Taofeek O. Awotidebe^1*, Rufus A. Adedoyin¹, Michael O. Balogun^2,3, Rasaq A. Adebayo^2,3, Victor O. Adeyeye³, Kayode I. Oke⁴, Rita N. Ativie⁵, Anthony O. Akintomide^2,3, Mukadas O. Akindele⁶

Show more
¹ Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
² Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
³ Cardiac Care Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
⁴ Department of Physiotherapy, School of Medical Sciences, University of Benin, Benin, Nigeria.
⁵ Department of Medical Rehabilitation, College of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Nigeria.
⁶ Department of Physiotherapy, College of Allied Health Sciences, Bayero University Kano, Kano State, Nigeria.
Show less

Abstract: Objective: This study investigated the effects of cardiac rehabilitation exercise protocols on physical function (PF) in patients with chronic heart failure (CHF). Study Design and Setting: This randomized controlled trial recruited 70 patients who are in stage II CHF with ejection fraction (≤40%) from a Nigerian university teaching hospital. They were randomly assigned into Exercise Group (EG: n = 35) or Control Group (CG: n = 35). Physical function, activity of daily living (ADL), distance walked in six minutes and grip strength were assessed using a validated ADL questionnaire, six minute walk test and a hand dynamometer respectively. In addition to medication, EG underwent aerobic and upper extremity resistance exercises thrice weekly for eight weeks while CG used medications only. Data were analyzed using descriptive and inferential statistics. Alpha level was at p < 0.05. Results: EG and CG were comparable in age and physical characteristics. Physical function and cardiovascular parameters were comparable at baseline (p > 0.05). Significant improvements were noticed at fourth week among participants’ ADL (30.0% ± 6.0%), 6MWD (321.7 ± 26.3 m) and VO₂ max (8.9 ± 0.4 mL/kg/min) variables within the exercise EG but no significant changes were observed in the CG (p > 0.05). Participants in EG demonstrated more significant improvements in ADL (15.0% ± 5.0%), 6MWD (406.0 ± 29.7 m) and VO₂ max (10.3 ± 0.5 mL/kg/min) (p < 0.05) than CG: ADL (42.0% ± 5.0%), 6MWD (321.0 ± 25.7 m) and VO₂ max (8.9 ± 0.4 mL/kg/min) at eighth (p > 0.05). Conclusions: Cardiac rehabilitation exercise protocols involving self-paced walking, sit-to-stand and upper extremity dynamic strength training improved activity of daily living, walking and functional capacity in patients with stable chronic heart failure.

Keywords: Cardiac Rehabilitation Exercise, Physical Function, Heart Failure

Cite this paper: Awotidebe, T. , Adedoyin, R. , Balogun, M. , Adebayo, R. , Adeyeye, V. , I. Oke, K. , Ativie, R. , Akintomide, A. and Akindele, M. (2016) Effects of Cardiac Rehabilitation Exercise Protocols on Physical Function in Patients with Chronic Heart Failure: An Experience from a Resource Constraint Nation. International Journal of Clinical Medicine, 7, 547-557. doi: 10.4236/ijcm.2016.78060.

References

[1]   Lloyd-Jones, D., Adams, R.J., Brown, T.M., Carnethon, M., Dai De, S. and Simone, G. (2010) On Behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association. Circulation, 121, e1-170.

[2]   Bleumink, G.S., Knetsch, A.M., Sturkenboom, M.C., Straus, S.M., Hofman, A. and Deckers, J.W. (2004) Quantifying the Heart Failure Epidemic: Prevalence, Incidence Rate, Lifetime Risk and Prognosis of Heart Failure. The Rotterdam Study. European Heart Journal, 25, 1614-1619.
http://dx.doi.org/10.1016/j.ehj.2004.06.038

[3]   Kingue, S., Dzudie, A., Menanga, A., Akono, M., Ouankou, M. and Muna, W. (2005) A New Look at Adult Chronic Heart Failure in Africa in the Age of the Doppler Echocardiography: Experience of the Medicine Department at Yaounde General Hospital. Annales de Cardiologie et d Angéiologie (Paris), 54, 276-283.
http://dx.doi.org/10.1016/j.ancard.2005.04.014

[4]   Adedoyin, R.A. and Adesoye, A.T. (2005) Incidence and Pattern of Cardiovascular Diseases in a Nigerian Hospital. Tropical Doctor, 35, 104-106.

