Purpose: to estimate efficiency of individualized approach to the development of more precisely physical rehabilitation program in HF patients with III FC.
Methods: We evaluated 48 hospitalized patients 40-68 years old, mean age 55+/-1.8, 33 men, with HF NYHA class III, ejection fraction (LVEF) 37,8+/-0,3%. All patients performed a symptom-limited cardiopulmonary exercise test (CPET) on a treadmill with gas exchange system "Oxycon Pro" initially and after 6 months. We measured oxygen uptake at lactate threshold (VO2LT), pH-threshold (VO2pH-T) and at exercise peak (VO2peak). The cubital venous catheter was installed in all subjects before exercise test. Blood samples were taken at baseline and at 1-minute intervals during test. PH, lactate and HCO3- concentration were estimated using analyzer i-STAT, cartridge CG4 (Abbot, USA). LT and pH-T were determined by changes in pH and lactate level. 48 patients were divided into two groups: 38 patients of main group (MG), who underwent physical rehabilitation program (PRP) based on lactate threshold and pH-threshold, that characterized the biological reserves of adaptation to physical activity; and 10 HF patients control group (CG), who performed usual PRP. HF patients in both groups were matched in age, sex, LVEF and BMI.
Results: At the study beginning CPET Results: VO2LT, VO2pH-T and VO2peak were similar in MG and CG, 8.7 of+/ - 0.5, 11,0+/-0,8, 13,5+/-0,9 ml/min/kg and 8.9 +/- 0.9, 11,5+/-1,3, 13,6+/-1,2 ml/min/kg, respectively (pVO2LTMG-CG = 0,08, pVO2pH-TMG-CG = 0,07, pVO2peakMG-CG = 0,09). First tree month patients of MG were trained 40 minutes every day on treadmill with exercise intensity that was observed at LT, every month after control CPET exercise intensity was increased gradually. Other tree month patients of MG were trained 35 minutes every day on treadmill with exercise intensity that was observed between LT and pH-T, every month after control CPET exercise intensity was increased gradually. Patients of CG were made training walking at 40% of VO2peak three times a week. After 6 months VO2LT, VO2pH-T and VO2peak were better in MG than in CG: 10.1 of+/ - 0.6, 12,8+/-0,5, 16,7+/-1,1 ml/min/kg and 9.3 +/- 1.0, 12,1+/-1,1, 14,6+/-1,2 ml/min/kg, respectively (pVO2LTMG-CG<0,01, pVO2pH-TMG-CG<0,05, pVO2peak MG-CG<0,01).
Conclusions: physical rehabilitation program, calculated based on individualized approach of exercise physiological stages, improves the biological reserves of adaptation to physical activity and exercise capacity in HF patients with III NYHA class more than usual PRP.