Associazione Nazionale Medici Cardiologi Ospedalieri



A new project of a specific exercise protocolfor ambulatory cardiovascular rehabilitation specific for heart failure: report of the first experience

Fontana Antonella Seregno(MB) – ASST Brianza Presidio Seregno | Vincenzi Antonella Seregno(MB) – ASST Brianza Presidio Seregno | Rabbiosi Patrizia Seregno(MB) – ASST Brianza Presidio Seregno

The indication to cardiovascular rehabilitation (CV rehab) was recently upgraded to I A in the European guidelines (GL) for the treatment of heart failure (HF), along with the four pharmacologic pillars. According to this change, we have implemented our CV rehab protocol to include specific exercises for patients (pts) with HF. We present our management of HF pts in CV rehab.

According to GL, all pts with HF should receive CV rehab in order to improve their quality of life and reduce readmissions for HF. We can admit up to 18 day-hospital (DH) pts, and starting from October 2023, we implemented a specific excercise protocol for HF pts. They are screened by the physiotherapist on admission day, and all the following activities are tailored based on this initial physical assessment. It includes the 6-minute-walking test (6MWT), the short physical performance battery (SPPB) for the evaluation of lower limbs strenght, and the explanation of the Borg scale. The SPPB evaluates equilibrium, speed and ability to stand up and sit down with a 0-12 score: a score < 6 indicates extreme frailty which contra-indicates training; a score between 7-9 indicates a frail pt, and a score 10-12 indicates a pre-frail pt. Based on this classification, different types of training are proposed: continuous training (CT), exercise training (ExT), interval training (IT) -further distinguished in low intensity (LIT) and high intensity (HIT)-; inspiratory muscle training (IMT) and resistance strength training (RST). At every DH access, pts exercise for 90 minutes alternating RST, IMT and aerobic training on cyclette (HIT). In each case, every 3-4 minutes of effective exercise an absolute pause of up to 90 seconds is observed. Moreover, the 'talk test' ensures that at every moment during excercise the pt can talk without dyspnoea. A nurse teaches basic sanitary notions (correct therapy intake, healthy lifestyle, symptoms recognition); a nutrition expert counsels pts about dietary intake; a psycologist supports pts with group and indivisual sessions, whereas the cardiologist optimizes therapy according to laboratory findings, which are modified by the physical training. In this way, the multidisciplinary team-approach to the HF pt allows for a better care of each individual. So far, our pts have appreciated this initiative and are willing to come back again and again. We plan to collect clinical data of all pts treated with this approach and test its efficacy over a two-year period.