[5]   Ojji, D.B., Alfa, J., Ajayi, S.O., Mamven, M.H. and Falase, A.O. (2009) Pattern of Heart Failure in Abuja, Nigeria: An Echocardiographic Study. Cardiovascular Journal of Africa, 20, 349-352.

[6]   Damasceno, A., Cotter, G., Dzudie, A., Sliwa, K. and Mayosi, B.M. (2007) Heart Failure in Sub-Saharan Africa: Time for Action. Journal of the American College of Cardiology, 50, 1688-1693.
http://dx.doi.org/10.1016/j.jacc.2007.07.030

[7]   Rees, K., Taylor, R.S., Singh, S., Coats, A.J. and Ebrahim, S. (2004) Exercise Based Rehabilitation for Heart Failure (Cochrane Review). In: The Cochrane Library, John Wiley, Chichester, 3.

[8]   Boxer, R.S., Wang, Z., Walsh, S.J., Hager, D. and Kenny, A.M. (2008) The Utility of the 6-Minute Walk Test as a Measure of Frailty in Older Adults with Heart Failure. The American Journal of Geriatric Cardiology, 17, 7-12.
http://dx.doi.org/10.1111/j.1076-7460.2007.06457.x

[9]   Ajiboye, O.A., Anigbogu, C.N., Ajuluchukwu, J.N. and Jaja, S.I. (2014) Exercise Training Improves Functional Walking Capacity and Activity Level of Nigerians with Chronic Biventricular Heart Failure. Hong Kong Physiotherapy, 33, 42-49.
http://dx.doi.org/10.1016/j.hkpj.2014.11.002

[10]   O’Connor, C.M., Whellan, D.J., Lee, K.L., Keteyian, S.J., Cooper, L.S. and Ellis, S.J. (2009) Efficacy and Safety of Exercise Training in Patients with Chronic Heart Failure: HF-ACTION Randomized Controlled Trial. JAMA, 301, 1439-1450.
http://dx.doi.org/10.1001/jama.2009.454

[11]   Lloyd-Williams, F., Mair, F.S. and Leitner, M. (2002) Exercise Training and Heart Failure: A Systematic Review of the Current Evidence. British Journal of General Practice, 52, 47-55.

[12]   Pi?a, I.L., Apstein, C.S., Balady, G.J., Belardinelli, R., Chaitman, B.R., Duscha, B.D., et al. (2003) Exercise and Heart Failure: A Statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation, 107, 1210-1225.
http://dx.doi.org/10.1161/01.CIR.0000055013.92097.40

[13]   Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., et al. (2007) The Patient Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group during Its First Two Years. Medical Care, 45, 3-11.
http://dx.doi.org/10.1097/01.mlr.0000258615.42478.55

[14]   Berg-Emons, van den H.J.G., Bussmann, J., Balk, A., Keijzer-Oster, D. and Stam, H. (2001) Level of Activities Associated with Mobility during Everyday Life in Patients with Chronic Congestive Heart Failure as Measured with an Activity Monitor. Physical Therapy, 81, 1502-1511.

[15]   Thompson, P.D. (2005) Exercise Prescription and Proscription for Patients with Coronary Artery Disease. Circulation, 112, 2354-2363.
http://dx.doi.org/10.1161/CIRCULATIONAHA.104.502591

[16]   Owen, A. and Croucher, L. (2000) Effect of an Exercise Programme for Elderly Patients with Heart Failure. European Journal of Heart Failure, 2, 65-70.
http://dx.doi.org/10.1016/S1388-9842(99)00067-7

[17]   Pozehl, B., Duncan, K., Hertzog, M. and Norman, J.F. (2010) Heart Failure Exercise and Training Camp: Effects of a Multicomponent Exercise Training Intervention in Patients with Heart Failure. Heart Lung, 39, S1-S13.
http://dx.doi.org/10.1016/j.hrtlng.2010.04.008

[18]   American Society of Hand Therapists (ASHT Editor) (1981) Clinical Assessment Recommendations. Garner, NC.

[19]   American Thoracic Society (ATS) Statement (2000) Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117.

