Percorrer por autor "Rebelo, Carina"
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- Early reabilitation in cardiology heart failure (ERICHF) program: multicenter randomized controlled trialPublication . Delgado, Bruno; Lopes, Ivo; Rebelo, Carina; Almeida, Cecília; Gomes, Bárbara; Novo, AndréIntroduction Decompensated Heart Failure (HF) patients are often characterized by functional dependence and impairment of performance in activities of daily living. This patients can benefit with a structured intervention aerobic exercise training (AET), to optimize their functional capacity, increase of exercise tolerance and promote a better lifestyle. Although the benefits, AET is not yet validated for inpatients. ERICHF (early rehabilitation in cardiology – Heart Failure) is an AET program designed to HF inpatients Purpose To evaluate the feasibility, safety, impact on functional capacity and reproducibility of ERICHF program Methods Ongoing multicenter randomized singleblind controlled trial developed in 8 cardiology wards. Data include cardiovascular history, HF history and two functional tools: London Chest of Daily Living Activities (LCADL) and Barthel Index (BI). Training Group (TG) patients perform the ERICHF program twice a day for 5 days a week. ERICHF program is a supervised AET program, with increasing levels of intensity, divided into 5 stages (respiratory training, cycloergometer training, gait training and climbing stairs). Vital signs and Borg Modified Percieved Exertion (BMPE) are evaluated before and immediately after the exercise. Control Group (CG) patients perform physical activity in accordance with the guidelines, always supervised too. At discharge, all patients are evaluated with LCADL, BI and a 6minute walking test (6MWT). The study was published in clinicaltrials.gov, Identifier: NCT03838003. Results Until now, 174 patients are randomized, 95 in TG and 79 in CG with an average of age of 71 (±11) years old, 96 are male, 76% are in NYHA class III, 28 have diabetes and 54 have resynchronization therapy. At admission, both groups have the same level of functional dependence according to LCADL and BI scores. TG patients performed a total of 1223 session of exercise with an average of 14 sessions each, for 14 (±12) days of hospitalization. About 32% of patients reached the final stage of the program – climbing stairs. At discharge, TG patients presented lower LCADL score, higher BI score and a 47 meters difference on the 6MWT (p=0,003) which represents a better functional capacity. Adverse events registered are: BMPE superior to 7 in 65 sessions of exercise, new onset of atrial fibrillation in 14 sessions, transitory precordial pain in 4 sessions and fall of systolic blood pressure after exercise in 210 sessions Conclusions The ERICHF program demonstrated, until now, to promote functional capacity. Regarding safety, we can infer that the few adverse events registered aren´t major, and does not represent that exercise can be deleterious for decompensated HF patients, however more research should be done. We can also infer that probably AET is safe and viable, for HF patients and must be encouraged. Reproducibility was validated too. No other study of our knowledge has demonstrated this findings.
