New model of home telemonitored nordic walking training in heart failure patients also those with cardiovascular implantable electronic devices:safety,effectiveness, adherence-randomized control study

Abstract

The benefits of cardiac rehabilitation (CR) in heart failure (HF) patients (pts) are well established. We are looking for an effective and safe type of training. Little is known about nordic walking training (NW) in HF pts especially in those with cardiovascular implantable electronic devices (CIEDs). Purpose: To assess safety effectiveness and adherence to home telemonitored NW in HF pts, including those with CIEDs (i.e.cardiac resynchronization therapy implantable cardioverter-defibrillator). Methods: The study group comprised 111 HF pts (58+/-11yrs;NYHA II-II;EF<40%). Pts were randomized to either 8 weeks of NW, five times a week, at 40-70% of maximal estimated heart rate-training group, n=75 (TG), or to a control group, n= 36 (CG). In TG 53 pts had CIEDs, in CG 17 pts had CIEDs. In order to perform CR, a special device was created which enabled pts to: (1) do NW according to a preprogrammed plan, (2) send ECG via mobile phone to the monitoring center. The effectiveness of CR was assessed by changes - delta (A) in duration (t) of the workload, peak oxygen consumption (pVO2) in cardiopulmonary exercise test, 6-minute walking test distance (6-MWT) and NT-pro-BNP level as a result of comparing t(s), pVO2 (ml/kg/min), 6-MWT (m) and NT-proBNP (pg/mL) from the beginning and the end of the program. In all pts with CIEDs, the devices were controlled after 8 weeks of follow-up. Results: Safety of CRIn neither group were there deaths, necessity for hospitalization because of HF decompensation. We did not observe any intervention from CIEDs during the supervised telemonitored NW. There were one intervention during unsupervised activity in one patient in TG and two interventions in CG. After 8 weeks of NW, CIEDs were controlled in all pts and found to function correctly. Effectiveness of CR: Within-group analysis: t, pVO2,6-MWT increased significantly in TG:t 458+/-88 vs 566+/-97 (p=0.0001), pVO2 16.0+/-4.0 vs 18.1+/-4.1 (p=0.0001), 6-MWT 424+/-18 vs 479+/-46 (p=0.0001). NTpro-BNP level tended to be lower only in TG pts 1225+/-1448 vs 1037+/-1239 (p=0.2145). In the untrained CG, the unfavourable results were observed: 540+/-126 vs 540+/-136 (p=0.4731) pVO2 17.4+/-3.3 vs 17.1+/-3.3 (p=0.52), 6-MWT 437+/-76 vs 464+/-91 (p=0.0892) NT-pro-BNP 862+/-699 vs 864+/-717 (p=0.7824). Between-group analysis. The differences between TG and CG were statistically significant: in DELTAt (p=0.0001) ApVO2 (p=0.0001); A6-MWT (p=0.0066) and ANT-pro-BNP (p=0.03). Adherence to CR. All pts in TG completed the 8-week CR. Conclusion: In HF pts, including those with CIEDs, home telemonitored CR based on NW is safe and effective. The adherence to home telemonitored CR based on NW seems promising.