Abstract
Background: In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients’ peak aerobic capacity, heart rate, and ventilation.Objectives: To assess the effects of short-term comprehensive cardiac rehabilitation (CR) on the metabolic requirement of ADLs in elderly patients with chronic HF.Methods: The study population comprised 99 elderly chronic HF patients (mean age 72 ± 5 years, 80% male, 61% ejection fraction <40%, mean NT-proBNP 2,559 ± 4,511 pg/ml) participating in a short-term (mean days 19 ± 7) residential CR program. Before and after CR, participants, while wearing a portable ergospirometer, performed a standardized ADL battery: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 min), ADL6 (climbing 1 flight of stairs carrying a 1.5 Kg load), and ADL7 (a standard 6-min walking test).Results: After CR, task-related oxygen uptake did not change in any of the domestic ADLs. Notably, there was a significant decrease in the cumulative time required to perform ADLs (ADL 1–4 and ADL6; from 412 ± 147 to 388 ± 141 s, p = 0.001) and a reduction in maximal heart rate in ADL1 and 3 (p = 0.005 and p = 0.027, respectively). Changes occurred in the 6MWT with an increase in oxygen uptake (p = 0.005) and in the distance covered (p < 0.001) and a significant decrease in the Borg scale of dyspnea (p = 0.004).Conclusion: Elderly patients with chronic heart failure who are engaged in a short-term residential CR program improve the performance of routine ADLs.
Highlights
Chronic heart failure (HF) is a disabling condition with a rising prevalence, especially in the elderly (Bui et al, 2011)
Elderly patients with chronic heart failure who are engaged in a short-term residential cardiac rehabilitation (CR) program improve the performance of routine ADLs
We extended our analysis to HF severity (NYHA class) and to those patients with reduced and preserved ejection fraction (EF); NYHA 2 elderly HF patients were more sensible to CR program, even though 6MWT was improved in both subgroups (i.e., NYHA class 2 and 3), while HF elderly patients with reduced EF and those with preserved EF had a comparable behaviour in cardiometabolic response after CR
Summary
Chronic heart failure (HF) is a disabling condition with a rising prevalence, especially in the elderly (Bui et al, 2011). Chronic HF patients exhibit a reduction of peak aerobic capacity and early onset of dyspnea and fatigue (Ponikowski et al, 2016). In chronic HF, aerobic exercise tolerance usually relates to habitual physical activity level, and progression of HF symptoms is associated with a progressive decrease of patients’ habitual activities (Mezzani et al, 2000). Chronic HF patients often complain of greater limitations when performing Activities of Daily Living (ADLs; Holland et al, 2010; Dunlay et al, 2015). In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients’ peak aerobic capacity, heart rate, and ventilation
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