Effects of an elastic band-based progressive resistance training (EB-PRT) on sarcopenia and clinical outcomes of patients with heart failure: A pilot mixed-method study

Background Sarcopenia is an important prognostic marker affecting 25% ambulatory HF patients, predicting poor activity tolerance, cardiac function and even mortality of HF patients. On the other hand, the pathophysiology of HF involving the metabolic, endocrine, vascular and inflammatory synergistic responses cause a pathological level of catabolism, which further aggravates the skeletal muscle loss and results in secondary sarcopenia.5 Resistance training is the guideline-based recommendation for sarcopenia. Yet, the exercise principles of "specificity," "overload," and "progression" have seldom integrated to stimulate muscle anabolism.9 Besides, the exercise format which can sustain the patient’s self-practice was least investigated. Purposes This pilot RCT investigated the effects of an elastic band-based progressive resistance training program (EB-PRT) on muscle mass, grip strength, physical function, symptoms and health-related quality of life (HRQL) of HF patients. Methods We randomized 58 HF patients[mean age=70.7 (8.9); NYHA classification: I/II 55.2%/44.8], who fulfilled the Asian Working Group of Sarcopenia (AWGS) 2019 criteria of sarcopenia, from the outpatient cardiac clinic to receive the 14-week EB-PRT program or usual care. The 12-week EB-PRT (Fig 2) was designed according to the principles of "specificity," "overload," and "progression". A trained RA with background in physical education delivered the program via hybrid in-person, tele and face-time visits. The outcomes included the ASMI by the bioimpedance analysis (BIA) using Inbody machine; hand grip strength; Short Physical Performance Battery, Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF); and e Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline (T0), posttest-14th week (T1), 26th week (T2). Results After adjusting the socio-demographic characteristics, two-way ANOVA analysis showed that the EB-PRT group reported significantly greater improvement in HF symptoms by MSAS-HF [β(95%CI)=-19.55 (-32.08 to -7.03), p=0.002 at T1; -15.10 (-28.54 to -1.66), p=0.028 at T2] and HRQL [MLHFQ [β(95%CI) =--6.17 (-11.78 to -0.55), p=0.031 at T1 only]. This pilot study also identified a non-significant trend of greater improvement in muscle mass and physical performance which reaching a medium effect size [BIA analysis [Adjusted mean difference (95% CI): ASMI=0.17(-0.05-0.38), Cohen’s d=0.403; right arm muscle=0.09(-0.02-0.20), Cohen’s d=0.449; left leg muscle=0.26(-0.04-0.56), Cohen’s d=0.473SBBP=0.16(-0.18-1.54), Cohen’s d=0.421]. Conclusions This pilot study highlights the high feasibility of using elastic band to engage the HF patients in RT. Based on the promising preliminary effects of EB-PRT on the criteria markers of sarcopenia, HF symptom control and HRQL, a full-scale trail to investigate the effects and mechanism is warranted.