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

2. Impact of rehabilitation in stable HF patients

3. Impact of rehabilitation in stable HF patients

4. Current exercise recommendations in HF

5. 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.

6. 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

7. Exercise/rehabilitation is key to recovery

8. During hospitalisation

9. Impact of rehabilitation in hospitalised HF patients

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

11. 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.

12. Impact of rehabilitation in hospitalised HF patients

13. Impact of rehabilitation in hospitalised HF patients

14. Immediately after hospitalisation

15. 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.

16. Impact of rehabilitation in hospitalised HF patients

17. 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?

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

19. Current exercise recommendations in HF

20. Current exercise recommendations in HF

21. 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.

22. What after hospitalisation?

23. 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