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EFFICACY OF A HOME-BASED EXERCISE PROGRAM FOR RECENTLY HOSPITALIZED CHRONIC HEART FAILURE PATIENTS
Background: Comprehensive cardiac rehabilitation
(CCR) has demonstrated favorable effects for recently hospitalized
chronic heart failure (CHF) patients. However,
currently proposed CCR models are not acceptable for many
CHF patients, because they live in remote geographic location,
have difficulty in transportation, or do not have the
sufficient financial resources to pay for an outpatient program.
Whereas, home-based programs have been reported to
be equally effective as center-based programs. Moreover, its
adherence is higher than that of center-based programs. However,
there are no trials evaluating home-based programs in
the early post-hospital period. This is an important clinical
question, because recently hospitalized CHF patients were
experienced the high rate of rehospitalization compared with
Purpose: To assessed the efficacy of a home-based exercise
program for recently hospitalized CHF patients.
Methods: This study was designed as a prospective randomized
controlled trial. We recruited consecutive CHF
patients hospitalized from January through December, 2013
in Tokushima Red Cross Hospital, Japan. Intervention group
was monitored by using activity monitors for three months
and followed up weekly through telephone interviews by a
physical therapist to assess their walking steps and symptoms.
It was followed by an original step chart to increase
the number of walking steps gradually to achieve the target
number. Control group was received usual care by either their
cardiologist or general practitioner. Six-min walk distance
and health-related quality of life were measured at baseline, a
month, and three months. Additionally, rehospitalization due
to worsening heart failure within six months was assessed.
Results: In total, sixty-three patients identified as being
suitable for the intervention, of whom fifty-two (83%)
agreed in this study (intervention group; n = 26, control
group; n = 26), and 68% of the intervention group patients
completed the program. Exercise intervention significantly
improved the six-min walk distance (median, 76.0 versus
27.5 m; p < 0.01) and health-related quality of life (physical
component summary and role/social component summary;
p < 0.01). Rehospitalization within six months was required
by four patients (15%) in the intervention group and eight
patients (30%) in the usual care (p = 0.20). No adverse events
were observed during exercise in intervention group.
Conclusion(s):In this study, the home-based exercise program
monitored by using activity monitors and telephone
interviews for recently hospitalized CHF patients was safety
and effective in improving participation rate, adherence,
physical function, and quality of life.
Implications: We should promote the home-based exercise
program for recently hospitalized CHF patients without
access to traditional CCR programs.
Keywords: Cardiac rehabilitation; Home-based exercise;
Chronic heart failure
source: physiotherapyjournal.com / article/S0031-9406(15)01478-9/pdf
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