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Haemodynamic effects of a novel, personalised, home-based physical activity intervention for chronic heart failure

Session Poster session 3

Speaker Nduka Charles Okwose

Event : Heart Failure 2017

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : NC Okwose (Newcastle upon Tyne,GB), S Cassidy (Newcastle upon Tyne,GB), K Bailey (Newcastle upon Tyne,GB), J Skinner (Newcastle upon Tyne,GB), GA Macgowan (Newcastle upon Tyne,GB), D Jakovljevic (Newcastle upon Tyne,GB)

Authors:
NC Okwose1 , S Cassidy1 , K Bailey2 , J Skinner2 , GA Macgowan3 , D Jakovljevic1 , 1Newcastle University, Institute of Cellular Medicine - Newcastle upon Tyne - United Kingdom , 2Royal Victoria Infirmary, Cardiology - Newcastle upon Tyne - United Kingdom , 3Freeman Hospital, The Cardiothoracic Centre - Newcastle upon Tyne - United Kingdom ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 489

Background/Aim: Exercise-based cardiac rehabilitation programmes are safe and recommended to improve symptoms and outcomes in chronic heart failure (CHF). However <10% of CHF patients in the UK participate in cardiac rehabilitation programmes due to lack of resources and absence of HF in local commissioning agreements. An effective home-based physical activity intervention may improve current clinical practice and benefit patients. The aim of the present study was to evaluate safety, compliance, and physiological effects of a novel, personalised, home based physical activity intervention in CHF.

Methods: A single-centre pilot study recruited 20 patients (mean age 68±7 years) with stable CHF due to left ventricular systolic dysfunction (LVEF=31±8). At baseline patients underwent maximal graded cardiopulmonary exercise testing with non-invasive bioreactance cardiac output monitoring, assessment of quality of life (Minnesota Living with Heart Failure Questionnaire, MLHFQ), NTproBNP and physical activity level over a 7-day period using pedometers. Following initial assessments, patients were asked to increase and maintain their daily physical activity level by at least 2000 steps per day from baseline for 12 weeks, as this increment has been shown to be associated with a significant 10% reduction in cardiovascular events in high risk patients. All patients were monitored weekly via telephone calls and daily activity levels were recorded using diaries. During the follow-up visit, all assessment performed at baseline were repeated.

Results: Seventeen patients (85%) completed the study, achieved and maintained targeted physical activity level (Figure 1). Number of steps increased significantly from baseline to 3 weeks by 2546 (5108±3064 to 7654±3849 steps/day, p=0.03), and was maintained until week 12 (9022±3942 steps/day). No adverse reactions to increased activity level were reported. On average MLHFQ score decreased by 4 points following intervention (26±18 vs. 22±19, p=0.50), suggesting improvement in quality of life. There was no clinically relevant change in NTproBNP (856±1106 vs 832±1164 ng/L, p=0.95), and O2 consumption at peak exercise (16.8±3.8 vs. 17.6±4.2 ml/kg/min, p=0.54), whereas peak exercise workload and cardiac index increased by 10% and 11% (82±10 vs. 91±19 watts, p=0.21; and 6.8±1.5 vs. 7.6±2.0 L/min/m2, p=0.19). Peak exercise heart rate remained unchanged following intervention (106±19 vs. 107±16 beats/min, p=0.92), while peak stroke volume index increased by 15% (64±14 vs. 75±17 ml/beat, p=0.04). Workload and O2 consumption at anaerobic threshold increased by 16% (49±16 vs. 59±14 watts, p=0.01) and 10% (11.5±2.9 vs. 12.8±2.2 ml/mg/min, p=0.39) after the intervention.

Conclusion: Personalised home-based physical activity intervention has minimal cost implications for the health service and is safe for CHF patients. It increases daily physical activity levels and improves exercise tolerance and hemodynamic response to exercise.

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