Home-based telemonitored Nordic walking training is well accepted,safe,effective and has high adherence among heart failure patients,including those with cardiovascular implantable electronic devices: a randomised controlled study

Abstract

Background

The benefits of rehabilitation in heart failure (HF) patients are well established. Little is known about Nordic walking (NW) training in HF patients especially in those with cardiovascular implantable electronic devices (CIEDs).

Purpose

The purpose of this study was to assess safety, effectiveness, adherence to and acceptance of home-based telemonitored NW in HF patients, including those with CIEDs (i.e. cardiac resynchronisation therapy, implantable cardioverter-defibrillator).

Methods

The study design was a single-centre, prospective, parallel-group, randomised (2:1), controlled trial among 111 HF patients, New York Heart Association (NYHA) II–III; left ventricular ejection fraction (EF) ≤ 40%. The intervention was a home-based telemonitored eight-week NW (training group (TG) n = 77) five times weekly vs usual care alone (control group (CG) n = 34). Outcome measures included a primary end point of functional capacity assessed by peak oxygen consumption (VO₂peak). Secondary end points included: workload duration (t) in cardiopulmonary exercise test (CPET), six-minute walking test (6-MWT) distance and quality of life (QoL), Medical Outcome Survey Short Form 36 (SF-36); safety; adherence to and acceptance of NW. Measurements were made before and after intervention.

Results

NW resulted in significant improvement in: VO₂peak (16.1 ± 4.0 vs 18.4 ± 4.1(ml/kg/min), p = 0.0001), t (471 ± 141 vs 577 ± 158 (s), p = 0.0001), 6-MWT(428 ± 93 vs 480 ± 87 (m), p = 0.0001) and QoL (79.0 ± 31.3 vs 70.8 ± 30.3 (score), p = 0.0001). We did not observe favourable results in the CG. The differences between the TG and CG were significant in: ΔVO₂peak (Δ2.0 ± 2.4 vs Δ−0.2 ± 2.1, p = 0.0004); Δt (Δ108 ± 108 vs Δ0.94 ± 109, p = 0.0031); Δ6-MWT (Δ53.8 ± 63.9 vs Δ22.0 ± 68.7, p = 0.0483). In neither group were there deaths nor necessity for hospitalisation. We did not observe any intervention from CIEDs during NW. All patients in the TG completed rehabilitation and accepted it well.

Conclusion

In HF patients, including those with CIEDs, home-based telemonitored NW is safe and effective. NW was well accepted by patients and adherence was high and promising.

Keywords

Telerehabilitation Nordic walking training heart failure

Get full access to this article

View all access options for this article.

References

McMurray

Adamopoulos

Anker

. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33: 1787–1869.

Fletcher

Ades

Kligfield

. Exercise standards for testing and training: a scientific statement from the AHA. Circulation 2013; 128: 873–934.

Isaksen K, Munk PS, Valborgland T, et al. Aerobic interval training in patients with heart failure and an implantable cardioverter defibrillator: A controlled study evaluating feasibility and effect. Eur J Prev Cardiol. Epub ahead of print 8 January 2014. DOI: 10.1177/2047487313519345.

Riedel S, Radzanowski S, Bowen TS, et al. Exercise training improves high-density lipoprotein-mediated transcription of proangiogenic microRNA in endothelial cells. Eur J Prev Cardiol. Epub ahead of print 23 June 2014. DOI: 10.1177/2047487314541036.

Bjarnason-Wehrens

McGee

Zwisler

. Cardiac rehabilitation in Europe: Results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil 2010; 17: 410–418.

Conraads

Deaton

Piotrowicz

. Adherence of heart failure patients to exercise: Barriers and possible solutions: A position statement of the Study Group on Exercise Training in Heart Failure of the HFA of the ESC. Eur J Heart Fail 2012; 14: 451–458.

Tschentscher

Niederseer

Niebauer

. Health benefits of Nordic walking: A systematic review. Am J Prev Med 2013; 44: 76–84.

Keast

Slovinec D'Angelo

Nelson

. Randomized trial of Nordic walking in patients with moderate to severe heart failure. Can J Cardiol 2013; 29: 1470–1476.

Lejczak

Wilczynski

Jasinski

. 12-week Nordic walking training improves physical fitness and quality of life in patients with systolic heart failure. Eur Heart J 2012; 32: S612–S612.

10.

Brignole

Auricchio

Baron-Esquivias

. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: The Task Force on cardiac pacing and resynchronization therapy of the ESC. Developed in collaboration with the EHRA. Eur Heart J 2013; 34: 2281–2329.

11.

Keell

Chambers

Francis

. Shuttle-walk test to assess chronic heart failure. Lancet 1998; 352: 705–705.

12.

Balady GJ. Medical evaluation and exercise testing. In: Williams MA (ed.) Guidelines for cardiac rehabilitation and secondary prevention programs, 4th edn. Champaign, IL: Human Kinetics, 2004, p.79.

13.

Piepoli

Corrà

Agostoni

. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: Recommendations for performance and interpretation Part II: How to perform cardiopulmonary exercise testing in chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006; 13: 300–311.

14.

Tylka

Piotrowicz

. SF-36 Polish version. Kardiol Pol 2009; 67: 1166–1169.

15.

Piepoli

Conraads

Corra

. Exercise training in heart failure: From theory to practice. A consensus document of the HFA and the EACPR. Eur J Heart Fail 2011; 13: 347–357.

16.

Borg

. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381.

17.

Piotrowicz

Baranowski

Bilinska

. A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: Effectiveness, quality of life, and adherence. Eur J Heart Fail 2010; 12: 164–171.

18.

Piotrowicz

. How to do telerehabilitation in heart failure patients. Cardiol J 2012; 19: 243–248.

19.

O’Connor

ChM

Whellan

Lee

. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. J Am Med Assoc 2009; 301: 1439–1450.