How to do: Telerehabilitation in heart failure patients

According to the present guidelines for heart failure patients, regular exercise training has obtained the class of recommendation I, level of evidence A. Despite the benefits of cardiac rehabilitation, many heart failure patients are inactive. Common patient’s rejection of existing forms of rehabilitation and limitations resulting from the disease itself hinder the outpatient cardiac rehabilitation. That is why home telerehabilitation seems to be the optimal form of physical activity for heart failure patients

Kardiologiczna telerehabilitacja hybrydowa

Current recommendations of the European Society of Cardiology and American Cardiac Societies clearly indicate that regular exercise training should be recommended in all stable patients with cardiovascular disease (class I of recommendation, level of evidence A). Despite this, there are large regional disparities in access to rehabilitation, both in Poland and in Europe. One of the possibilities to solve this problem is to introduce hybrid cardiac telerehabilitation. Published data indicate that this form of rehabilitation is effective, safe and well accepted by patients. Moreover, the adherence to telerehabilitation was high and promising. The transfer of cardiac rehabilitation to the patients’ homes creates the opportunity to increase access to rehabilitation programs.Aktualne rekomendacje Europejskiego Towarzystwa Kardiologicznego i Amerykańskich Towarzystw Kardiologicznych jednoznacznie wskazują, że regularny trening fizyczny powinien być zalecany u wszystkich stabilnych chorych ze schorzeniami układu krążenia (I klasa wskazań, poziom dowodów A). Mimo tego istnieją duże dysproporcje regionalne w dostępie do rehabilitacji zarówno w Polsce, jak i w Europie. Jedną z możliwości rozwiązania tego problemu jest wprowadzenie kardiologicznej telerehabilitacji hybrydowej. Opublikowane dane wskazują, że ta forma rehabilitacji jest efektywna, bezpieczna i dobrze akceptowana przez chorych, co przekłada się na dobrą interaktywną współpracę pacjentów. Przeniesienie rehabilitacji kardiologicznej do miejsca zamieszkania pacjentów stwarza sposobność zwiększenia dostępności do programów rehabilitacji

The influence of water-based training on arrhythmia in patients with stable coronary artery disease and preserved left ventricular function

Background: Water immersion may cause adverse cardiovascular events, including arrhythmias in patients with damaged cardiac muscle, e.g. with cardiac failure. So far, there have been rather few reports on arrhythmia induced by water training in patients with coronary artery disease (CAD). The aim of the study was to assess the influence of exercise training in moderately cold water (28–30°C) on arrhythmia and physical capacity in stable CAD patients with preserved left ventricular (LV) function. Methods: Sixty-two post-myocardial infarction male patients, mean age 50.9 ± 7.9 years, participated in 16 water-based trainings (WBT), which lasted 55-min, twice a week in water at 28–30°C. Each subject underwent 24 h Holter on-land monitoring (Holter-24) once during the study and twice in-water Holter monitoring (Holter-W) during WBT. Before and after WBT cardiopulmonary exercise test (CPET) was performed. The following parameters were analyzed: peak oxygen consumption (peak VO2), mean number of ventricular ectopic beats (VEBs) and supraventricular ectopic beats (SVEBs) during Holter-24 and Holter-W, the percentage of men who developed arrhythmia during CPET vs. Holter-24 and vs. Holter-W. Results: WBT significantly improved patients’ physical capacity, and more often provoked arrhythmia, mainly SVEBs, than CPET or daily activity assessed during Holter-24. During WBT 58% men developed VEBs and 62% SVEBs. Conclusions: 1. WBT provoked arrhythmias significantly more often than did CPET and normal daily activity. 2. Owing to WBT patients improved their physical capacity which was still maintained at 1-year follow-up.

Influence of aerobic training on neurohormonal and hemodynamic responses to head-up tilt test and on autonomic nervous activity at rest and after exercise in patients after bypass surgery

Background: Little is known about the influence of aerobic training on the neurohormonal and hemodynamic responses to head-up tilt (HUT) and on autonomic balance at rest and after exercise in optimally treated, low risk post-coronary artery bypass grafting (CABG) patients. Methods: One hundred male patients, mean age 56 ± 6 years, 3 months after CABG, were randomized to either 6-week training on cycloergometer, 3 times a week, at 70–80% of max tolerated heart rate (HR) (training group, n = 50) or to a control group (n = 50). At baseline and at the end of the study, all patients underwent: (1) cardiopulmonary exercise test with HR recovery (HRR) assessment; (2) 60% HUT during which HR, blood pressure (BP), stroke volume (SV by impedance cardiography) were monitored and blood samples were taken for determination of plasma catecholamines and ANP levels, and plasma renin activity; (3) assessment of HR variability (HRV) in the time and frequency domains at rest. Results: During the final tests, HUT-induced changes in HR, BP, SV, cardiac output, total peripheral resistance, and noradrenaline were significantly lower in training group than in controls. In addition, after training faster post-exercise HRR, increased SDNN and a tendency towards an increase in the high frequency HRV power spectrum were found. Conclusions: Aerobic training improved neurohormonal and hemodynamic responses to head-up tilt test and favorably modified sympatho-vagal balance in low risk post-CABG patients

