Benefits of Combined Aerobic/Resistance/Inspiratory Muscle Training in Patients with Chronic Heart Failure. The Ideal Exercise Program for CHF?

Transcription

1 Benefits of Combined Aerobic/Resistance/Inspiratory Muscle Training in Patients with Chronic Heart Failure. The Ideal Exercise Program for CHF? I D. Laoutaris, S Adamopoulos, A Manginas, D B. Panagiotakos, M S. Kallistratos, C Doulaptsis, A Kouloubinis, V Voudris, G Pavlides, D V. Cokkinos, A Dritsas Onassis Cardiac Surgery Center, Athens, Greece

2 PURPOSE We tested the hypothesis that combined moderate aerobic training (AT) with selective peripheral skeletal muscle low-moderate resistance training (RT) and high intensity endurance inspiratory muscle training (IMT) (ARIS training program) may result to a significant improvement in both peripheral skeletal and respiratory muscle function compared to standard AT and this may be associated with enhanced benefits in exercise capacity, dyspnea and quality of life (QoL)

3 METHODS Twenty-three patients, age 58±9.6 yrs, NYHA II/III and LVEF 29±6% were randomly assigned to a combined AT/RT/IMT (ARIS) group (n=11) or to an AT group (n=12) and exercised 3 times per week for 12 weeks

4 Table 1. Demographic and clinical characteristics of patients participating in the study ARIS group (n=11) AT group (n=12) p Age (yrs) 56.4± ± Males/Females 8/3 10/ BMI (kg.m -2 ) 27.1± ± peakvo 2 (ml.kg -1.min -1 ) 17.2± ± LVEF (%) 27.7± ± NYHA (II/III) 5/6 7/ Disease aetiology (DCM/ICM) 8/3 8/ Medication (%) ACE-Inhibitors Beta-blockers Digoxin Diuretics BMI, body mass index; peakvo 2, peak oxygen consumption; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; DCM, dilated cardiomyopathy; ICM, ischemic cardiomyopathy

5 Training Protocol Aerobic/Resistance/Inspiratory (ARIS) group (n=11) Aerobic Training (AT) group (n=12) Aerobic training (AT) 30 min using a bike at 70-80% of maximal heart rate (HR) + Resistance training (RT) 15 min of the quadriceps at 50% of 1 repetition maximum (1RM) combined with upper limb exercises using dumbbells (1-2 kg) + Inspiratory Muscle Training (IMT) 20 min high intensity IMT at 60% of sustained maximal inspiratory pressure (SPI max ), Aerobic training 45 min using a bike at 70-80% of max HR

6 Pre- and post-training all patients underwent: (i) cardiopulmonary exercise testing (CPET) on a treadmill using the Dargie protocol (i) dyspnea assessment with the Borg scale at the end of CPET (ii) evaluation of cardiac function and structure using 2-dimensional echocardiography (iii) quadriceps muscle function measurement using a dynamometer and the 1RM maximum (iv) inspiratory muscle strength (PI max ), and endurance (sustained PI max [SPI max ]) measurement by an electronic manometer connected to computer software (v) QoL evaluation using the Minnesota Living with Heart Failure questionnaire (MLwHFQ)

7 RESULTS Table 2. Lower Limb and Inspiratory Muscle Function ARIS group (n=11) AT group (n=12) pre post p pre post p *p QMT peak (Nw.m) 1.9± ±0.4 < ±0.2 2± RM (kg) 19.7± ±3.8 < ± ± QME (kg.maxreps) 141.5± ±32 < ± ± PI max (cmh 2 O) 73.6±10 98±17 < ±14 85± SPI max (cmh 2 O.s ) 310±29 413±26 < ±22 308± <0.001 QMT peak, peak quadriceps muscle torque; 1RM, (1Repetition maximum); QME, quadriceps muscle endurance (50%1RM x maximal repetitions); PI max, inspiratory muscle strength; SPI max, sustained PI max (inspiratory muscle endurance); *p-values derived using repeated measures analysis of variance (RMANOVA)

8 Table 3. Exercise capacity (CPET) ARIS group (n=11) AT group (n=12) pre post p pre post p *p peakvo 2 (ml.kg -1 min -1 ) 17.2± ± ± ± Time (min) 8.6± ± ±1 9.7± VE/VCO ± ± ± ± VT(ml.kg -1 min -1 ) 14.4± ± ±3 13.7± VE (Lmin -1 ) 58±16 64± ±13 58± RER 1±0.1 1± ± ± HR rest (bpm) 78±19 72± ±14 78± HR peak (bpm) 124±26 130± ±15 145± SBP rest (mmhg) 105±11 105± ±15 105± SBP peak (mmhg) 136±27 150± ±28 142± CP(ml.kg -1 min -1 mmhg) 2449± ± ± ± VT, ventilatory threshold; RER, respiratory exchange ratio; HR, heart rate; SBP, systolic blood pressure; CP, circulatory power (peakvo 2 x SBP peak ); *p-values derived using repeated measures analysis of variance (RMANOVA)

9 Table 4. Echocardiography ARIS group (n=11) AT group (n=12) pre post p pre post p *p LVEF (%) 27.7± ± ±5 32.8± LVESD (mm) 65.1± ± ±3.2 60± LVEDD (mm) 72.1±10 70± ±4 64.6± LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVEDD, left ventricular end-diastolic diameter; *p-values derived using repeated measures analysis of variance (RMANOVA)

10 Table 5. Quality of Life, Dyspnea and NYHA classification ARIS group (n=11) AT group (n=12) pre post p pre post p *p MLwHFQ 41±2.9 33±2.8 < ±2.2 40± Dyspnea (6-20) 17.8± ± ± ± NYHA 2.5± ± ± ± MLwHFQ, Minnesota Living with Heart Failure Questionnaire; NYHA, New York Heart Association; *p-values derived using repeated measures analysis of variance (RMANOVA)

11 CONCLUSION Combined AT/RT/IMT was safe and resulted to a further improvement in peripheral and respiratory muscle weakness, cardiopulmonary exercise parameters, central adaptations and QoL compared to AT only The ARIS training program Conflict of interest: none declared