercise in patients with chronic heart failure. With emphasis on peripheral muscle training, hydrotherapy and type 2 diabetes mellitus

Chronic heart failure (CHF) is not uncommon in developed countries with a growing ageing population. CHF is a chronic syndrome, which markedly impact negatively on the patient s life situation. Considerable impaired physical function and reduced health related quality of life is often present. Type 2 diabetes mellitus is a frequent comorbidity in patients with CHF and results in an even greater impairment of physical function. Exercise is physiologically beneficial for patients with these conditions, however little is known about the effect of peripheral muscle training, and hydrotherapy has never earlier been studied in these patients. The aim of this thesis was to evaluate: 1). the chronic effect of peripheral muscle training in patients with CHF, 2). the chronic effect of hydrotherapy in patients with CHF withor without type 2 diabetes mellitus, 3). the acute cardiorespiratory reaction during warm water immersion in patients with CHF and in healthy subjects. Peripheral muscle training during five months was evaluated using ergospirometry, clinical and isokinetic muscle function tests and health related quality of life questionnaires. Twenty-four patients were randomised to either peripheral muscle training or control group. Peripheral muscle training resulted in a significantly improved anaerobic threshold and muscle endurance. The effect of eight weeks hydrotherapy (combined peripheral muscle training and aerobic exercise in warm water) was assessed in two studies, one where 25 randomised older patients with CHF and in another study where 20 patients with the combination of CHF and type 2 diabetes mellitus were evaluated. Exercise capacity, muscle function and health related quality of life was assessed. A test for metabolic function was added in patients with type 2 diabetes mellitus. Hydrotherapy resulted, in both studies, in a significant improved exercise capacity, walking distance and muscle function as well as a decreased HbA1c in type 2 diabetes mellitus. In some items, health related quality of life improved within the training group, both in patients with and without type 2 diabetes mellitus. The cardiorespiratory reaction during warm water immersion was studied in 12 patients with CHF and in 12 healthy subjects using gas analysis and with echocardiography in 13 patients with CHF and 13 healthy subjects. Patients with CHF had a lower oxygen uptake in warm water, at rest compared to healthy subjects. Hemodynamics increased during warm water immersion i.e. ejection fraction increased significantly in patients with CHF and stroke volume and cardiac output increased significantly in healthy subjects. Conclusion: Peripheral muscle training improves muscle function in patients with CHF and hydrotherapy improves exercise capacity and muscle function in patients with CHF, with or without type 2 diabetes mellitus. Moreover, immersion in warm water and hydrotherapy result immediately in an improved heamodynamic function in patients with CHF. These training regimens can therefore be included in the rehabilitation programme for patients with CHF, with or without type 2 diabetes mellitus. A smorgasbord with different exercise regimens might increase the possibility for patients with pronounced disability to remain physically active

The relationship between six-minute walked distance and health-related quality of life in patients with chronic heart failure

Objectives. To assess the relationship between the six-minute walk test (6MWT) and health-related quality of life (HRQL) in patients with chronic heart failure. Methods. Forty-six patients (37 men and 9 women) with chronic heart failure, mean age 68 (SD 9), NYHA II-III and EF 29 (9) % were included. They performed 6MWT and assessed HRQL using two tools, a Swedish version of the 36-item Short Form (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). This was performed repeatedly during a study period of one year. Results. Patients with a walking distance lower than median experienced a lower HRQL than the higher performing half of the cohort, in four dimensions of the SF-36 and the summary of physical and mental components, but not in the dimensions of MLHFQ. Conclusion. Patients with heart failure with a short walking distance assessed their quality of life as inferior in half of the dimensions in the SF-36 but not in the dimensions measured with the MLHFQ. Thus, different aspects of the symptomatology are uncovered using the 6MWT and the different HRQL tools

Nonresponders of Physical Activity on Prescription (PAP) Can Increase Their Exercise Capacity with Enhanced Physiotherapist Support

Swedish physical activity on prescription (PAP) is an evidence-based method to promote physical activity. However, few studies have investigated the effect of Swedish PAP on physical fitness, in which better cardiorespiratory fitness is associated with lower risks of all-cause mortality and diagnose-specific mortality. Direct measures of cardiorespiratory fitness, usually expressed as maximal oxygen uptake, are difficult to obtain. Hence, exercise capacity can be assessed from a submaximal cycle ergometer test, taking the linear relationship between heart rate, work rate, and oxygen uptake into account. The aim of this study was to evaluate exercise capacity in the long term, following PAP treatment with enhanced physiotherapist support in a nonresponding patient cohort. In total, 98 patients (48 women) with insufficient physical activity levels, with at least one component of the metabolic syndrome and nonresponding to a previous six-month PAP treatment, were randomized to PAP treatment with enhanced support from a physiotherapist and additional exercise capacity tests during a two-year period. A significant increase in exercise capacity was observed for the whole cohort at two-year follow-up (7.6 W, p ≤ 0.001), with a medium effect size (r = 0.34). Females (7.3 W, p = 0.025), males (8.0 W, p = 0.018) and patients ≥58 years old (7.7 W, p = 0.002) improved significantly, whereas a nonsignificant increase was observed for patients &lt;58 years old (7.6 W, p = 0.085). Patients with insufficient physical activity levels who did not respond to a previous six-month PAP treatment can improve their exercise capacity following PAP treatment with enhanced support from a physiotherapist during a two-year period. Future studies should include larger cohorts with a control group to ensure valid estimations of exercise capacity and PAP

Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry

Background With increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI. Methods and Results Data from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status. Conclusions The present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.Ischemisk hjärtsjukdo

Functional muscle power in the lower extremity in adults with congenital heart disease

Background: We aimed to investigate functional muscular power in the lower extremity in adults with congenital heart disease (ACHD) and compare results with those of healthy persons. Secondarily, we set out to assess muscle power in relation to age, sex, and complexity of ACHD. Methods: Between 2013 and 2019, 1126 patients attended the ACHD Unit of Sahlgrenska University Hospital/Östra and performed a test battery to determine physical fitness. Of these patients, 559 who performed the Timed-Stands Test (TST)—which requires 10 stands from a chair at the maximal possible speed—were included in the study. Results: Patients with ACHD performed the TST slower than reference (14.6 s [12.0–18.0] vs. 11.7 s [9.8–14.3], p 65 years. Women with ACHD performed the TST more rapidly or according to reference in 21% of patients aged 18–39 years, 56% of patients aged 40–65 years, and 32% of patients aged >65 years. Men with ACHD performed the TST significantly faster than women with ACHD (p < 0.001). Conclusions: Decreased functional muscle power was observed in patients with ACHD and was most pronounced in patients aged 18–39 years. Decreased muscle power is important to detect and requires further assessment because it may contribute to an increased risk of falling and developing lifestyle related diseases

Impact of walk advice alone or in combination with supervised or home-based structured exercise on patient-reported physical function and generic and disease-specific health related quality of life in patients with intermittent claudication, a secondary analysis in a randomized clinical trial

Background Supervised exercise is an integral part of the recommended first-line treatment for patients with intermittent claudication (IC). By reflecting the patients’ perspectives, patient-reported outcome measurements provide additional knowledge to the biomedical endpoints and are important outcomes to include when evaluating exercise interventions in patients with IC. We aimed to evaluate the one-year impact of three strategies: unsupervised Nordic pole walk advice (WA), WA + six months of home-based structured exercise (HSEP) or WA + six months of hospital-based supervised exercise (SEP) on health-related quality of life and patient-reported physical function in patients with IC. Methods This secondary exploratory analysis of a multi-center, randomized clinical trial compared three exercise strategies. The primary outcome of the secondary analysis was the one-year change in the 36-Item Short-Form (SF-36). Secondary outcomes were three- and six-months SF-36 changes alongside three, six- and 12-months changes in the disease-specific Vascular Quality of Life instrument (VascuQoL) and the Patient-Specific Functional Scale (PSFS). The Kruskal–Wallis test with Bonferroni-adjusted post-hoc tests were used for between-group comparisons. Effect size calculations were used to describe the size of observed treatment effects, and the clinical meaningfulness of observed changes in the VascuQoL summary score at one year was studied using established minimally important difference (MID) thresholds. Results A total of 166 patients with IC, mean age: 72.1 (SD 7.4) years, 41% women, were randomized. No significant between-group differences were observed over time for the SF-36 or the PSFS scores whereas some significant between-group differences were observed in the VascuQoL domain and summary scores over time, favoring SEP and/or HSEP over WA. The observed SF-36 and VascuQoL domain and summary score effect sizes were small to moderate, and many domain score effect sizes also remained unchanged over time. A significantly higher proportion of the patients in the SEP group reached the VascuQoL summary score MID of improvement in one year. Conclusion Clinically important improvements were observed in SEP using the VascuQoL, while we did not observe any significant between-group differences using the SF-36. Whereas effect sizes for the observed changes over time were generally small, a significantly higher proportion of patients in SEP reached the VascuQoL MID of improvement

Which patients benefit from physical activity on prescription (PAP)? A prospective observational analysis of factors that predict increased physical activity

Abstract Background There is robust evidence that regular physical activity (PA) has positive health effects. However, the best PA methods and the most important correlates for promoting PA remain unclear. Physical activity on prescription (PAP) aims to increase the patient’s motivation for and level of PA. This study investigated possible predictive baseline correlates associated with changes in the PA level over a 6-month period of PAP treatment in order to identify the primary care patients most likely to benefit from a PAP intervention. Methods The study included 444 patients with metabolic risk factors who were aged 27 to 85 years and physically inactive. The patients received PAP treatment that included individual counseling plus an individually-tailored PA recommendation with a written prescription and individualised structured follow-up for 6 months. Eight baseline correlates of PA were analysed against the PA level at the 6-month follow-up in a predictor analysis. Results Five baseline correlates predicted the PA level at the 6-month follow-up: self-efficacy expectations for changing PA; the patient’s preparedness and confidence regarding readiness to change PA; a BMI <  30; and a positive valued physical health. The proportion of patients increasing the PA level and achieving a PA level that was in accordance with public health recommendations was higher with a positive valued baseline correlate. The odds of achieving the recommended PA level increased substantially when 2 to 4 predictive correlates were present. PA levels increased to a greater extent among patients with low PA at baseline than patients with high PA at baseline, especially in combination with 2 to 4 positively-valued correlates (87–95% vs. 62–75%). Conclusions This study identified potential predictive correlates of an increased PA level after a 6-month PAP intervention. This contributes to our understanding of PAP and could help individualise PAP support. The proportion of patients with the lowest PA level at baseline increased their PA level in a higher extent (84%) and thus may benefit the most from PAP. These results have clinical implications for behavioural change in those patients having the greatest health gains by increasing their PA level. Trial registration ClinicalTrials.gov; NCT03586011. Retrospectively registered on July 17, 2018