Birgitta Blakstad Nilsson

Effects of Group-Based High-Intensity Aerobic Interval Training in Patients With Chronic Heart Failure

The aim of this study was to evaluate the effectiveness of a novel group-based aerobic interval training of high intensity on functional capacity and quality of life in patients with chronic heart failure (CHF) and examine the relation between changes in functional capacity and quality of life. Eighty patients with stable CHF (63 men, 17 women; mean age 70.1 +/- 7.9 [SD] years; left ventricular ejection fraction 30 +/- 8.5%) on optimal medical treatment were randomly assigned to either a 16-week group-based aerobic high-intensity interval training model twice weekly for 65 to 80 minutes/day (n = 40) or a control group (n = 40) that received standard care. Functional capacity was measured using the 6-minute walk test and cycle ergometer test. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. After 16 weeks, functional capacity improved significantly in the exercise group compared with the control group measured using the 6-minute walk test (+58 vs -15 meters; p <0.001) and for both workload and time measured using the bicycle ergometer test (+10 vs -1 W; p < 0.001; + 57 vs -8 seconds; p <0.001). Quality of life improved significantly in the exercise group compared with the control group (p = 0.03), and a significant inverse correlation was found between quality of life and functional capacity (r = -0.49, p <0.05). In conclusion, our exercise model significantly improved functional capacity and quality of life compared with the control group in patients with CHF. Improvements in quality of life were significantly related to functional capacity.

Long-Term Effects of a Group-Based High-Intensity Aerobic Interval-Training Program in Patients With Chronic Heart Failure

Studies on the long-term effects of exercise training programs on functional capacity and the quality of life in patients with chronic heart failure (CHF) are sparse. The aim of this study was to evaluate the long-term effects of group-based, high-intensity interval training on functional capacity and the quality of life in 80 patients with stable CHF (mean age 70.1 +/- 7.9 years) in New York Heart Association classes II to IIIB. Patients were randomized to either an exercise group (n = 40) or a control group (n = 40). The mean ejection fractions at baseline were 31 +/- 8% in the exercise group and 31 +/- 1% in the control group. The exercise group exercised twice a week for 4 months in addition to 4 consultations with a CHF nurse. Six-minute walking distance, workload and exercise time on a cycle ergometer test, and the quality of life were measured at baseline and 4 and 12 months after enrollment. After 4 months, functional capacity (6-minute walking distance +58 vs -15 m, p <0.001) and the quality of life (Minnesota Living With Heart Failure Questionnaire score +10 vs -1 point, p <0.005) improved significantly in the exercise group compared with the control group. After 12 months, the improvements were still significant in the exercise group compared with the control group for all parameters (6-minute walking distance +41 vs -20 m, p <0.001; workload +10 vs -1 W, p = 0.001; exercise time +53 vs -6 seconds, p = 0.003; quality of life +10 vs -6 points, p = 0.003). In conclusion, the results support the implementation of a group-based aerobic interval training program to improve long-term effects on functional capacity and the quality of life in patients with CHF.

Group-based Aerobic Interval Training in Patients With Chronic Heart Failure: Norwegian Ullevaal Model

Background and Purpose: The purpose of this case report is to describe the responses of 4 patients with chronic heart failure (CHF) to a novel rehabilitation program: a group-based, high-intensity, interval-training program that includes aerobic, resistance, flexibility, and balance activities. Case Descriptions: Four patients (55–71 years of age) with CHF (New York Heart Association class III) participated in the rehabilitation program twice per week for 16 weeks. Outcome measures included a 6-minute walk test (6MWT), a cycle ergometer test (aerobic capacity), and a quality-of-life questionnaire. Outcomes: Patients 1, 2, and 3 increased their aerobic capacity (17%, 25%, and 52%, respectively). Patient 4 did not complete the cycle ergometer test because of limitations associated with his pacemaker. All patients increased their 6MWT distance (117, 66, 135, and 143 m for patients 1, 2, 3, and 4, respectively). No adverse events were reported. Discussion: The Norwegian Ullevaal Model of cardiac rehabilitation is a novel high-intensity, interval-training program. The 4 patients with CHF in this case series who participated in this program experienced improvements in physical capacity and quality of life and had no adverse events. These results are consistent with recent evidence supporting the efficacy of high-intensity interval training in people with CHF. Randomized clinical trials are needed to evaluate the clinical efficacy of this group-based, high-intensity, aerobic interval-training program for patients with CHF.

Inflammatory markers as related to disease severity in patients with chronic heart failure: Limited effects of exercise training

Abstract Background. Chronic heart failure (CHF) is associated with increased inflammation, and exercise training has in some studies been shown to have anti-inflammatory effect, although controversies exist. We investigated the effects of exercise training in CHF patients on markers of inflammation, and further explored any association between inflammation and the severity and etiology of the disease. Methods. Eighty patients in stable CHF were randomized to 4 months of group-based high intensity exercise training or to a control group. Physical capacity was measured by 6-minute walk test and cycle ergometer test. Blood samples were drawn at baseline, after 4 months and after 12 months follow-up for analyses of a range of biomarkers. Results. Physical capacity was significantly inversely related to CRP, IL-6, VCAM-1 and TGF-β, and NT pro-BNP levels were significantly correlated to CRP, TNF-α, IL-6, VCAM-1, ICAM-1 and TGF-β (p < 0.05 for all). Patients with hypertension as etiology of CHF showed higher levels of CRP (p < 0.01), IL-6 (p = 0.05) and TNF-α (p = 0.02) as compared to other etiologies. No significant differences in changes between the exercise group and the control group were obtained in any of the measured variables, except in patients with idiopathic dilated cardiomyopathy (IDCM), where significant reductions in CRP, ICAM-1, TGF-β and TNF-α levels were observed (p < 0.05 for all). Conclusions. Measures of CHF severity were significantly correlated with several markers of inflammation. We could not demonstrate over-all anti-inflammatory effect of exercise in this population of CHF patients. However, the etiology of CHF affected the inflammatory profile and the effect of exercise training.

