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      Home-based versus centre-based cardiac rehabilitation

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          Abstract

          Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015.

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          Most cited references95

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          ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

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            Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.

            Findings from previous studies of the effects of exercise training on patient-reported health status have been inconsistent. To test the effects of exercise training on health status among patients with heart failure. Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure with left ventricular ejection fraction of 35% or less. Patients were randomized from April 2003 through February 2007. Usual care plus aerobic exercise training (n = 1172), consisting of 36 supervised sessions followed by home-based training, vs usual care alone (n = 1159). Randomization was stratified by heart failure etiology, which was a covariate in all models. Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary scale and key subscales at baseline, every 3 months for 12 months, and annually thereafter for up to 4 years. The KCCQ is scored from 0 to 100 with higher scores corresponding to better health status. Treatment group effects were estimated using linear mixed models according to the intention-to-treat principle. Median follow-up was 2.5 years. At 3 months, usual care plus exercise training led to greater improvement in the KCCQ overall summary score (mean, 5.21; 95% confidence interval, 4.42 to 6.00) compared with usual care alone (3.28; 95% confidence interval, 2.48 to 4.09). The additional 1.93-point increase (95% confidence interval, 0.84 to 3.01) in the exercise training group was statistically significant (P < .001). After 3 months, there were no further significant changes in KCCQ score for either group (P = .85 for the difference between slopes), resulting in a sustained, greater improvement overall for the exercise group (P < .001). Results were similar on the KCCQ subscales, and no subgroup interactions were detected. Exercise training conferred modest but statistically significant improvements in self-reported health status compared with usual care without training. Improvements occurred early and persisted over time. clinicaltrials.gov Identifier: NCT00047437.
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              Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure.

              The purpose of this study was to determine the effects of systemic exercise training on endothelium-mediated arteriolar vasodilation of the lower limb and its relation to exercise capacity in chronic heart failure (CHF). Endothelial dysfunction is a key feature of CHF, contributing to increased peripheral vasoconstriction and impaired exercise capacity. Local handgrip exercise has previously been shown to enhance endothelium-dependent vasodilation in conduit and resistance vessels in CHF. Twenty patients were prospectively randomized to a training group (n=10, left ventricular ejection fraction [LVEF] 24+/-4%) or a control group (n=10, LVEF 23+/-3%). At baseline and after 6 months, peak flow velocity was measured in the left femoral artery using a Doppler wire; vessel diameter was determined by quantitative angiography. Peripheral blood flow was calculated from average peak velocity (APV) and arterial cross-sectional area. After exercise training, nitroglycerin-induced endothelium-independent vasodilation remained unaltered (271% versus 281%, P=NS). Peripheral blood flow improved significantly in response to 90 microg/min acetylcholine by 203% (from 152+/-79 to 461+/-104 mL/min, P<0.05 versus control group) and the inhibiting effect of L-NMMA increased by 174% (from -46+/-25 to -126+/-19 mL/min, P<0.05 versus control group). Peak oxygen uptake increased by 26% (P<0.01 versus control group). The increase in peak oxygen uptake was correlated with the endothelium-dependent change in peripheral blood flow (r=0.64, P<0. 005). Regular physical exercise improves both basal endothelial nitric oxide (NO) formation and agonist-mediated endothelium-dependent vasodilation of the skeletal muscle vasculature in patients with CHF. The correction of endothelium dysfunction is associated with a significant increase in exercise capacity.
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                Author and article information

                Journal
                Cochrane Database of Systematic Reviews
                Wiley
                14651858
                June 30 2017
                Affiliations
                [1 ]University of Exeter Medical School; Institute of Health Research; Veysey Building, Salmon Pool Lane Exeter UK EX2 4SG
                [2 ]Peninsula Postgraduate Medical Education; Raleigh Building, 22A Davy Road, Plymouth Science Park Plymouth UK PL6 8BY
                [3 ]University of Exeter Medical School, University of Exeter; c/o Institute of Health Research; St Lukes Campus Heavitree Road Exeter Exeter UK EX1 2LU
                [4 ]University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals Trust; Department of Primary Care; Truro UK TR1 3HD
                [5 ]University of Exeter; University of Exeter Medical School; Veysey Building Salmon Pool Lane Exeter Devon UK EX2 4SG
                [6 ]University of Birmingham; Institute of Applied Health Research; Birmingham UK
                [7 ]University Hospital Ayr; Cardiac Rehabilitation; Ayr UK
                [8 ]Agency for Health Technology Assessment and Tariff System; I. Krasickiego St. 26 Warsaw Poland 02-611
                Article
                10.1002/14651858.CD007130.pub4
                6481471
                28665511
                43279adc-55d1-4b86-9c53-21c3391898f8
                © 2017
                History

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