Dominique Hansen, PhD, FESC Cardiac rehabilitation: crucial to recovery after heart failure decompensation? Dominique Hansen, PhD, FESC

Impact of rehabilitation in stable HF patients

Impact of rehabilitation in stable HF patients

Current exercise recommendations in HF

Current exercise recommendations in HF 60% of the maximal inspiratory mouth pressure (PImax). Training duration should be 20–30 min/day with a frequency of 3–5 sessions.

Impact of prolonged bed rest in decompensated HF Muscle weakness Muscle wasting Oxidative stress Atelactasis Inflammation Insulin resistance Orthostatic hypotension Thrombo-embolic disease Endothelial dysfunction

Exercise/rehabilitation is key to recovery

During hospitalisation

Impact of rehabilitation in hospitalised HF patients

Impact of rehabilitation in hospitalised HF patients ETCL, endurance test with constant workload NIV, non-invasive ventilation

Impact of rehabilitation in hospitalised HF patients Intervention group: Functional electrical stimulation for the lower limbs (10 Hz frequency, 150 ms pulse width, 70 mA intensity, 60 min/day) for 8–10 consecutive days. Control group underwent electrical stimulation at an intensity of<20 mA.

Impact of rehabilitation in hospitalised HF patients

Impact of rehabilitation in hospitalised HF patients

Immediately after hospitalisation

Impact of rehabilitation in hospitalised HF patients The goal of the intervention program: to improve performance in 4 domains: balance, strength, mobility, and endurance. Method: Majority of the intervention: 60-min sessions 3 times per week, 12 weeks in the outpatient setting beginning immediately after discharge. When feasible, daily 30-min sessions during the hospitalization were also conducted. Target intensity was RPE 12 up to 13 for endurance training and 15 to 16 for strength training. To guide exercise prescription, participants in the intervention arm were stratified into 1 of 4 levels for each functional domain (balance, mobility, strength, endurance). Exercises appropriate to the participant’s functional level in each domain were then selected from the intervention protocols.

Impact of rehabilitation in hospitalised HF patients

Impact of rehabilitation in hospitalised HF patients Interim conclusion Rehabilitation seems to lead to significant and clinically relevant improvements in functional capacity This translates into a lower risk for re-hospitalisation during follow-up But studies are limited and often small samples were studied And what about muscle mass, insulin sensitivity, inflammation, etc?

But how should rehabilitation be initiated and executed in hospitalized HF patients?

Current exercise recommendations in HF

Current exercise recommendations in HF

Current exercise recommendations in HF 30% of the maximal inspiratory mouth pressure (PImax). Training duration should be 20–30 min/day with a frequency of 3–5 sessions.

What after hospitalisation?

Conclusions Exercise prescription in decompensated HF patients can be challenging Evidence indicates that rehabilitation during hospitalisation is clinically relevant Clinical guidelines are published how to start up rehabilitation Referral to ambulatory rehabilitation must be stimulated