- Early Reabilitation in Cardiology Heart Failure (ERICHF) program: multicenter randomized controlled trialPublication . Delgado, Bruno; Lopes, Ivo; Rebelo, Carina; Almeida, Cecília; Gomes, Bárbara; Novo, AndréIntroduction Decompensated Heart Failure (HF) patients are often characterized by functional dependence and impairment of performance in activities of daily living. This patients can benefit with a structured intervention aerobic exercise training (AET), to optimize their functional capacity, increase of exercise tolerance and promote a better lifestyle. Although the benefits, AET is not yet validated for inpatients. ERICHF (early rehabilitation in cardiology – Heart Failure) is an AET program designed to HF inpatients Purpose To evaluate the feasibility, safety, impact on functional capacity and reproducibility of ERICHF program Methods Ongoing multicenter randomized singleblind controlled trial developed in 8 cardiology wards. Data include cardiovascular history, HF history and two functional tools: London Chest of Daily Living Activities (LCADL) and Barthel Index (BI). Training Group (TG) patients perform the ERICHF program twice a day for 5 days a week. ERICHF program is a supervised AET program, with increasing levels of intensity, divided into 5 stages (respiratory training, cycloergometer training, gait training and climbing stairs). Vital signs and Borg Modified Percieved Exertion (BMPE) are evaluated before and immediately after the exercise. Control Group (CG) patients perform physical activity in accordance with the guidelines, always supervised too. At discharge, all patients are evaluated with LCADL, BI and a 6minute walking test (6MWT). The study was published in clinicaltrials.gov, Identifier: NCT03838003. Results Until now, 174 patients are randomized, 95 in TG and 79 in CG with an average of age of 71 (±11) years old, 96 are male, 76% are in NYHA class III, 28 have diabetes and 54 have resynchronization therapy. At admission, both groups have the same level of functional dependence according to LCADL and BI scores. TG patients performed a total of 1223 session of exercise with an average of 14 sessions each, for 14 (±12) days of hospitalization. About 32% of patients reached the final stage of the program – climbing stairs. At discharge, TG patients presented lower LCADL score, higher BI score and a 47 meters difference on the 6MWT (p=0,003) which represents a better functional capacity. Adverse events registered are: BMPE superior to 7 in 65 sessions of exercise, new onset of atrial fibrillation in 14 sessions, transitory precordial pain in 4 sessions and fall of systolic blood pressure after exercise in 210 sessions Conclusions The ERICHF program demonstrated, until now, to promote functional capacity. Regarding safety, we can infer that the few adverse events registered aren´t major, and does not represent that exercise can be deleterious for decompensated HF patients, however more research should be done. We can also infer that probably AET is safe and viable, for HF patients and must be encouraged. Reproducibility was validated too. No other study of our knowledge has demonstrated this findings.
- ERIC-HF program (early rehabilitation in cardiology - heart failure) - pilot studyPublication . Delgado, Bruno; Lopes, Ivo; Gomes, Bárbara; Rebelo, Carina; Novo, AndréDecompensated Heart Failure (HF) patients are often characterized by functional dyspnea, fatigue, edema, functional dependence and impairment of performance in activities of daily living. Aerobic exercise training (AET) is a well establish cardiac rehabilitation intervention which improves symptoms, promotes the functional capacity and even increase exercise tolerance. Although the benefits, exercise is not yet validated for inpatients during the phase of stabilization. Purpose: To evaluate the feasibility and safety of an AET program for patients admitted due to decompensated HF: ERICHF (Early Rehabilitation in Cardiology – Heart Failure) program Methods: Pilot randomized controlled singleblind trial Patients are randomized in training group (TG) or control group (CG). Data include cardiovascular history, HF history and two functional tools: London Chest of Daily Living Activities (LCADL) and Barthel Index (BI). TG patients performed the ERICHF program twice a day for 5 days per week. ERICHF program is a supervised AET program, with increasing levels of intensity, divided into 5 stages (respiratory training, cycloergometer training, gait training and climbing stairs, for progressive duration periods). Vital signs were evaluated before and immediately after the exercise, as well as the Borg Modified Perceived Exertion. CG patients performed physical activity in accordance with the guidelines available for inpatients, always supervised too. A sixminute walking test (6MWT) was performed as soon as patients are able to do it. At discharge, all patients perform another 6MWT, as so as evaluation of LCADL and BI. Results: 114 patients were randomized (64 in TG and 50 in CG) with an average of age of 72 (±9) years old, 70 are male, 82% are in NYHA class III. At admission, both groups have the same level of functional dependence according to LCADL (31 vs 32) and Barthel (73 vs 73) scores. TG patients performed 932 sessions of exercise, with an average of 17 sessions each, for 15 (±9) days of hospitalization. There is a difference of 83 meters between the two 6MWT performed by TG patients, which demonstrates clinical significance. At discharge, TG patients presented lower LCADL score (12 vs 16, p=0,006), higher BI (98 vs 92, p=0,038) score and a 64 meters difference on the 6MWT (p=0,0032) which represents a better functional capacity. There were absence of adverse events like falls, precordial pain, malignant arrhythmias and worsening of clinical state Conclusions: ERICHF program demonstrated, in this sample of patients, to be safe and to promote functional capacity. We can also infer that probably AET is safe and viable, for this kind of patients, related to the absence of adverse events. No other study of our knowledge has demonstrated this findings.
