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

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

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

Effects of exergaming on exercise capacity in patients with heart failure: results of an international multicentre randomized controlled trial

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Measuring physical activity with activity monitors in patients with heart failure: from literature to practice. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology

The aims of this paper were to provide an overview of available activity monitors used in research in patients with heart failure and to identify the key criteria in the selection of the most appropriate activity monitor for collecting, reporting, and analysing physical activity in heart failure research. This study was conducted in three parts. First, the literature was systematically reviewed to identify physical activity concepts and activity monitors used in heart failure research. Second, an additional scoping literature search for validation of these activity monitors was conducted. Third, the most appropriate criteria in the selection of activity monitors were identified. Nine activity monitors were evaluated in terms of size, weight, placement, costs, data storage, water resistance, outcomes and validation, and cut-off points for physical activity intensity levels were discussed. The choice of a monitor should depend on the research aims, study population and design regarding physical activity. If the aim is to motivate patients to be active or set goals, a less rigorously tested tool can be considered. On the other hand, if the aim is to measure physical activity and its changes over time or following treatment adjustment, it is important to choose a valid activity monitor with a storage and battery longevity of at least one week. The device should provide raw data and valid cut-off points should be chosen for analysing physical activity intensity levels. Other considerations in choosing an activity monitor should include data storage location and ownership and the upfront costs of the device

Physical activity in patients with heart failure : motivations, self-efficacy and the potential of exergaming

Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity. The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity. Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home. Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity. More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming. The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming. Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy. Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.Achtergrond: Het aantal patiënten met hartfalen (HF) dat zich kan houden aan de aanbevolen lichamelijke activiteit is over het algemeen klein. Het is essentieel om te onderzoeken in hoeverre en waarom patiënten met HF lichamelijk actief zijn. Het hebben van self-efficacy (een persoonlijke overtuiging dat hij/zij capabel is om te doen wat nodig is om een taak te volbrengen op een bepaald kwaliteitsniveau) en motivatie voor lichamelijke activiteit is belangrijk om meer lichamelijk actief te worden. Het is echter niet duidelijk wat de rol van self-efficacy is in relatie tot motivatie en lichamelijke activiteit bij patiënten met HF. Alternatieve benaderingen zijn nodig om patiënten te motiveren lichamelijk actiever te zijn en de self-efficacy te verhogen. Een van de mogelijke alternatieven om patiënten met HF te helpen lichamelijk actiever te zijn is de inzet van exergames: computerspellen om fysieke activiteit te bevorderen. Er is tot nu toe geen onderzoek is gedaan naar de inzet van exergaming bij patiënten met hartfalen en de mogelijkheden van exergaming om patiënten te stimuleren tot meer lichamelijke activiteit. Het doel van dit proefschrift is het beschrijven van de lichamelijke activiteit van patiënten met HF met extra aandacht voor de motivatie en self-efficacy ten opzichte van lichamelijke activiteit. Een tweede doel is om inzicht te krijgen in de mogelijkheid om exergaming te gebruiken om de lichamelijke activiteit van patiënten met HF te verhogen. Methode: In dit proefschrift worden gegevens van 4 studies beschreven (studie I-IV). Studie I (n = 154) en II (n = 101) hebben een crosssectioneel survey design. Studie III (n = 32) is een 12 weken durende pilot-interventie studie met een pretest-posttest design waarbij patiënten 12 weken lang een exergame platform thuis konden gebruiken. Studie IV (n = 14) beschrijft de ervaringen van patiënten die deelnamen aan de interventiegroep van een gerandomiseerde studie waarin zij een exergame platform thuis kregen. Resultaten: In totaal hebben 34% van alle patiënten met hartfalen een laag niveau van lichamelijke activiteit, 46% had een matig niveau, en 23% een hoog niveau. Een hoger opleidingsniveau, self-efficacy en motivatie significant werd geassocieerd met een hogere hoeveelheid lichamelijke activiteit. Het bleek dat barrières voor fysieke activiteit moeilijk te overbruggen waren. Met betrekking tot motivatie, bleek dat psychologische motivatie de belangrijkste drijfveer was om fysiek actief te zijn. Verder bleek dat vrouwen een significant hogere motivatie voor fysieke activiteit hebben dan mannen. Een ander belangrijk resultaat was dat self-efficacy de relatie tussen motivatie en lichamelijke activiteit beïnvloedt; motivatie leidt tot een hogere self-efficacy wat leidt tot hogere fysieke activiteit. Met betrekking tot de resultaten van exergaming bleek dat de inspanningscapaciteit van meer dan de helft van de patiënten aanzienlijk was toegenomen na 12 weken gebruik gemaakt te hebben van een exergame platform thuis. Patiënten met een lager NYHA-klasse en een kortere tijd na de diagnose verhogen significant meer hun inspanningscapaciteit. Ook bleek dat het hebben van een partner en kleinkinderen gerelateerd is aan meer tijd besteden aan exergaming. De analyse van de ervaringen van patiënten in de kwalitatieve studie resulteerde in drie categorieën: (i) zorgen dat exergaming werkt, (ii) toegevoegde waarde van exergaming, (iii) geen aantrekking tot exergaming. Conclusie: Een derde van de patiënten met HF heeft een laag niveau van lichamelijke activiteit in hun dagelijks leven. Opleidingsniveau, self-efficacy en motivatie zijn belangrijke factoren om rekening mee te houden bij het geven van advies aan patiënten met HF betreffende fysieke activiteit. Naast een hoge motivatie tot bewegen is het belangrijk dat patiënten met HF een hoog niveau van self-efficacy hebben om fysiek actief te zijn. Exergaming heeft potentie om inspanningscapaciteit bij patiënten met HF te verhogen. Uit de resultaten blijkt ook dat deze techniek geschikt is voor een deel van de patiënten, terwijl een deel van de patiënten wellicht liever andere vormen van lichamelijke activiteit beoefenen