Reactivatie bij patienten met zowel COPD als hartfalen

Abstract

The effect of outpatient physical training programs on exercise capacity and quality of life, in patients with heart failure; a systemic review

Background: Heart failure is a chronic disease in which patients suffer from shortness of breath and fatigue. Exercise training is recommended for stable heart failure patients to improve their exercise capacity and quality of life. For patients it is easier to train nearby home. Aim: Systematically investigate the effects of near-home physical training programs on exercise capacity and quality of life. Methods: Eligible studies since 1998 were included through a systematic literature search. Randomized controlled trials in which the patients had heart failure with a left ventricular ejection fraction (LVEF) less than 40% were included. Methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) list. A meta-analysis was performed for the outcome measures exercise capacity (six minute walk test and maximal cycle ergometry) and quality of life (Minnesota Living with Heart Failure Questionnaire). Results: Eighteen articles were included. Methodological quality varied from 4 to 8 points on the PEDro list. The six minute walking test, VO₂max and quality of life improved significantly with 52 meters, 2 ml/kg/min and 8 points respectively. There were no adverse events mentioned related to the interventions. Conclusion: Outpatient training programs have a positive effect on exercise capacity and quality of life and are safe.

Effect, safety and feasibility of a reactivation program for patients with both COPD and heart failure, a pilot study

Background: Chronic heart failure (CHF) is an important co-morbidity in patients with chronic obstructive pulmonary disease (COPD) and vice versa. The beneficial effects of reactivation programs on exercise tolerance have already been demonstrated in patients with solely COPD or solely CHF. However, there is no evidence for treatment efficacy in patients with both diseases. Aim: To investigate whether a community based reactivation program for patients with a combination of COPD and CHF is safe, feasible, and improves exercise performance and quality of life. Methods: Patients with both COPD (GOLD II-III) and heart failure (NHYA class II-III) between 40 and 75 years were included. The reactivation program consisted of 10 weeks of exercise training in a local physiotherapy practice. Training included cycling, walking, lifting and strength training of the m. quadriceps. Two self- management sessions were given by a respiratory nurse and heart failure nurse. Outcome measures included exercise performance, measured with the six minute walking test and incremental shuttle walk test and health-related quality of life. Feasibility was assessed in patients with interviews and in physiotherapists by means of discussion meetings. Results: Six patients were included. The program was safe and feasible for patients and therapists and there were no adverse events related to the intervention. There was a non significant improvement in exercise performance and no improvement in quality of life. Conclusion: A reactivation program for patients with both COPD and heart failure seems safe and feasible. Further research must determine the effect of a reactivation program on exercise performance and quality of life.