VOLUME OF EXERCISE PERFORMED BY HEART FAILURE INPATIENTS UNDERGOING CARDIAC REHABILITATION – A QUASI-EXPERIMENTAL STUDY

Bruno Miguel Delgado; Ivo Lopes; Fátima Rodrigues; Célia Neto; Ana Seixas Pereira; André Novo

doi:10.33194/rper.2025.377

Autores/as

Bruno Miguel Delgado Centro Hospitalar Universitário de Santo António https://orcid.org/0000-0002-6847-1314
Ivo Lopes Centro _Hospitalar Universitário de Santo António https://orcid.org/0000-0002-3125-5714
Fátima Rodrigues Centro _Hospitalar Universitário de Santo António https://orcid.org/0009-0008-0201-5165
Célia Neto Centro _Hospitalar Universitário de Santo António https://orcid.org/0009-0000-5962-1520
Ana Seixas Pereira Centro _Hospitalar Universitário de Santo António https://orcid.org/0009-0005-9858-6621
André Novo Instituto Politécnico de Bragança https://orcid.org/0000-0001-8583-0406

DOI:

https://doi.org/10.33194/rper.2025.377

Palabras clave:

Insuficiencia cardíaca, Ejercicio físico, Entrenamiento aeróbico, capacidad funcional, reabilitacion cardíaca

Resumen

Introducción: Los pacientes hospitalizados con insuficiencia cardíaca presentan una importante dependencia funcional, deterioro del rendimiento en las actividades de la vida diaria y baja tolerancia al ejercicio. La cantidad de ejercicio está directamente relacionada con sus beneficios y el volumen de ejercicio realizado debe ajustarse a cuestiones de seguridad. El objetivo de este estudio es evaluar el volumen de ejercicio realizado y su relación con la capacidad funcional y encontrar un nivel basal de volumen seguro y efectivo.

Metodología: Estudio cuasiexperimental con 50 pacientes hospitalizados que realizaron un programa de entrenamiento con ejercicios aeróbicos. El volumen de ejercicio se registró en términos de número de vueltas cicloergómetro, metros caminados, escalones subidos y el tiempo total de ejercicio. La percepción subjetiva del esfuerzo se evaluó en cada sesión de entrenamiento al inicio y al final. Los pacientes realizaron dos pruebas de caminata de 6 minutos (6MWT).

Resultados: Se realizaron 987 sesiones de ejercicio. La mayoría de los pacientes presentaban un deterioro significativo: el 81,9% son NYHA III y el 73,6% presentan ICFEr. Los pacientes alcanzaron menores niveles de esfuerzo percibido a lo largo de la estancia hospitalaria: 6 (±3) (ingreso) y 2(±2) (alta). Los pacientes que realizaron más volumen de ejercicio caminaron una mayor distancia en el alta de 6MWT.

Comclusión: Un mayor volumen de ejercicio aeróbico se relaciona con una mejor mejoría en los resultados funcionales. Una media de más de 10 minutos por sesión parece ser más eficaz en términos de mejora de la capacidad funcional.

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Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Rev Esp Cardiol (Engl Ed). Dec 2016;69(12):1167. doi:10.1016/j.rec.2016.11.005

Dunlay SM, Griffin JM, Redfield MM, Roger VL. Patient Activation in Acute Decompensated Heart Failure. J Cardiovasc Nurs. 2017 Nov/Dec 2017;32(6):560-567. doi:10.1097/JCN.0000000000000367

Palmer K, Bowles KA, Paton M, Jepson M, Lane R. Chronic Heart Failure and Exercise Rehabilitation: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 12 2018;99(12):2570-2582. doi:10.1016/j.apmr.2018.03.015

Tucker WJ, Beaudry RI, Liang Y, et al. Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update. Prog Cardiovasc Dis. 2019 Mar - Apr 2019;62(2):163-171. doi:10.1016/j.pcad.2018.08.006

Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N. Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev. 07 2019;24(4):535-547. doi:10.1007/s10741-019-09774-5

Lee CT, Chen LW, Chien MY. Effects of exercise training on anabolic and catabolic markers in patients with chronic heart failure: a systematic review. Heart Fail Rev. 11 2017;22(6):723-730. doi:10.1007/s10741-017-9639-y

ACSM. Guidelines for Exercise Testing and Prescription. In: American, Medicine. CoS, editors. Tenth Edition ed2018.

Seo YG, Jang MJ, Lee GY, Jeon ES, Park WH, Sung JD. What Is the Optimal Exercise Prescription for Patients With Dilated Cardiomyopathy in Cardiac Rehabilitation? A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev. 07 2019;39(4):235-240. doi:10.1097/HCR.0000000000000382

Hansen D, Niebauer J, Cornelissen V, et al. Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group. Sports Med. 08 2018;48(8):1781-1797. doi:10.1007/s40279-018-0930-4

Slimani M, Ramirez-Campillo R, Paravlic A, Hayes LD, Bragazzi NL, Sellami M. The Effects of Physical Training on Quality of Life, Aerobic Capacity, and Cardiac Function in Older Patients With Heart Failure: A Meta-Analysis. Front Physiol. 2018;9:1564. doi:10.3389/fphys.2018.01564

Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 01 2019;1:CD003331. doi:10.1002/14651858.CD003331.pub5

Morris JH, Chen L. Exercise Training and Heart Failure: A Review of the Literature. Card Fail Rev. Feb 2019;5(1):57-61. doi:10.15420/cfr.2018.31.1

Harris AD, McGregor JC, Perencevich EN, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc. 2006 Jan-Feb 2006;13(1):16-23. doi:10.1197/jamia.M1749

Delgado BM, Lopes I, Gomes B, Novo A. Early rehabilitation in cardiology - heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation. Eur J Cardiovasc Nurs. Apr 2020:1474515120913806. doi:10.1177/1474515120913806

Association WM. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. Nov 2013;310(20):2191-4. doi:10.1001/jama.2013.281053

ACSM. Guidelines for Exercise Testing and Prescription. In: Agiovlasitis S, Baruth M, Baynard T, Beck, Darren T., Brawner CA, editors. Tenth Edition ed2016.

