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European Journal of Physical and Rehabilitation Medicine 2021 Jul 22

DOI: 10.23736/S1973-9087.21.06727-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial

Yuta NAKAYA 1, 2 , Masanori AKAMATSU 1, Akiyoshi OGIMOTO 3, Hiroaki KITAOKA 4

1 Department of Rehabilitation, Uwajima City Hospital, Uwajima, Japan; 2 Medical Science Graduate School of Kochi University, Kochi, Japan; 3 Department of Cardiology, Uwajima City Hospital, Uwajima, Japan; 4 Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan


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BACKGROUND: Improvements in the Short Physical Performance Battery (SPPB) rather than exercise tolerance reportedly lead to favorable prognosis in elderly patients with acute decompensated heart failure (ADHF). However, about 50% of heart failure shows heart failure with preserved ejection fraction, safe and effective interventions to improve SPPB for these types remain unclear. In addition, although a standard cardiac rehabilitation (CR) program for heart failure is widely used in Japan, whether this is sufficient to improve SPPB in elderly patients with ADHF remains unclear.
AIM: This study was to evaluate whether the addition of multidisciplinary physical interventions to the standard CR program would prove effective for improving SPPB among elderly patients with ADHF regardless types of heart failure.
DESING: Randomized, prospective study.
SETTING: Patients admitted to our hospital due to ADHF in Japan.
POPULATION: Elderly patients with ADHF between March 2019 and March 2020 were randomized to two groups, an Intervention group and a Control group.
METHODS: The Control group performed standard CR. The Intervention group received balance training and resistance training and used a cycling ergometer in addition to the standard CR program. The primary outcome was the improvement in SPPB after CR.
RESULTS: Seventy-five patients with ADHF were divided into the two groups (Intervention group, n=36; Control group, n=39). At baseline, both groups showed low physical performance and a high prevalence of frailty. Intervention size effect was an improvement in SPPB score of +2.2 (+3.7±1.1 vs. +1.5±1.7; p<0.001). Of the 3 components of SPPB, both gait speed and timed repeated chair rise were significantly improved in the Intervention group compared to the Control group, with intervention size effect of +0.76 and +0.94, respectively (p<0.001). Subgroup analysis of heart failure with preserved ejection fraction showed significant improvement in SPPB score in the Intervention group compared to the Control group (p<0.001).No adverse events were observed during the study period.
CONCLUSIONS: A multi-faceted intervention in addition to standard CR improved physical performance among elderly patients with ADHF regardless types of heart failure.
CLINICAL REHABILITATION IMPACT: We believe that use of a cycling ergometer and loadspecific resistance training provide specific CR for patients with ADHF during acute hospitalization and highlight the need for active intervention.


KEY WORDS: Cardiac rehabilitation; Physical function; Acute decompensated heart failure; Elderly

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