Evaluation of the effectiveness of a muscle strengthening protocol as a complement to rehabilitation training in patients with heart failure

Abstract Background Heart failure is a symndrome characterized by reduced cardiac output and/or increased ventricular filling pressures, resulting in variable funcional impairment, often expressed as a dyspnea and reduced exercise tolerance. Tradicional rehabilitation is based on farmacology therapy and aerobic training aimed at improving caridiovascular performance. However, recent evidence shows that peripheral alterations, particularly in skeletal muscle, are crucial factors in exercise intolerance, expecially in patients in whom muscledys function and systemic inflammation prevail over the central cardiac component. Clinical studies and meta-analyses in recent years have shown that combined training (aerobic + resistance) brings significant benefits in terms of strength and quality of life compared to aerobic training alone. Objective To evaluate the effectiveness of a muscle strengthening program aimed at developing strength, as a complement to tradicional rehabilitation training. In particular, we investigated whether the introduction of a multi-joint strength exercise, such as the progressive load box squat, can improve physical performance in patients with heart failure, compared to a control group undergoing conventional training alone. Methods 22 patients (of both sexes) diagnosed with chronic heart failure, clinically stable, indipendent in daily activities, and already enrolled in a rehabilitation program were recruited. All participants were assesed using the Short Physical Performance Battery (SPPB), 6 Minute Walking Test (6MWT), and Handgrip Strength test at admission and discharge. The experimental group followed a rehabilitation protocol including aerobic exercises, calisthenics, and a muscle strengthening program with box squats performed daily. The intensit was modulated using a weighted vest with load progression from 0% to 10% of body weight (BW) over 6 consecutive days. Each session consisted of 5 sets of 5 repetitions, with a maximum recovery of 4 minutes between sets, from Monday to Friday; at the weekend, the exercise was performed independently with free weights. The differences between the grups were analyzed using appropriate static tests (ANOVA for repeated measures), considering results with p 0,05 to be significant. Results The rehabilitation program based on box squats with load progression led to a significant improvement mainly in the strength of the SPPB and 6MWT scores. A positive trend was also observed in exercise tolerance and the patients’ perception of well-being. Conclusions The integration of multi-joint strength exercises, such as box squats, into the rehabilitation program of patients with heart failure has been shown to be effective in improving physical performance. However, further studies on larger samples and with longer follow-ups are needed to confirm and consolidate these preliminary results.