Ammann BC, Knols RH, Baschung P, de Bie RA, de Bruin ED. Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review. BMC Neurol. Aug 2014;14:167. doi:10.1186/s12883-014-0167-2

Passantino A, Lagioia R, Mastropasqua F, Scrutinio D. Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice. J Am Coll Cardiol. Jul 2006;48(1):99-105. doi:10.1016/j.jacc.2006.02.061

Pollentier B, Irons SL, Benedetto CM, et al. Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review. Cardiopulm Phys Ther J. Mar 2010;21(1):13-21.

Gremeaux V, Troisgros O, Benaïm S, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil. Apr 2011;92(4):611-9. doi:10.1016/j.apmr.2010.11.023

Guyatt GH, Thompson PJ, Berman LB, et al. How should we measure function in patients with chronic heart and lung disease? J Chronic Dis. 1985;38(6):517-24.

Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. Apr 2017;23(2):377-381. doi:10.1111/jep.12629

Enright PL, McBurnie MA, Bittner V, et al. The 6-min walk test: a quick measure of functional status in elderly adults. Chest. Feb 2003;123(2):387-98.

Alvarez P, Hannawi B, Guha A. Exercise And Heart Failure: Advancing Knowledge And Improving Care. Methodist Debakey Cardiovasc J. 2016 Apr-Jun 2016;12(2):110-5. doi:10.14797/mdcj-12-2-110

Cattadori G, Segurini C, Picozzi A, Padeletti L, Anzà C. Exercise and heart failure: an update. ESC Heart Fail. 04 2018;5(2):222-232. doi:10.1002/ehf2.12225

Haykowsky MJ, Daniel KM, Bhella PS, Sarma S, Kitzman DW. Heart Failure: Exercise-Based Cardiac Rehabilitation: Who, When, and How Intense? Can J Cardiol. 10 2016;32(10 Suppl 2):S382-S387. doi:10.1016/j.cjca.2016.06.001

Mezzani A, Hamm LF, Jones AM, et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol. Jun 2013;20(3):442-67. doi:10.1177/2047487312460484

Delgado B, Lopes I, Gomes B, Novo A. Early rehabilitation in cardiology – heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation. European Journal of Cardiovascular Nursing 2020;doi:10.1177/1474515120913806

Aimo A, Barison A, Mammini C, Emdin M. The Barthel Index in elderly acute heart failure patients. Frailty matters. Int J Cardiol. 03 2018;254:240-241. doi:10.1016/j.ijcard.2017.11.010

Motoki H, Nishimura M, Kanai M, et al. Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure. Int J Cardiol. 10 2019;293:125-130. doi:10.1016/j.ijcard.2019.06.071

Carvalho VO, Garrod R, Bocchi EA, Pitta F, Guimaraes GV. Validation of the London Chest Activity of Daily Living scale in patients with heart failure. J Rehabil Med. Sep 2010;42(8):715-8. doi:10.2340/16501977-0578

Pichurko BM. Exercising your patient: which test(s) and when? Respir Care. Jan 2012;57(1):100-10; discussion 110-3. doi:10.4187/respcare.01428

Casanova C, Celli BR, Barria P, et al. The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J. Jan 2011;37(1):150-6. doi:10.1183/09031936.00194909

Hoffmann JM, Hellwig S, Brandenburg VM, Spaderna H. Measuring Fear of Physical Activity in Patients with Heart Failure. Int J Behav Med. Jun 2018;25(3):294-303. doi:10.1007/s12529-017-9704-x

Andrade DC, Arce-Alvarez A, Toledo C, et al. Revisiting the physiological effects of exercise training on autonomic regulation and chemoreflex control in heart failure: does ejection fraction matter? Am J Physiol Heart Circ Physiol. 03 2018;314(3):H464-H474. doi:10.1152/ajpheart.00407.2017

Oliveira NL, Ribeiro F, Teixeira M, et al. Effect of 8-week exercise-based cardiac rehabilitation on cardiac autonomic function: A randomized controlled trial in myocardial infarction patients. Am Heart J. May 2014;167(5):753-61.e3. doi:10.1016/j.ahj.2014.02.001

Santos-Hiss MD, Melo RC, Neves VR, et al. Effects of progressive exercise during phase I cardiac rehabilitation on the heart rate variability of patients with acute myocardial infarction. Disabil Rehabil. 2011;33(10):835-42. doi:10.3109/09638288.2010.514016

Reddy HK, McElroy PA, Janicki JS, Weber KT. Response in oxygen uptake and ventilation during stair climbing in patients with chronic heart failure. Am J Cardiol. Jan 1989;63(3):222-5. doi:10.1016/0002-9149(89)90289-0

Labate V, Guazzi M. Past, present, and future rehabilitation practice patterns for patients with heart failure: the European perspective. Heart Fail Clin. Jan 2015;11(1):105-15. doi:10.1016/j.hfc.2014.08.007

Abreu A, Mendes M, Dores H, et al. Mandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of Cardiology. Rev Port Cardiol. May 2018;37(5):363-373. doi:10.1016/j.repc.2018.02.006