Upper-Extremity Exercise Training in Heart Failure

Effect of different types of aerobic training on peak VO2 and ejection fraction for diastolic heart failure patients; a comparative randomized control trial

BACKGROUND

Heart failure is described by a lack of confirmed efficient therapies and exercise intolerance. Engagement in physical activity decreases the possibility of adverse cardiovascular consequences involving heart failure.

THE PURPOSE OF THE STUDY

Determine the effect of different types of aerobic training on peak VO2 and ejection fraction in diastolic heart failure patients.

SUBJECT AND METHODS

The study was designed as a randomized control trail. Forty-eight eligible male patients with diastolic heart failure, aged between 50 and 65 years old, enrolled in this study. They were picked up from Police hospital outpatient clinic and were assigned to 2 equal groups in numbers. The first group (A) received aerobic exercise for the upper limb in the form of arm ergometer exercises, while the second group (B) received aerobic exercise for the lower limb in the form of cycling. Training duration for both groups was 3 sessions/week for 12 weeks. Peak VO2, and ejection fraction of both groups were measured and compared pre- and post-treatment.

RESULTS

There was no significant difference (p > 0.05) in the ejection fraction between groups post-treatment. However, a significant increase (p < 0.001) was observed in the peak VO2 of group B when compared to group A post-treatment.

CONCLUSION

There is no effect of different types of aerobic training on ejection fraction in diastolic heart failure patients, but lower limb exercise is more effective than upper limb exercise in improving peak VO2 in diastolic heart failure patients. Therefore, the current study recommended the use of lower limb exercise over upper limb exercise in training diastolic heart failure patients.

CLINICAL TRIAL REGISTRATION

The study was registered in ClinicalTrial.gov as a clinical trial ID (NCT05637125).

Effects of upper extremity aerobic exercise training on oxygen consumption, exercise capacity, dyspnea and quality of life in patients with pulmonary arterial hypertension

BACKGROUND

Pulmonary and extrapulmonary impairments are prevalent in pulmonary arterial hypertension (PAH) which is a rare, chronic and progressive disease.

OBJECTIVES

To investigate the effects of upper extremity aerobic exercise training on exercise capacity, oxygen consumption, dyspnea and quality of life in patients with PAH.

METHODS

In a prospective, randomized controlled, double-blinded study, eleven patients in training group applied upper extremity aerobic exercise training (50-80% of maximal heart rate), 15-45 min/day, 3 days a week for 6 weeks and 11 patients in control group alternating active upper extremity exercises for the same period. Exercise capacity evaluated using six minute walk test (6MWT), oxygen consumption simultaneously measured during 6MWT using a portable instrument, dyspnea modified Borg scale and Modified Medical Research Council dyspnea scale and quality of life Short Form 36 Health Survey, before and after the exercise training.

RESULTS

Baseline characteristics of groups were similar (p>0.05). Dyspnea (p<0.001) and peak oxygen consumption (p = 0.031) were significantly improved in training group compared the controls. Dyspnea, exercise capacity, peak oxygen consumption, minute ventilation, tidal volume, end tidal carbon-dioxide pressure, and vitality, social functioning and role-physical were significantly improved within training group (p<0.05). Oxygen consumption at anaerobic threshold were significantly decreased within control group (p<0.05).

CONCLUSIONS

Upper extremity aerobic exercise training improves oxygen consumption, and decreases dyspnea perception. It is a safe and effective intervention in patients with PAH. (ClinicalTrials.gov registration: NCT02371733).

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

Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

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

Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.

Clinical utility of exercise training in chronic systolic heart failure

The volume of literature attesting to the clinical benefits of exercise training in patients with stable chronic heart failure (CHF) is substantial. Training can improve symptoms and exercise capacity, as well as reducing morbidity, mortality, and rates of emergency hospitalization. These benefits are apparent in all patients with stable CHF, irrespective of age or sex, or the etiology or severity of heart failure. Training regimens for patients with stable, systolic CHF should form part of a comprehensive heart-failure support effort and are best delivered using supervised in-hospital exercise combined with some training at home or in a group setting in community centers. In this Review, the modes and intensity of exercise training, selection of patients, duration of training effects, and other clinical guidance for using this treatment option are discussed.

Evaluation of cardiorespiratory functional reserve from arm exercise in the elderly

BACKGROUND

When the subject is not able to satisfy traditional testing procedures, alternative exercises or indices such as arm cranking or the oxygen uptake efficiency slope (OUES) have been proposed. However, the OUES has not yet been used on elderly subjects from an exercise performed with the arms.

OBJECTIVE

The aim of our study was to evaluate the possibility of using the OUES as an index of the cardiorespiratory functional reserve in the elderly when the exercise evaluation test is performed with the arms and when this parameter is estimated from submaximal responses.

METHODS

Seventeen adults (62-82 years) undergoing total joint arthroplasty of the hip took part in this study. Maximal incremental exercise tests were performed on an arm crank ergometer 1 month before (T₁) and 2 months after (T₂) surgery. Gas exchanges were measured continuously to determine oxygen consumption at peak exercise (V˙O₂ peak) and were used to calculate the OUES. The correlation coefficient was calculated between V˙O₂ peak and OUES, and their relative changes between T₁ and T₂.

RESULTS

V˙O₂ peak was not significantly different between T₁ and T₂: 10.3 ± 0.7 and 9.8 ± 0.5 mL/min per kilogramme respectively. The OUES estimated from submaximal responses did not show a significant difference between T₁ and T₂. Significant correlations were observed between individual V˙O₂ peak and OUES, as well as at T₁ and T₂.

CONCLUSION

The use of arm cranking exercises and the calculation of the OUES from the submaximal respiratory response can be used for the objective quantification of cardiorespiratory functional reserve in the elderly.