Exploring factors related to good exercise capacity in patients undergoing ERIC-HF program
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Decompensated Heart Failure (HF) patients are characterized by
functional dependence and low exercise capacity. The factors associated to a
good response to exercise are still unexplored. The ERIC-HF program is an aerobic
exercise training program developed for HF inpatients and includes cycloergometer
training, walking and climbing stairs in order to promote patient’s functional capacity
during the in-hospital stay period.
Purpose: to identify the factors related to good response to an aerobic exercise
training program for decompensated heart failure (HF) patients.
Methods: Cross-sectional study with 143 inpatients who performed the ERIC-HF
program. Functional capacity was evaluated using three different tools: the London
Chest of Activity of Daily Living (LCADL) scale, the Barthel Index (BI) and the
6-minute walking test (6MWT). A good response to the program was defined as a ≥
300 meters distance at the 6MWT at discharge. Univariate analysis was performed
between patients who walked 300 meters or more at the 6MWT and patients who
walked less than 300meters, using Chi-square tests and Student’s T-test. Logistic
regression analysis was performed to describe factors that were independently
related to better functional capacity at discharge. Variables with a p-value smaller
than 0.15 in the univariate analyses were entered into the logistic regression. A
significance level at p <0.05 was assumed.
The dependent variables were: 1) distance walked at the 6MWT, 2) the change
between admission-to-discharge scores of BI and 3) LCADL. Independent variables
were: 1) gender, 2) age, 3) number of exercise sessions, 4) number of days of
in-hospital stay, 5) BIad, 6) LCADLad, 7) NYHA functional class, 8) left ventricular
ejection fraction (LVEF) and 9) etiology.
Results: The mean age of the patients was 67 (±10) years, 15.4% were NYHA class
IV and 80% had reduced ejection fraction. The aetiology of HF was similar between
ischaemic disease (32.9%) and valvular (33.6%). Patients presented a high level of
impairment on FC. The majority were male (97; 67.8%), with an average of three
CVRF and mostly sedentary, with only 17% performing regular physical activity.
There was no significant difference between etiologies of HF.
Comparison between the group of patients who walked 300meters or more, at the
6MWT, and patients who walked less than 300metrs, showed statistically significant
differences in terms of gender, age, BI, LCADL, etiology of HF and LVEF. After
logistic regression, age (p = 0.002), gender (p = 0.001) and BI (p<0.000) at admission
showed to be statistically significant factors that affect the distance walked.
Conclusions: The ERIC-EF programe appears to be more effective in male, younger
patients and with low FC at admission. Apparently, reduced ejection fraction
does not interfere with progression during the programe. Gender influences the
performance of patients, since men presented with higher FC at discharge.
