Exploring factors related to good exercise capacity in patients undergoing ERIC-HF program

Decompensated Heart Failure (HF) patients are characterized by functional dependence and low exercise capacity. The factors associated to a good response to exercise are still unexplored. The ERIC-HF program is an aerobic exercise training program developed for HF inpatients and includes cycloergometer training, walking and climbing stairs in order to promote patient’s functional capacity during the in-hospital stay period. Purpose: to identify the factors related to good response to an aerobic exercise training program for decompensated heart failure (HF) patients. Methods: Cross-sectional study with 143 inpatients who performed the ERIC-HF program. Functional capacity was evaluated using three different tools: the London Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the 6-minute walking test (6MWT). A good response to the program was defined as a ≥ 300 meters distance at the 6MWT at discharge. Univariate analysis was performed between patients who walked 300 meters or more at the 6MWT and patients who walked less than 300meters, using Chi-square tests and Student’s T-test. Logistic regression analysis was performed to describe factors that were independently related to better functional capacity at discharge. Variables with a p-value smaller than 0.15 in the univariate analyses were entered into the logistic regression. A significance level at p <0.05 was assumed. The dependent variables were: 1) distance walked at the 6MWT, 2) the change between admission-to-discharge scores of BI and 3) LCADL. Independent variables were: 1) gender, 2) age, 3) number of exercise sessions, 4) number of days of in-hospital stay, 5) BIad, 6) LCADLad, 7) NYHA functional class, 8) left ventricular ejection fraction (LVEF) and 9) etiology. Results: The mean age of the patients was 67 (±10) years, 15.4% were NYHA class IV and 80% had reduced ejection fraction. The aetiology of HF was similar between ischaemic disease (32.9%) and valvular (33.6%). Patients presented a high level of impairment on FC. The majority were male (97; 67.8%), with an average of three CVRF and mostly sedentary, with only 17% performing regular physical activity. There was no significant difference between etiologies of HF. Comparison between the group of patients who walked 300meters or more, at the 6MWT, and patients who walked less than 300metrs, showed statistically significant differences in terms of gender, age, BI, LCADL, etiology of HF and LVEF. After logistic regression, age (p = 0.002), gender (p = 0.001) and BI (p<0.000) at admission showed to be statistically significant factors that affect the distance walked. Conclusions: The ERIC-EF programe appears to be more effective in male, younger patients and with low FC at admission. Apparently, reduced ejection fraction does not interfere with progression during the programe. Gender influences the performance of patients, since men presented with higher FC at discharge.info:eu-repo/semantics/publishedVersio

Development of a novel forward dynamic programming method for weather routing

This paper presents a novel forward dynamic programming method for weather routing to minimise ship fuel consumption during a voyage. Compared with traditional weather routing methods which only optimise the ship's heading, while the engine power or propeller rotation speed is set as a constant throughout the voyage, this new method considers both the ship power settings and heading controls. A float state technique is used to reduce the iterations required during optimisation and thus save computation time. This new method could lead to quasiglobal optimal routing in comparison with the traditional weather routing methods

Effectiveness and reproducibility of an exercise training program: the ERIC-HF - multicenter randomized controlled trial

Decompensated Heart Failure patients are characterized by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, promoting functional capacity and increasing exercise tolerance. Little is known about the effectiveness and feasibility of it. The ERIC-HF program is an aerobic exercise training program developed for HF inpatients and includes cycloergometer training, walking and climbing stairs in order to promote patient’s functional capacity during the in-hospital stay period. Objective: To analyze the effect of an aerobic exercise training program (ERIC-HF)on exercise capacity of patients with decompensated heart failure. Secondary objectives were to assess the effects of an aerobic exercise training on functional independence and experience of dyspnea during activities of daily living. Design and setting: A randomised controlled clinical trial with follow-up at discharge. Eight different hospitals were included where patients with decompensated heart failure, admitted to the hospital, were randomly assigned to training (aerobic exercise program) or control (usual rehabilitation care guideline recommended). Patients were randomized (at a ratio of 1:1) to training group or control group using the software available online. After randomization, patients were clarified about the study and asked to provide informed consent. Patients were not informed about the group they were part of and no one declined participation. Only the investigators knew in which group patients were. The main outcome was exercise capacity, measured by 6-minute walking test at discharge. Other outcomes were the independence for the activitiers of daily living and the dyspnea associated to the activities of daily living. Results: 257 patients were included. The mean age of the patients was 67±11 years, 84% (n = 205) presented reduced ejection fraction and the in hospital stay average was 16±10 days. At discharge, patients in the ERIC-HF group walked further compared to the control group (278±117m vs 219±115m) and this difference stayed significant after correcting for confounders (p-value<0.001). A statistically significant difference was found favoring the ERIC-HF exercise group in functional independence (96±7 vs 93±12) and dyspnea associated to ADL (13±5 vs 17±7) and these differences stayed in correcting for baseline values and confounders (functional independence p-value=0.002; dyspnea associated to ADL p = 0.018). Conclusion: The ERIC-HF program is safe, feasible and an effective exercise program to increase exercise capacity and functional independence and to decrease dyspnea during ADL in in-hospital patients admitted due to decompensated HF.info:eu-repo/semantics/publishedVersio

Sequential Monte Carlo simulation of collision risk in free flight air traffic

Within HYBRIDGE a novel approach in speeding up Monte Carlo simulation of rare events has been developed. In the current report this method is extended for application to simulating collisions with a stochastic dynamical model of an air traffic operational concept. Subsequently this extended Monte Carlo simulation approach is applied to a simulation model of an advanced free flight operational concept; i.e. one in which aircraft are responsible for self separation with each other. The Monte Carlo simulation results obtained for this advanced concept show that the novel method works well, and that it allows studying rare events that stayed invisible in previous Monte Carlo simulations of advanced air traffic operational concepts

The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: results of a multicenter randomized controlled trial (ERIC-HF study)

To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. Design A randomized controlled clinical trial with follow-up at discharge. Settings Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. Group Assignments Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). Main outcome Functional exercise tolerance was measured with a 6-min walking test at discharge. Results In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). Conclusion The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.info:eu-repo/semantics/publishedVersio