Body-Weight Supported Treadmill Training in Patients with Severe Heart Failure

Abstract

Patients with severe heart failure (HF) are often excluded from exercise training studies due to their potentially unstable nature and severe exercise intolerance. Steady state cycling and walking have been the most common interventions and it is unknown whether these training modalities are appropriate and safe for patients with severe HF as they can produce significant cardiovascular stress. Body-weight supported treadmill (BWST) training may be beneficial in patients with severe HF by improving the periphery while minimizing cardiac loading. The purpose of this study was to: 1) assess the safety and feasibility of BWST training in severe HF patients and 2) to evaluate the effect of BWST training on functional capacity, health-related quality of life (HRQL ), cardiopulmonary function, and blood vessel function. Three male patients with severe HF participated in the study. On study entry and at the end of 24 sessions of physician supervised BWST training, patients completed a cardiopulmonary exercise test, two HRQL questionnaires, a 6-Minute Walk Test (6-MWT), and a Doppler ultrasound study. Although there were no study-related adverse events, only one subject (Patient 1) was able to complete post-testing. However, all three patients seemed to demonstrate a general trend towards increased exercise tolerance. By the seventeenth exercise session, the BWS was reduced to zero for Patient 1. In addition, Patient 1 achieved an average walking speed of2.0 km/hr and was completing 34 minutes ofwalking with minimal rest periods by the end of the training program. Patients 2 and 3 also responded to the training as evidenced by a slight increase in exercise duration. However due to fluctuations in their health status, they did not have any substantial improvement. Patient 1 experienced substantial increases in functional capacity: a 64% increase in V02 peak (7.2 to 11.7 ml/kg/min); a 33% increase in peak power output (300 to 400 kpm/min); a 37% increase in VE peak (28 to 39 L/min); and a 28% increase in 6-MWT distance (223. 5 to 286m). In addition, Patient 1 's NYHA-FC improved after training from class III to II. A significant training effect was also evident by reductions in HR at rest (96 to 79 bpm) and during submaximal exercise (100 kpm/min) (105 to 84 bpm). HRQL also tended to improve for Patient 1. Based on these findings and observations, two conclusions can be made. First, patients with severe HF can safely participate in BWST training and may derive considerable benefits. Second, the feasibility of training patients with severe HF is highly dependent on their cardiac condition and other co-morbidities remaining stable enough to allow consistent training.