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Purpose: There is a growing evidence based for the benefits of exercise as part of cardiac rehabilitation (CR), yet uptake in heart failure (HF) patients is low, with as few as of 1 % of patients referred for CR. Many factors contribute to this situation; however the mode of exercise, which is often carried out in a standing position, is likely to be a significant deterrent in moderate to severe HF patients who are breathless at rest. Chair-based exercise (CBE) could be an alternative method for enabling moderate to severe HF patients to participate in exercise training, but such exercise is less well researched in the literature. Our study was therefore aimed at developing appropriate exercises and an exercise prescription protocol, and evaluating the utility for patients during CBE programme. in addition, the thesis also aimed to evaluate the reliability of assessment and outcomes during CBE and to establish the extent of any relationship between baseline characteristics and those derived from exercise testing and clinical measures. Methods: Two studies have been conducted. The fIrSt study was a feasibility study, involving twenty cardiac patients and the second study was the main CBE study, involving thirty HF patients. Conventional cardiac patients were recru ited from a coronary support group and HF patients were recruited from an NHS HF service and HF patient support group. The main CBE study data was used for the development of e BE, reliability, assessment and exercise prescription. Both studies involved sub-maximal and steady state testing for ann and leg. The feasibi lity study, in contrast to the eBE study, involved testing while sitting and standing, while the eBE study included additional testing such as a BNP test, 6MWT, and need to answer a Total Activity Measure 2 (TAM 2) questionnaire. The CBE study participants were also asked to wear an accelerometer for a week to determine the extent of the validity ofthe eBE in a new physical activity questionnaire. Results: The findings showed that the eBE programme gave a good range of intensity for HF patients. The study found that the level of intensity was as suggested by the guidelines. The measurement exercise variables during eBE testing and BNP testing was highly reliable, using intra-class correlation coefficient (ICC), limits of agreement (LOA) and standard error of measurement (SEM). The physical questionnaire showed less reliable and less valid results for the HF patient population. In add ition to these findings, 6MWT turned out to be most powerful tool for predicting eBE levels, while NYHA and BNP tests could be used as alternative methods if the patients are not able to perform fitness testing. Conclusion: The eBE programme is safe and offers a range of intensity levels and is suitable to the abi lity range of most patients with HF. |
