Effects of education, self care instruction and physical exercise on patients with chronic heart failure

Background Evidence is now evolving of the importance of team management for patients with chronic heart failure. This includes education, patient self-care and physical exercise training. How such programs should be implemented is still under discussion. Aim To assess the efficacy of an in-hospital rehabilitation clinic-based program, we studied its influence on cardiopulmonary parameters and quality of life in an outpatient setting. Methods and results 75 patients (62 male, 13 female, mean age 65 +/- 8 years) underwent an exercise program including education, bicycle ergometer, muscle strength training and the 6-min walk test as a training unit for 4 weeks. Patients were studied at baseline (T1), before discharge (T2) and after a follow-up period of 29.9 +/- 5.5 weeks (T3). Baseline data (T1): left ventricular ejection fraction (LVEF): 33.8 +/- 7.6%, left ventricular end-diastolic volume (LVEDV): 130 +/- 51 ml, peak VO2: 12.3 +/- 4.3 ml/kg, maximum work load (Watt max): 71 +/- 27 W At discharge (T2) and follow-up (T3) LVEF increased to 36.8 +/- 8% and 41.8 +/- 9.2%, LVEDV decreased to 127 +/- 43 ml and 114 +/- 40 ml, peak VO2 increased to 14.1 +/- 5.1 ml/kg and 15.2 +/- 5 ml/kg, and Watt max increased to 84 +/- 28 W and 98 +/- 42 W (all p<0.01). Quality of life improved significantly at discharge and follow-up in nearly all domains and in the summary score for physical health. There were no significant changes for anxiety and depression at T2 and T3. Conclusion A specialized in-hospital rehabilitation program including education, patient self-management and training has a sustained positive effect on cardiopulmonary parameters and physical well-being.