BACKGROUND: Physical activity is pivotal in managing heart failure with reduced ejection fraction, and walking integrated into daily life is an especially suitable form of physical activity. This study aimed to determine whether a 6-month lifestyle walking intervention combining self-monitoring and regular telephone counseling improves functional capacity assessed by the 6-minute walk test (6MWT) in patients with stable heart failure with reduced ejection fraction compared with usual care. METHODS: The WATCHFUL trial (Pedometer-Based Walking Intervention in Patients With Chronic Heart Failure With Reduced Ejection Fraction) was a 6-month multicenter, parallel-group randomized controlled trial recruiting patients with heart failure with reduced ejection fraction from 6 cardiovascular centers in the Czech Republic. Eligible participants were ≥18 years of age, had left ventricular ejection fraction <40%, and had New York Heart Association class II or III symptoms on guidelines-recommended medication. Individuals exceeding 450 meters on the baseline 6MWT were excluded. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly telephone counseling from research nurses who encouraged them to use behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The patients in the control group continued usual care. The primary outcome was the between-group difference in the distance walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate to vigorous physical activity as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity C-reactive protein biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention to treat. RESULTS: Of 218 screened patients, 202 were randomized (mean age, 65 years; 22.8% female; 90.6% New York Heart Association class II; median left ventricular ejection fraction, 32.5%; median 6MWT, 385 meters; average 5071 steps/day; average 10.9 minutes of moderate to vigorous physical activity per day). At 6 months, no between-group differences were detected in the 6MWT (mean 7.4 meters [95% CI, -8.0 to 22.7]; P=0.345, n=186). The intervention group increased their average daily step count by 1420 (95% CI, 749 to 2091) and daily minutes of moderate to vigorous physical activity by 8.2 (95% CI, 3.0 to 13.3) over the control group. No between-group differences were detected for any other secondary outcomes. CONCLUSIONS: Whereas the lifestyle intervention in patients with heart failure with reduced ejection fraction improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the lack of association between increased physical activity and functional outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03041610.
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- chůze MeSH
- dysfunkce levé srdeční komory * MeSH
- funkce levé komory srdeční MeSH
- kvalita života MeSH
- lidé MeSH
- senioři MeSH
- srdeční selhání * terapie farmakoterapie MeSH
- tepový objem MeSH
- životní styl MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
AIMS: A reduction of habitual physical activity due to prolonged COVID-19 quarantine can have serious consequences for patients with cardiovascular diseases, such as heart failure. This study aimed to explore the effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients. METHODS AND RESULTS: We analysed the daily number of steps in 26 heart failure patients during a 6-week period that included 3 weeks immediately preceding the onset of the quarantine and the first 3 weeks of the quarantine. The daily number of steps was assessed using a wrist-worn accelerometer worn by the patients as part of an ongoing randomized controlled trial. Multilevel modelling was used to explore the effect of the quarantine on the daily step count adjusted for weather conditions. As compared with the 3 weeks before the onset of the quarantine, the step count was significantly lower during each of the first 3 weeks of the quarantine (P < 0.05). When the daily step count was averaged across the 3 weeks before and during the quarantine, the decrease amounted to 1134 (SE 189) steps per day (P < 0.001), which translated to a 16.2% decrease. CONCLUSIONS: The introduction of the nationwide quarantine due to COVID-19 had a detrimental effect on the level of habitual physical activity in heart failure patients, leading to an abrupt decrease of daily step count that lasted for at least the 3-week study period. Staying active and maintaining sufficient levels of physical activity during the COVID-19 pandemic are essential despite the unfavourable circumstances of quarantine.
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- akcelerometrie metody MeSH
- časové faktory MeSH
- COVID-19 MeSH
- cvičení fyziologie MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- karanténa * MeSH
- kohortové studie MeSH
- koronavirové infekce epidemiologie prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- pandemie prevence a kontrola statistika a číselné údaje MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- senioři MeSH
- srdeční selhání patofyziologie rehabilitace MeSH
- tělesná výkonnost fyziologie MeSH
- test chůzí statistika a číselné údaje MeSH
- virová pneumonie epidemiologie prevence a kontrola MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
Mimonemocniční zástava oběhu je jedním ze zásadních problémů současné medicíny. S přežitou srdeční zástavou stoupá u postiženého riziko vzniku úzkostných a depresivních stavů jak během hospitalizace, tak i po propuštění do domácích podmínek. Psychologická péče není pacientům po přežité oběhové zástavě rutinně poskytována. Pacienti zařazení do tohoto pilotního výzkumu byli identifikováni v registru nemocných po oběhové zástavě. K realizaci bylo využito standardizovaného Montrealského kognitivního testu (MoCA) a nestandardizovaného dotazníkového šetření. Celkově bylo do studie zahrnuto 28 pacientů, kteří přežili oběhovou zástavu. Průměrný věk respondentů činil 54 let. V souboru bylo 20 mužů a 8 žen. Bylo zjištěno, že 18 (64,3 %) dotazovaných trpí od doby, kdy prodělali kritický stav v podobě oběhové zástavy, negativně vnímanými a obtěžujícími symptomy, především strachem z další srdeční příhody, poruchami spánku, přetrvávající únavou atd. Jen 12 z 28 pacientů dosáhlo skóre v testu MoCA > 26 bodů, což je pokládáno za normální výsledek. Ačkoli byl náš výzkumný vzorek pacientů relativně malý a jistě je potřeba rozsáhlejších studií věnujících se dané problematice, došli jsme k alarmujícímu zjištění vysokého výskytu úzkostných a depresivních symptomů u nemocných po oběhové zástavě, stejně tak kognitivních deficitů u převážné většiny pacientů. V situaci, kdy těmto postiženým není poskytována rutinní psychologická péče, se jeví časný psychologický zásah jako vysoce účelný, s potenciálem příznivého ovlivnění návratu pacientů do běžného života.
Out-of-hospital circulatory arrest is a major challenge of current medicine. Circulatory arrest survivors bear increased risk of developing anxiety disorders and depressions both during hospitalization and after discharging to the home care. Circulatory arrest survivors are not provided routinely with psychological care. Patients included in our pilot research were identified in the register of surviving circulatory arrest. The survey was carried out using a non-standardized questionnaire. A total of 28 patients surviving the circulatory arrest were included in the pilot research. The average age of respondents was 54 years. There were 20 men and 8 women. The project showed that 18 (64.3 %) people, since they went through the critical status, have suffered from negative and bothering symptoms, such as: fear of a repeated cardiac arrest, sleeping disorders, persistent tiredness etc. Despite the fact that our group of patients was relatively small and larger studies addressing the issue are needed, our finding is alarming – the patients after the cardiac arrest suffer from many anxious and depressive symptoms as well as from cognitive deficit. In the situation when the common psychological intervention by a specialist is not provided, it seems that an early psychological invention is highly desirable and may have a beneficial effect on return of the patients to their everyday life.
- Klíčová slova
- preventivní programy, výuka, pasivní kouření, karcinom plic, kuřák, nekuřák, závislost, zdravotnická škola,
- MeSH
- studenti MeSH
- tabák MeSH
- Publikační typ
- abstrakt z konference MeSH
