The effect of home-based exercise training on functional capacity and quality of life in patients with heart failure

With the improvement of the quality of care for patients with heart failure, the number of these patients in the world is increasing. The quality of life of patients with heart failure is low and inadequate due to physical limitations, reduced functional capacity and frequent hospitalizations.(1, 2) Cardiac rehabilitation (CR) is a well - recognized part of the treatment for heart failure that helps to control the symptoms and improve the quality of life of patients.  In some studies demonstrate that the exercise therapy program at the hospital or at home with tele-monitoring is a safe treatment option(3) but many patients are not able to participate in CR sessions in heart centers. On the other hand, home - based CR with tele-monitoring has not become available in our country. Cardiac rehabilitation at home was first reported in 1980(4), and its use increased because it was more acceptable and convenient for some patients to perform. Some studies have shown that home- based exercise therapy can probably be as beneficial as hospital- based exercise therapy in patients with heart failure(5). Thus, the aim of this study was to investigate the effect of home - base exercise therapy on functional capacity and quality of life of patient with heart failure in Shahid Rajaie Cardiovascular, Medical and Research Center. 

In this semi - experimental study, 69 patients with New York Heart Association class II and III heart failure with ejection fraction less than 40%, were divided into two groups of control (n = 34) and intervention (n = 35) at Shahid Rajaie center in 1397. Patients in the intervention group were asked to walk with moderate - intensity on a flat surface daily for 8 weeks so that the walking duration lasted more than 150 minutes per week. Patients who had ICDs were asked to have a pulse rate 10 beats less than the number set by the pacemaker during walking. The control group was not trained to walk and only received routine medication. The Heart Failure Quality of Life (HF - QOL) questionnaire(6) and 6‐minute walking test were performed for each patient at entry and after 8weeks. After collecting data, SPSS software was used to analyze the data. Significance level was considered P = 0.05. 

There was no significant difference between the two groups in terms of baseline demographic and clinical characteristics of patients except for the incidence of diabetes. Comparison of changes in blood pressure and heart rate and oxygen saturation in the intervention and control groups did not show a significant difference. Only diastolic blood pressure was statistically significant difference in the second visit after the 6-minute walk test between the control and intervention groups ( P = 0.03) which is not clinically significant. . At the beginning of the study, the comparison of quality of life (P = 0.07) and distance traveled in the 6-minute test (P = 0.16) between the control and intervention groups was not statistically significant.   TABLE 1:Comparison of and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (2 O2 SAT) in the intervention and control groups with Mann-Whitney test   P value Control group   Intervention group Variable Median Mean rank Median Mean rank 0.65 122 41.6 117 39.3 SBP before 6MWT in first visit   0.91 77 40.2 78.5 40.7 DBP before 6MWT in first visit 0.59 75 41.9 75 39.1 HR before 6MWT in first visit   0.46 96 42.3   96 38.6 %O2 SAT before 6MWT in first visit 0.36 123 42.8 123 38.1 SBP after 6MWT in first visit   0.79 79.5 41.1 78.5 39.8 DBP after 6MWT in first visit 0.08 88 45 83 35.9 HR after 6MWT in first visit 0.80 96 41.1   96 39.8 %O2 SAT after 6MWT in first visit 0.19 118 38.2 111 31.8 SBP before 6MWT in second visit     0.12 77 38.8 72 31.3 DBP before 6MWT in second visit  0.95 77 34.3 78 34.6 HR before 6MWT in second visit   0.85 95 34   98 34.9 %O2 SAT before 6MWT in second visit 0.05 123 39.6 113 30.5 SBP after 6MWT in second visit   0.03* 79 40.2 72 29.9 DBP after 6MWT in second visit 0.35 90 36.7 88 32.3 HR after 6MWT in second visit   0.46 96 32.7   97 36.2 O2 SAT after 6MWT in second visit %      TABLE 2 Comparison of functional capacity and quality of life in control and intervention groups with paired sample t test   P value QOL after 8 weeks QOL at entery P value distance travelled in the 6-MWT after 8 weeks distance travelled in the 6-MWT at entery group 0.09 51±7 49±8 0.13 349±79 367 (320-414) control <0.001 58±7 52±8 >0.001 437±57 380 (355-419) intervention     Quality of life and functional capacity only in the intervention group in the second visit compared to the first has a statistically significant difference. In comparing quality of life and functional capacity at the end of study showed a significant difference between the intervention and control groups in the scores of quality of life and distance traveled in the 6-minute test of the intervention group compared to the control group (P <0.001 and P <0.001, respectively).  

For convenience, the study results are presented in two parts: findings related to quality of life and findings related to the results of the 6-minute walk test. Regarding the effect of home exercise therapy training on quality of life in patients with heart failure, our study showed that home exercise therapy significantly increased the quality of life score in the intervention group and the difference was significant compared to the control group. The most clinically important finding regarding the effect of exercise therapy training is the functional capacity of patients with heart failure. Our study showed that the travelled distance in the six-minute walk test and as a result the functional capacity of the intervention group has improved significantly. The results of the present study confirm that home exercise therapy is a safe, low-cost, useful and appropriate intervention to improve the quality of life and functional capacity of patients with heart failure. Due to the impossibility of attending and performing cardiac rehabilitation in the hospital under the supervision and with tele-monitoring for all patients with heart failure and the possibility of decreased functional capacity and quality of life in them, home education and exercise therapy programs are recommended for these patients.