The Effectiveness of Exercise Interventions Supported by Telerehabilitation For Recently Hospitalized Adult Medical Patients: A Systematic Review

Objective: To evaluate the effectiveness of exercise interventions delivered via telerehabilitation (via videoconference) for recently hospitalized adult medical patients. Data sources: A search was undertaken across six databases for English language publications from inception to May 2020. Methods: Studies were selected if they included an exercise intervention for recently hospitalized adults, delivered by a physiotherapist via videoconference. Two reviewers independently screened 1,122 articles (21 full text screening) and assessed methodological quality using the Downs and Black Checklist. A narrative synthesis of the included studies was undertaken. Results: Three studies met eligibility criteria involving 201 participants with chronic heart failure or chronic obstructive pulmonary disease. Findings demonstrated limited evidence supporting the effectiveness of exercise delivered via telerehabilitation in improving physical function and patient reported quality of life outcomes in recently hospitalized medical patients. Telerehabilitation in this setting was also associated with high attendance rates and patient satisfaction. Conclusions: Findings provide preliminary support for the benefits of exercise interventions delivered via telerehabilitation for recently hospitalized medical patients. Results do need to be interpreted with caution as further high-quality studies specific to this method of exercise intervention delivery are needed

Timed up and go test: a reliable and valid test in patients with chronic heart failure

Background The timed up and go test (TUGT) is a short-duration functional test frequently used in rehabilitation settings as a measure of balance and mobility. Reliability and validity for patients with chronic heart failure (CHF) has yet to be determined. This prospective cohort study aimed to determine test-retest reliability of the TUGT in patients with CHF, relationships between the TUGT and other variables, including functional tests, and predictors of the TUGT. Methods and Results This was a secondary analysis of data collected in a multicenter randomized controlled trial of exercise training in recently hospitalized patients with heart failure (EJECTION-HF). The TUGT was conducted twice at baseline to determine reliability. Assessments were compared with 6-minute walk distance (6MWD), 10-m walk test time, and other clinical variables. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability and correlations for relationships with other variables. A multiple regression was used to identify predictors of the TUGT. In 278 participants (mean age 62 years), the TUGT demonstrated excellent within-day test-retest reliability (ICC 0.93). A shorter (better) TUGT time was associated with longer 6MWD (r = −0.81; P < .001) and shorter 10-m walk test time (r = 0.80; P < .001). Best predictors of the TUGT were 6MWD and age, which accounted for 66% of the variance. Conclusions The TUGT appears to be a reliable and valid functional measurement in patients with CHF

Evidence based guidelines for exercise and chronic heart failure

The document provides a review of the current literature specific to various forms of exercise available for patients with Chronic Heart Failure

Prescribing exercise

Exercise offers significant health benefits to older people, but may also carry risks of injury and cardiovascular events. These can be minimized with appropriate screening, prescription, and monitoring of an exercise program. Tailored exercise prescription is developed in consultation with the participant, taking into account identified risks, functional limitations, and individual goals. Exercise professionals can provide valuable assistance with screening, prescription, and supervision of an exercise program, but limited access to experienced staff and supervised programs remains a significant barrier to exercise participation. Innovative models of care are required to investigate optimal participant targeting, long-term exercise adherence, and cost-effectiveness

Prescribing exercise

Exercise offers significant health benefits to older people, but may also carry risks of injury and cardiovascular events. These can be minimized with appropriate screening, prescription, and monitoring of an exercise program. Tailored exercise prescription is developed in consultation with the participant, taking into account identified risks, functional limitations, and individual goals. Exercise professionals can provide valuable assistance with screening, prescription, and supervision of an exercise program, but limited access to experienced staff and supervised programs remains a significant barrier to exercise participation. Innovative models of care are required to investigate optimal participant targeting, long-term exercise adherence, and cost-effectiveness

Getting to the Heart of the Matter: What Is the Landscape of Exercise Rehabilitation for People With Heart Failure in Australia?

The benefits of exercise rehabilitation for people with heart failure (HF) are well established. In Australia, little is known about how the guidelines around exercise rehabilitation for people with HF are being implemented in clinical practice. Furthermore, it is unknown what organisational barriers are faced in providing exercise rehabilitation programs for this population. The aim of this study is to provide an updated review of exercise rehabilitation services for people with HF in Australia and to identify perceived organisational barriers to providing these services.A cross-sectional survey of cardiac rehabilitation centres in Australia, investigating the number and characteristics of services providing exercise rehabilitation for people with HF.A total of 334 of 457 identified services responded to the survey. Of these, 251 reported providing a supervised group-based exercise rehabilitation program for people with HF. These services were mapped, showing their distribution across Australia. Services which were unable to provide group-based exercise training for HF patients reported organisational barriers including insufficient funding (60%), staffing (56%) and clinical resources (53%). Of the 78 services that reported patients in their local area were unable to access appropriate exercise guidance, 81% were located in regional or remote areas. We found that reported exercise practices align with current best-practice guidelines with 99% of group based exercise programs reportedly including endurance training and 89% including resistance training.In Australia, exercise practices for people with HF align with current best-practice guidelines for this condition. Limited resources, funding and geographic isolation are reported as the major organisational barriers to providing these programs. Future endeavours should include the development of alternative and flexible delivery models such as telerehabilitation and other home-based therapies to improve access for these individuals to such services