- Promoting functional capacity in decompensated heart failure inpatients - ERIC- HF protocol, the pilot studyPublication . Delgado, Bruno; Lopes, Ivo; Rebelo, Carina; Almeida, Cecília; Gomes, Bárbara; Novo, AndréDecompensated Heart Failure (HF) patients are often characterized by functional dyspnea, fatigue, edema, functional dependence and impairment of performance in activities of daily living (ADL). Aerobic exercise training (AET) is a well establish cardiac rehabilitation intervention which leads to improvement of symptoms, promotes the functional capacity of the patients and even an increase of exercise tolerance. Although the benefits, exercise is not yet validated for inpatients during the phase of stabilization. Purpose: To evaluate the feasibility and safety of an AET program for patients admitted due to decompensated HF: ERICHF (Early Rehabilitation in Cardiology – Heart Failure) program Methods: Patients are randomized in training group (TG) or control group (CG). Data include cardiovascular history, HF history and two functional tools: London Chest of Daily Living Activities (LCADL) and Barthel Index (BI). TG patients performed the ERICHF program twice a day for 5 days per week. ERICHF program is a supervisedAET program, with increasing levels of intensity, divided into 5 stages (respiratory training, cycloergometer training, gait training and climbing stairs, for progressive duration periods). Vital signs were evaluated before and immediately after the exercise, as well as the Borg Modified Prceived Exertion. CG patients performed physical activity in accordance with the guidelines available for inpatients, always supervised too. A sixminute walking test (6MWT) was performed as soon as patients are able to do it. At discharge, all patients perform another 6MWT, as so as evaluation of LCADL and BI. Results: 114 patients were randomized (64 in TG and 50 in CG) with an average of age of 72 (±9) years old, 70 are male, 82% are in NYHA class III. At admission, both groups have the same level of functional dependence according to LCADL and Barthel scores. TG patients performed a global amount of 932 sessions of exercise, with an average of 17 sessions each, for 15 (±9) days of hospitalization. There is a difference of 83 meters between the two 6MWT performed by TG patients, which demonstrates clinical significance. At discharge, TG patients presented lower LCADL score (12 vs 16, p=0,006), higher BI score (98 vs 92, p=0,038) and a 64 meters difference on the 6MWT (p=0,032) which represents a better functional capacity. There were absence of adverse events like falls, precordial pain, malignant arrhythmias and worsening of clinical state Conclusions: ERICHF program demonstrated, in this sample of patients, to be safe and to promote functional capacity. We can also infer that probably AET is safe and viable, for this kind of patients, related to the absence of adverse events. No other study of our knowledge has demonstrated this findings.
- The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: results of a multicenter randomized controlled trial (ERIC-HF study)Publication . Delgado, Bruno; Novo, André; Lopes, Ivo; Rebelo, Carina; Almeida, Cecília; Pestana, Sandra; Gomes, Bárbara; Froelicher, Erika; Klompstra, LeonieTo analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. Design A randomized controlled clinical trial with follow-up at discharge. Settings Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. Group Assignments Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). Main outcome Functional exercise tolerance was measured with a 6-min walking test at discharge. Results In total 257 patients with DHF were included, with a mean age of 67 ± 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 ± 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 ± 117m vs 219 ± 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 ± 7 vs 93 ± 12, p = 0.02) and dyspnea associated to ADL (13 ± 5 vs 17 ± 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). Conclusion The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.