| 1. |
- Lans, Charlotta, 1965-
(författare)
-
Exercise training and testing in patients with heart failure
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with heart failure (HF) suffer from symptoms such as dyspnea, fatigue and reduced quality of life, which affect their physical function and often lead to immobilization and poor survival prognosis. Exercise training in cardiac rehabilitation should be offered to every patient with HF and can be performed both in a hospital-setting and with a home training programme. Exercise, in patients with HF, improves physical function and functional capacity as well as health-related quality of life (HRQoL) and reduces the need for hospital care. There are several barriers against participating in exercise based cardiac rehabilitation despite information about its benefits. The patient may anticipate not being able to exercise, that the exercise would be too hard, lives far away or has not been referred.Aim: The aim of this thesis was to evaluate the effects of exercise in heart failure patients, of a one-year training programme, with hospital-based training followed by a home-based setting or only home-based, with special emphasis on peripheral muscle training (PMT). Furthermore, to study frequently used methods for evaluation of the effects, i.e the 6-minute walk test and instruments for estimating health-related quality of life.Methods and findings: In study I, PMT was evaluated and the PMT programme in a hospital-setting (with equipment) and subsequent homebased training (with elastic bands) was compared with solely home-based training, over 1 year. At follow-up every third month, duplicated six minute walk test (6MWT) and two HRQoL questionnaires were used. The walking distance increased significantly after three months in both groups and was maintained thereafter. Also HRQoL increased but at different time points. In study II, PMT was compared with interval training on an ergometer bike/free walking. Both groups started under supervision of a physiotherapist in a hospital-setting, for three months and thereafter at home for nine months. The same measurements were used as in study I. Neither walking distance nor HRQoL changed over the study period. However, this may be regarded as a positive effect in the light of the known progressive nature of heart failure. In study III, the 6MWTs from study I and II were used to evaluate the necessity of performing duplicated 6MWTs in follow-ups clinically and for research purposes. We found that it is sufficient to perform one 6MWT. In study IV, both 6MWT and HRQoL forms from study I and II were used to investigate the relationship between walking distance and perceived HRQoL in HF patients. Patients with shorter walking distance, than the group median, experienced poorer general HRQoL but not HRQoL related to HF, than the higher performing half of the study group. There were no longitudinal trends in these relationships.Conclusion: PMT can be used as an exercise modality in patients with HF, both in hospital and at home, and may be evaluated with a single 6MWT. Shorter walking distance was related to a lower general HRQoL as judged by the patients but there was no significant relation between short walking distance and the HF-related HRQoL. Individualizing the training programme and methods, and offering the choice of exercise modality and the possibility of exercising at home, might be a way to increase adherence in cardiac rehabilitation.
|
|
| 2. |
- Wisén, Anita
(författare)
-
Assessment of Aerobic Capacity A Novel Rating Scale and Further Development of an Exercise Test including Analysis of Gas Exchange
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Different methods are proposed to assess the aerobic capacity. A novel scale, rating of perceived capacity (RPC) based on metabolic equivalents (METs) from 1 to 20, is presented. Selected MET values are linked to physical activities. Comparison of the rating with an exercise test in a group of women revealed that a correction based on age more accurately predicted the maximal exercise capacity. An incremental exercise test, including a constant work rate for four minutes, was introduced and combined with breath-by-breath measurements of gas exchange. Data collected every ten seconds were digitally filtered to determine selected variables. Fits of polynomials were utilised to determine the increasing contribution of the anaerobic metabolism, reflected by V'CO2, at three different thresholds. Equations were utilised to assess the time constant of V'O2 (Tau V'O2) (reflecting the time required to reach steady state) and the change in V'O2 corresponding to a specific change in work rate (delta V'O2/delta W). The repeatability of measures of the aerobic capacity (V'O2max, the three thresholds, V' O2 and delta V' O2/delta W) and of variables at rest, at sub-maximal and maximal levels was investigated. Considerable variations were found, which could mainly be explained by biological variation. Reference values for aerobic capacity were generated based on values from 25 healthy women (22–44 years) at low or moderate activity levels, and 41 healthy men (18–48 years) at moderate capacity. The results show that several variables and parameters can be determined in a single exercise test, which together describe the aerobic profile in a comprehensive manner.
|
|
