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A longitudinal study of quality of life in patients with chronic
heart failure following an exercise training program
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Miche E, Roelleke E, Zoller B et al. A longitudinal study of quality of life in patients with chronic heart failure following an
exercise training program. European Journal of Cardiovascular Nursing. 2009; 8: 281-287.
Abstract
Background: Chronic heart failure (CHF) will become one of
the greatest medical challenges during the next decades. This
is especially true with regard to elderly patients. Besides
medical diagnostics and drug therapy, efficient treatment of
CHF must also include exercise training. Aims: The purpose of
our study was 1) to record health-related quality of life (QOL) in
elderly patients with CHF and 2) to assess the efficacy
of a training program, as well as to evaluate any changes
detected during a six month follow-up.
Methods: In our non-randomized study, 116 patients, divided
according to age into Group 1 (>70 years) and Group 2 (<70
years), took part in a 4-week training program.
Results: There were differences in the clinical parameters and
the QOL between the older and the younger patients both after
4 weeks and at the follow-up. After six months, however, the
older patients again recorded having an inferior QOL to that of
the younger patients.
Conclusion: Elderly patients can also benefit from physical
exercise training, with improvement in clinical parameters and
QOL. In order to maintain the subjectively improved QOL in the
long term, however, continued special heart failure education
and support is required.
Introduction
Heart failure will be a major burden on the public healthcare
system during the next decades, and its prevalence is
increasing with the aging population. Mortality can be reduced
in these patients by using drug therapy, but the most effective
intervention is heart failure management programs. These
management programs are not only effective in younger
populations, multidisciplinary interventions also lead to lower
readmission rates in elderly patients.
Purpose
The aim of this study was to evaluate the physical and mental
status of patients with chronic heart failure following a fourweek endurance training program including a six month followup. Specific objectives were to evaluate these three variables
after completing the endurance training program:
•Cardiopulmonary performance
•Quality of life
•Level of anxiety and depression
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Methods
Study population: This study comprised patients who have been
admitted to the hospital after being diagnosed with chronic heart
failure and who were undergoing rehabilitation.
•116 patients were included in the study and subjected
to a standardized 4-week exercise program.
•The sample was divided into two groups according to
age. Group 1 (>70 years) and Group 2 (<70 years)
Quality of life, anxiety, and depression: Quality of life in Group
1 improved noticeably between admission and discharge but
deteriorated after 6 months. Group 2 improved throughout.
Measurements of anxiety and depression provided no significant
results.
Results
All 116 patients participated in the training program during an inpatient hospital stay. Medical parameters and performance data
were recorded at the beginning of rehabilitation, at the end, and
after a six month follow-up. None had to stop prematurely and no
severe cardiac events occurred.
Echocardiographic data: In both Groups 1 & 2, the left
ventricular end systolic and diastolic volumes decreased from the
beginning of rehabilitation to the six month follow up. There were
no significant differences between the two groups. The left
ventricular ejection fraction in Groups 1 & 2 both increased from
the beginning of rehabilitation to the six month follow up. Here
too, there were no significant differences between the groups.
Spiroergometry and training-related data: Peak VO2
increased significantly in both groups from the beginning of
rehabilitation to the six month follow up. The maximum work load
in both groups during the study changed significantly. The sixminute walk test was recorded at the beginning and the end of
the endurance training program. The walking distance covered in
the six-minute walk test increased in both groups.
The results of this study underline the necessity of
comprehensive intervention, especially in elderly patients, if
quality of life is to be improved. In the studies opinion, treatment
of chronic heart failure must incorporate team management.
Article # 1 Evidence
Chien C, Lee C, Wu Y et al. Home-based exercise improves the
quality of life but not the psychological status of people with
chronic heart failure: a randomized trial. Journal of Physiotherapy.
2011; 57: 157-163.
Study Design: A non-randomized clinical trial was used in which
patients were assigned to one of two groups; Group 1 (>70
years) and Group 2 (<70 years).
Exercise Training Program: The program was made up of
endurance training using a bicycle ergometer, the 6-minute walk
test, and muscle strength training for the upper and lower
extremities. Muscle strength training was conducted 2–3 times
per week, bicycle ergometer training 3 times and the 6-minute
walk test as a training unit twice a week.
Conclusion
Discussion
This study investigates the viability of a training program
consisting endurance and muscle strength training, especially in
elderly patients. The study showed an increase of physical
performance in both young and elderly patients with chronic
heart failure, but especially in elderly patients. These results
show that physical training is not contraindicated in patients with
chronic heart failure, but crucial, especially in older patients,
whom compared to younger patients, increased their physical
performance even more significantly. Limitations of the this study
include that it was a non-randomized control trial and that the
period of exercise was short and should be viewed critically.
Clinical Significance
Chronic heart failure has proved in becoming a challenge during
the upcoming decades due to the increase of the aging population.
It commonly leads to a poor prognosis and is linked with increased
morbidity and a decreased quality of life. Exercise training has not
only proved to have favorable outcomes for chronic heart failure
patients from a physical aspect, but also a psychological aspect,
showing improvements in the overall quality of life of the patient.
With more upcoming and recent research, specific exercise
programs could be utilized by physical therapists and become a
strong and effective intervention in patients with diagnosed chronic
heart failure.
This article supports the original article in saying that exercise
programs help improve the physical function, and quality of life in
chronic heart failure patients but not psychological factors such
as anxiety or depression. Although both articles measure physical
function, quality of life, and psychological factors of anxiety and
depression, they both do so differently, using different
measurement tools and times at which the measurements were
taken, but obtained the same results.
Article #2 Evidence
Yeh G, McCarthy E, Wayne P et al. Tai Chi Exercise in Patients
with Chronic Heart Failure. American Medical Association. 2011;
8:750-757
This article is supportive by agreeing that an exercise program
improves the quality of life in patients with chronic heart failure,
but did not have the same results in the aspect of function. At the
end of a 12 week period, there was no significant difference in
functional capacity measurements between the tai chi group and
the control group, but the findings were significant showing that
the tai chi group had greater improvements in quality of life.
Summary
Exercise training programs are beneficial to patients diagnosed
with chronic heart failure, improving both their physical function
and quality of life. Research proves that chronic heart failure
patients of all ages benefits from an exercise training program,
especially elderly patients. With further research, specific
exercise training programs could be implemented in physical
therapy and could be used as a significant intervention with
patients with chronic heart failure.
Poster by: Kara Casey, Physical Therapy Student