[20]   American College of Sport Medicine (ACSM) (1995) Prediction of Maximum Oxygen Consumption VO2 Max during Level Walking.

[21]   Pincus, T., Sokka, T. and Kautiainen, H. (2005) Further Development of a Physical Function Scale on a Multidimensional Health Assessment Questionnaire for Standard Care of Patients with Rheumatic Diseases. Journal of Rheumatology, 32, 1432-1439.

[22]   Miller, J. (2009) Chairs. Conran, Mannheim, Deutschland.

[23]   Canning, C.G., Shepherd, R.B., Carr, J.H., Alison, J.A., Wade, L. and White, A. (2003) A Randomized Controlled Trial of the Effects of Intensive Sit-to-Stand Training after Recent Traumatic Brain Injury on Sit-to-Stand Performance. Clinical Rehabilitation, 17, 355-362.
http://dx.doi.org/10.1191/0269215503cr620oa

[24]   Hetherington, N. (2005) How to Assess Your One Repetition Maximum (1RM) for Strength Training. In: Brian Mackenzie’s Successful Coaching, 2nd Edition, Electric Word Plc., 10-11.

[25]   Pollock, M.L., Franklin, B.A., Balady, G.J., Chaitman, B.L., Fleg, J.L., Fletcher, B., et al. (2000) Resistance Exercise in Individuals with and without Cardiovascular Disease: Benefits, Rationale, Safety, and Prescription: An Advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology. American Heart Association, Position Paper Endorsed by the American College of Sports Medicine, AHA Science Advisory, Circulation, 101, 828-833.
http://dx.doi.org/10.1161/01.cir.101.7.828

[26]   Maruf, F.A., Akinpelu, A.O. and Salako, B.L (2013) Self-Reported Quality of Life before and after Aerobic Exercise Training in Individuals with Hypertension: A Randomized-Controlled Trial. Applied Psychology: Health and Well-Being, 5, 209-224.
http://dx.doi.org/10.1111/aphw.12005

[27]   Kiilavuori, K., Naveri, H., Salmi, T. and Harkonen, M. (2000) The Effect of Physical Training on Skeletal Muscle in Patients with Chronic Heart Failure. European Journal of Heart Failure, 2, 53-63.
http://dx.doi.org/10.1016/S1388-9842(00)00058-1

[28]   Hulsmann, M., Quittan, M. and Berger, R. (2004) Muscle Strength as a Predictor of Long Term Survival in Severe Congestive Heart Failure. European Journal of Heart Failure, 6, 101-107.
http://dx.doi.org/10.1016/j.ejheart.2003.07.008

[29]   Gottlieb, S.S., Fisher, M.L. and Freudenberger, R. (1999) Effects of Exercise Training on Peak Performance and Quality of Life in Congestive Heart Failure Patients. Journal of Cardiac Failure, 5, 188-194.
http://dx.doi.org/10.1016/S1071-9164(99)90002-7

[30]   McKelvie, R.S. (2003) Heart Failure. Clinical Evidence, 9, 95-118.

[31]   Jackson, L., Leclerc, J., Erskine, Y. and Linden, W. (2005) Getting the Most out of Cardiac Rehabilitation: A Review of Referral and Adherence Predictors. Heart (British Cardiac Society), 91, 10-14.
http://dx.doi.org/10.1136/hrt.2004.045559

[32]   Jack, K. McLean, S.M., Moffett, J.K. and Gardinerc, E. (2010) Barriers to Treatment Adherence in Physiotherapy Outpatient Clinics: A Systematic Review. Manual Therapy, 15, 220-228.
http://dx.doi.org/10.1016/j.math.2009.12.004

[33]   Adedoyin, R.A., Adeyanju, S.A., Balogun, M.O., Akintomide, A.O., Adebayo, R.A., Akinwusi, P.O., et al. (2010) Assessment of Exercise Capacity in African Patients with Chronic Heart Failure Using Six Minute-Walk. International Journal of General Medicine, 3, 109-113.
http://dx.doi.org/10.2147/IJGM.S5533

[34]   Mampuya, W.M. (2012) Cardiac Rehabilitation Past, Present and Future: An Overview. Cardiovascular Diagnosis and Therapy, 2, 38-49.