Stimulation in home based cardiac rehabilitation protocol, the effect on aerobic capacity and quality of life

Abstract Introduction heart failure is a serious condition with high Morbi-mortality and can seriously impact quality of life. Cardiac rehabilitation, even strongly recommended, still with little uptake worldwide. Since resources are limited, ambulatory cardiac rehabilitation programs are promising. Aims to measure the impact of patients ‘stimulation with repeated phone calls, to reinforce the benefit of daily walking exercise, on aerobic capacity and quality of life of heart failure’s patients Methods we conducted a single-center, open-label, randomized, controlled trial. over a period of six month (01/10/2023 au 30/06/2024), we prospectively included patients with chronic heart failure. They benefit from a repeated adjusted education with a mother tongue leaflet about heart failure with emphasis on the benefit of the regular home exercises (walking 30 mn/day), Patients were randomized whether to receive or not monthly phone calls to reinforce the benefit of daily walking. All patients underwent 6 minutes-Walk Test (6MWT) and answered the quality of Life (QoL) enquiry of Minesota at two times: before and after the protocol of home rehabilitation (regular walking of 30 mn per day). Results We enrolled 78 patients, 38 in the stimulated group and 40 in the control group. Both were similar in clinical and socio-demographic baseline characteristics: mean age was 59.9+/-9.3 (p=.057) years old. Males in78 % of cases, low instructive level in 44.9% (p=0.86). Social insurance in 64.1% (p=0.49). High burden of comorbidities: Hypertension in 51.4%; (p=0.82) Diabetes in 51.3% (p=0 .26), obesity in 16.7% (p=0.76), Obstructive sleep apnoea in 39.5% (p=0.16). Ischemic cardiomyopathy was the most prevalent in 77.1% (p=0.7); mean ejection fraction was37.5 % +/-10.9 ; 15 ;49; p=0.49. Sedentarity noted in 62.8% (p=0.9). Patients in both groups have an intermediate quality of Life deterioration with the Minnesota mean score (30.95 +/-16.4; p=0.62). the mean distance in the 6 MWT was 298.2 +/-135 m (p=0.14) . After 6 months, adherence to physical activity reached 65.4 % (p=0.2), to medical treatment 92.3% (p=0.1). 6MWT mean distance’ enhancement was highly significant in all patients (298.2 +/-135.6 then 337.5 (135.6); p0.001) and in the stimulated group (273.21+/-142.69 then322.47+/-136.83; p0.001) with a mean gain of 33.84 +/-91.97 (p0.001)m. However, mean 6MWT increased in the control group with no statistical significance (315.18 +/-123.75 then 352.14 +/-119.2 m;p=0.081). The Minnesota QoL scores has significantly decreased in both groups (30.95+/-16.4 then 26.85 ± 16.46;p 0.0001) Conclusion The significant enhancement of aerobic capacity and quality of life underline the benefit of home-based rehabilitation, drawn essentially by the patient’s centered care protocol allowed by this study. better structured protocols are worth to be developed to enhance the uptake as well the long term adherence to physical activity in patients with heart failure.