Implementing a Community-Based Model of Exercise Training Following Cardiac, Pulmonary, and Heart Failure Rehabilitation

Purpose: Encouraging patients to continue regular activity beyond the period of formal cardiac, heart failure, or pulmonary rehabilitation is a challenge faced by all program coordinators. The purpose of this study was to evaluate the feasibility of a community model run by fitness instructors as long-term maintenance for patients exiting a disease-specific rehabilitation program. Methods: Heartmoves programs were established in close proximity to all major tertiary hospitals in Brisbane, Queensland, Australia, and all eligible patients were offered supported referral to a program. Referred patients and rehabilitation staff were surveyed regarding perceived barriers to attendance. Referral rates and individual attendance rates for the first 12 weeks were recorded. Results: Over 12 months, 241 patients were referred to a community Heartmoves class, of whom 141 (59%) attended at least once and 76 (32% of referrals, 54% of initial attendees) attended more than 6 of the first 12 weeks. Preattendance surveys identified concerns about quality and safety, as well as social and logistic barriers. The programs proved to be sustainable, as evidenced by the growth of programs from 18 at the end of the project to 31 over a 18-month period. Conclusions: A supported referral pathway to Heartmoves provides a feasible and acceptable model for maintenance exercise following cardiac, heart failure, and pulmonary rehabilitation. Strategies that recognize and address barriers perceived by participants and by rehabilitation program staff should be part of the supported referral process

Predictors of Exercise Training and Physical Activity Adherence in People Recently Hospitalized with Heart Failure: A BRIEF REPORT

For individuals with heart failure (HF), frequent attendance at exercise training programs and meeting physical activity (PA) guidelines are significantly associated with improvements in 6-min walk distance. Despite the evidence, adherence to exercise interventions remains poor. The aim of this study was to identify predictors of these 2 variables in patients recently hospitalized with HF. Methods: In this substudy of the Exercise Joins Education: Combined Therapy to Improve Outcomes in Newly-discharged Heart Failure (EJECTION-HF) trial, all participants were enrolled in a HF disease management program, including weekly review of a home exercise program for 12 wk. Intervention group participants additionally undertook twice weekly supervised exercise training. Primary outcomes were frequent exercise training program attendance (≥12 sessions) and attainment of PA guidelines (150 min/wk of moderate intensity exercise) at 12 wk. Participant and clinical characteristics were analyzed using a logistic regression model to identify significant predictors of each outcome. Results: A total of 278 participants provided PA data and 140 contributed attendance data. New diagnosis of HF was a significant predictor of frequent program attendance (OR = 2.3; 95% CI, 1.1-4.7; P =.03). Predictors of meeting PA guidelines at follow-up included new HF diagnosis (OR = 2.4; 95% CI, 1.2-4.8, P =.013), and being physically active at baseline (OR = 2.7; 95% CI, 1.3-5.6; P =.007). Gender, symptom severity, multimorbidity, and disability were not significantly associated with either outcome in multivariate analysis. Conclusion: To improve adherence, specific strategies may be required for patients with decompensated HF and those physically inactive at time of referral

Impact of exercise training program attendance and physical activity participation on six minute walk distance in patients with heart failure

Background: Exercise training is recommended for all people with stable heart failure (HF) however adherence is poor. This study sought to describe exercise participation in recently hospitalized HF patients who participated in a 12-week exercise training program. The association between exercise training variables and improvement in 6-min walk distance (6MWD) was also investigated. Methods: This study is a secondary analysis of results from the intervention arm of the EJECTION-HF trial (ACTRN12608000263392), (n = 140). Exercise program attendance was defined according to session frequency (= 12 sessions) and attendance duration (= 6 weeks) over the 12 weeks. Physical activity at baseline and follow up were reported according to self-report of 150 min of moderate intensity exercise per week. Primary outcome was change in 6MWD at 12 weeks. Results: Being physically active (OR 3.8, CI 1.3-11.5) and frequent program attendance (OR 2.7, CI 1.2-5.9) were associated with significant improvements in 6MWD. Program duration and baseline physical activity were not significantly associated with the outcome. Conclusions: Attainment of 150 min of moderate intensity exercise per week and at least weekly attendance at the program, were associated with significant improvements in 6MWD at follow up. Efforts should be made to assist patients with HF to achieve these targets