Abstract
Introduction: The Pritikin intensive cardiac rehabilitation (ICR) program includes structured exercise sessions augmented by heart health education sessions for patients recovering from myocardial infarction, cardiac surgery, PCI, and stable angina. Medicare coverage for ICR expanded to include patients with heart failure (HF) with reduced ejection fraction (HFrEF, EF <35%). However, the efficacy of outpatient ICR on improvement of cardiovascular disease (CVD) risk factors in all patients with HF, regardless of EF, is unknown. Hypothesis: Patients with HF who participate in the outpatient Pritikin ICR program will have improvements in several clinically significant CVD risk factors, including cardiorespiratory fitness, strength, body composition, and lipid profiles. Methods: We performed a prospective cohort study of patients with HF enrolled in the outpatient Pritikin ICR program at Barnes Jewish West County Hospital in St. Louis, MO. Patients referred for ICR since 1/1/2017 were invited to participate in assessments at baseline (BL) and after completing 24 ICR visits. Each visit included a monitored exercise session plus a Pritikin education session focusing on dietary changes (low-fat, low-sodium, high-fiber foods) and stress management through a series of videos, cooking classes, and workshops. We measured body composition using bioelectrical impedance, cardiorespiratory fitness using a 6-min walk test, hand grip strength by dynamometry, and lipids by venipuncture. Values are presented as median difference, and interquartile range (IQR) from BL to visit 24. Results: 84 patients with HF (68% HfrEF, 32% HfpEF; 70.2% also diagnosed with MI, CABG, or PCI; 40% women; mean age 69.9 [SD 9.6] y), completed BL and visit 24 assessments over an average of 9.9 weeks. Significant improvements (all P <0.01) were observed for whole-body fat (-1.2%, IQR -2.4, 0.8), trunk fat (-1.3%, -3.2, 0.5), fat free mass (+0.6 kg, -0.3, 1.7), 6-min walk distance (+45.7 m, 17.9, 68.9), hand grip strength (+1.0 kg, -0.4, 2.9), and LDL cholesterol (-3 mg/dL, -14, 6). Conclusion: Outpatient Pritikin ICR results in significant cardiovascular benefits in patients with HF by enhancing exercise capacity and strength, reducing adiposity, and improving lipid profiles.
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