No effect of group-based aerobic interval training on N-terminal pro- B-type natriuretic peptide levels in patients with chronic heart failure

Abstract Objectives. Exercise training might improve cardiac function as well as functional capacity in patients with chronic heart failure (CHF). N-terminal pro-B-type natriuretic peptide (NT pro-BNP), is associated with the severity of the disease, and has been reported to be an independent predictor of outcome in CHF. We evaluated the effect of a four months group-based aerobic interval training program on circulating levels of NT pro-BNP in patients with CHF. We have previously reported improved functional capacity in 80 patients after exercise in this exercise program. Methods. Seventy-eight patients with stable CHF (21% women; 70±8 years; left ventricular ejection fraction 30±8.6%) on optimal medical treatment were randomized either to interval training (n=39), or to a control group (n=39). Circulating levels of NT pro-BNP, a six minute walk test (6MWT) and cycle ergometer test were evaluated at baseline, post exercise, and further after 12 months. Results. There were no significant differences in NT pro-BNP levels from baseline to either post exercise or long-term follow-up between or within the groups. Inverse correlations were observed between NT pro-BNP and 6MWT (r=−0.24, p=0.035) and cycle exercise time (r=−0.48, p<0.001) at baseline. But no significant correlations were observed between change in NT pro-BNP and change in functional capacity (6MWT; r=0.12, p=0.33, cycle exercise time; r=0.04, p=0.72). Conclusion. No significant changes in NT pro-BNP levels were observed after interval training, despite significant improvement of functional capacity.

Hemodynamic Responses to Resistance Exercise in Patients with Coronary Artery Disease.

PURPOSE Investigate hemodynamic responses of resistance exercise (RE) with moderate load (i.e., international guidelines for RE of patients) versus RE with high load in patients with coronary artery disease (CAD). METHODS Medically stable male (n = 11) and female patients (n = 4) treated with PCI or percutaneous coronary intervention, or coronary artery bypass surgery a minimum of 6 months before this study, performed three sets of 15RM and 4RM RE in a randomized order on separate days. Beat-to-beat systolic (SBP), diastolic (DBP) blood pressure, heart rate (HR), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR) were monitored at preexercise, and continuously during RE. RESULTS Compared with preexercise, SBP and DBP (mean of three sets) increased by 12% to 13% (both; P < 0.001) and 35% to 40% after 15RM RE (both; P < 0.001). 15RM SBP and DBP were higher than 4RM SBP and DBP (both; P < 0.001). The SBP of the fourth repetition of 15 RM RE was similar to the SBP of the fourth repetition of 4RM RE. Compared with preexercise, SV increased moderately after 4RM and 15 RM RE, respectively (both, P < 0.001). HR increased more after 15RM compared with 4RM RE (P < 0.05); thus, higher CO after 15RM (compared with 4RM RE; P < 0.05) was mainly caused by higher HR. SVR decreased by 15% (P < 0.001) and 50% (P < 0.01) after 4RM and 15RM RE. CONCLUSIONS SBP and DBP increased significantly more during moderate load RE; thus, the magnitude of the external load is not the prime determinant of the pressure response during RE. If management of blood pressure is of concern, high load/low rep RE is preferable to medium load/high rep RE.

Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials: Exercise-based rehabilitation in patients with chronic heart failure

To undertake an individual patient data (IPD) meta‐analysis to assess the impact of exercise‐based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity.

Implementation and evaluation of the Norwegian Ullevaal model as a cardiac rehabilitation model in primary care

Abstract Purpose: To describe the Norwegian Ullevaal model, customised for cardiac patients in primary care, and to evaluate the feasibility of the model through patient outcomes after the 12 week outpatient cardiac rehabilitation programme. Materials and methods: A descriptive interventional cohort study with pre-post design. Patients referred to cardiac rehabilitation (n = 273) were enrolled. Group-based high-intensity interval training was offered twice weekly. The primary outcome measure was change in peak oxygen uptake. Quality of life was measured using the COOP-WONCA questionnaire. Results: A total of 87% completed the 12 weeks exercise based rehabilitation programme and there were no adverse events during testing or exercise training. Peak oxygen uptake improved significantly from 31.6 ± 7.5 to 34.1 ± 7.8 ml/kg/min. Mean difference was 4.1 ml/kg/min (95% confidence interval, 3.74.5). COOP-WONCA was significantly improved in all domains. Conclusions: The Norwegian Ullevaal model was effective and safe, and resulted in significant and clinically meaningful improvements in cardiopulmonary fitness and quality of life. Implications for rehabilitation Cardiac rehabilitation programmes giving at least 3.5 ml/kg/min improvements of peak oxygen uptake are shown to be beneficial. The detailed description of the Norwegian Ullevaal model, applied as a cardiac rehabilitation programme in primary care, may help clinicians with planning and initiating of group-based high intensity cardiac rehabilitation, as well as implementing evidence based science into practice. The findings from this study provide preliminary evidence in support of alternative exercise prescriptions compared to present modalities for cardiac rehabilitation in primary care.