Patterns in the multiannual course of growing season in Central Europe since the end of the 19th century

The research identified patterns in the multiannual course of start and end dates, and length of growing sea son (GS) in Central Europe since the end of the 19th century in selected cities of Central Europe in the period 1893-2020. GS start in the analysed stations was characterised by high year-to-year variability, particularly in those located more southwards, i.e. in Prague and Vienna. A smaller variability occurred in GS end dates. The GS was subject to prolon gation, although these changes in particular cities were uneven and had different causes. In Toruń and Potsdam, its increase was caused by a greater shift of the end date, and in the remaining stations, it was determined by its earlier start date. Two subperiods were distinguished that differ in terms of intensity of changes of the start and end dates, as well as the length of the GS. The intensification was observed recently

Feasibility of home-based cardiac telerehabilitation: Results of TeleInterMed study

Background: Cardiac rehabilitation (CR) is recommended as an important component of a comprehensive approach to cardiovascular disease (CVD) patients. Data have shown that a small percentage of eligible patients participate in CR despite their well established benefits. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR. The purpose of the study was to evaluate a wide implementation and feasibility of home-based cardiac telerehabilitation (HTCR) in patients suffering from CVD and to assessits safety, patients’ acceptance of and adherence to HTCR.Methods: The study included 365 patients (left ventricular ejection fraction 56 ± 8%; aged 58 ± 10 years). They participated in 4-week HTCR based on walking, nordic walking or cycloergometer training. HTCR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with CR. The influence on physical capacity was assessed by comparing changes — in time of exercise test, functional capacity, 6-min walking test distance from the beginning and the end of HTCR. At the end of the study, patients filled in a questionnaire in order to assess their acceptance of HTCR.Results: HTCR resulted in a significant improvement in all parameters. There were neither deaths nor adverse events during HTCR. Patients accepted HTCR, including the need for interactive everyday collaboration with the monitoring center. There were only 0.8% non-adherent patients.Conclusions: HTCR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high and promising.

Influence of percutaneous pulmonary valve implantation on exercise capacity: Which group of patients benefits most from the intervention?

Background: The aim of the study was to evaluate the role of cardiopulmonary exercise testing (CPET) parameters in assessing exercise capacity improvement after percutaneous pulmonary valve implantation (PPVI). Additionally, it aimed to determine if there are any baseline characteristics influencing that change. Methods and results: The study comprised 32 patients (mean age 26 ± 9); 53% males; diagnosis: tetralogy of Fallot (n = 18), pulmonary atresia (n = 6), Ross procedure (n = 4), other (transposition of great arteries, pulmonary stenosis, double outlet right ventricle, common arterial trunk type II — n = 4) who underwent successful PPVI due to right ventricular out­flow tract dysfunction (predominant pulmonary regurgitation — n = 17, predominant pulmo­nary stenosis — n = 15). Treadmill CPET was performed before and a year after PPVI along with clinical evaluation, cardiac magnetic resonance and transthoracic echocardiography. Twelve months post successful PPVI (pulmonary valve competence restoration and pulmonary gradient reduction from 58.8 ± 47.1 to 26.6 ± 10.8 mm Hg) there was a significant decrease in the ventilatory equivalent for CO2 at peak exercise (EQCO2) (25.3 ± 3.3 to 24.3 ± 3.0, p = 0.04) and oxygen consumption at peak exercise (pVO2) (20.4 ± 5.0 to 22.6 ± 5.3 mL/kg/min, p = 0.04). Improved EQCO2 correlated with an increase in right and left ventricular ejection fraction (respectively R = –0.57, p = 0.002; R = –0.56, p = 0.002). In this study, no baseline factors that might affect improvement in exercise function were found. Conclusions: Successful PPVI leads to an improvement in exercise capacity and hemodynamic response to exercise. The correlation between the improvement in EQCO2 or peak VO2 and baseline characteristics was too weak to reliably identify the group of patients that will benefit from the procedur