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

Aquatic exercise training and stable heart failure: A systematic review and meta-analysis

Aim A meta-analysis and review of the evidence was conducted to determine the efficacy of aquatic exercise training for individuals with heart failure compared to traditional land-based programmes. Methods A systematic search was conducted for studies published prior to March 2014, using MEDLINE, PUBMED, Cochrane Library, CINAHL and PEDro databases. Key words and synonyms relating to aquatic exercise and heart failure comprised the search strategy. Interventions included aquatic exercise or a combination of aquatic plus land-based training, whilst comparator protocols included usual care, no exercise or land-based training alone. The primary outcome of interest was exercise performance. Studies reporting on muscle strength, quality of life and a range of haemodynamic and physiological parameters were also reviewed. Results Eight studies met criteria, accounting for 156 participants. Meta-analysis identified studies including aquatic exercise to be superior to comparator protocols for 6 minute walk test (p < 0.004) and peak power (p < 0.044). Compared to land-based training programmes, aquatic exercise training provided similar benefits for VO2peak, muscle strength and quality of life, though was not superior. Cardiac dimensions, left ventricular ejection fraction, cardiac output and BNP were not influenced by aquatic exercise training. Conclusions For those with stable heart failure, aquatic exercise training can improve exercise capacity, muscle strength and quality of life similar to land-based training programmes. This form of exercise may provide a safe and effective alternative for those unable to participate in traditional exercise programmes

Incidence of adverse physiological changes in intensive care – a multi-centre audit

There has been some concern in the literature as to whether physiotherapy causes adverse physiological changes (APC) that could be harmful to intensive care patients. A multicentre audit was performed to: investigate the incidence of APC during physiotherapy in critically ill patients over a three-month period; benchmark this against studies which have recorded spontaneous APC; and to investigate whether there were any trends in patient category, demographic characteristics, type of intervention, or seniority of physiotherapist. There were 12 800 physiotherapy treatments completed with 29 treatments resulting in adverse physiological changes (0.22%). This incidence was significantly lower than a previous study of APC (663 events/247 patients over a 24-hour period), that is, the incidence during physiotherapy was lower than during general ICU care. Significant trends in the 29 patients who had an APC during physiotherapy were apparent, with a deterioration in cardiovascular status the major APC noted (i.e. decrease in blood pressure or arrhythmia) in patients on medium to high doses of inotropes/vasopressors, having unstable baseline hemodynamic values, previous cardiac co-morbidities, receiving intervention consisting of positive pressure, and/or with junior physiotherapists completing the intervention. Combinations of incidents in these 29 patients demonstrated that a decrease in blood pressure commonly occurred if a patient on inotropes with unstable baseline values was either turned to right side lying (2 sided Fishers exact test, p = 0.006) or received positive pressure (2-sided Fishers exact test, p = 0.07). This audit has demonstrated that the overwhelming majority of physiotherapy treatments in intensive care are safe. Zeppos, L., Paratz, J., Adsett, J., Berney, S., Bridson, J., & Patman, S. (2006). Incidence of adverse physiological changes in intensive care – a multi-centre audit. Australian Journal of Physiotherapy, 52(1), S35. ISSN: 0004-951