心不全患者におけるノルディックウォーキングと標準的な心臓リハビリテーションのランダム化試験

実験的：Nordic Walking Group

Participants in the Nordic walking group will be provided with walking poles (GymstickTM Nordic Walking Poles, Gymstick International OY, Lahti, Finland) for the duration of the study. They will attend on-site exercise classes twice weekly for 12 weeks. The on-site exercise training classes will be one hour in length and include the following components: a 15 minute chair warm-up that excludes resistance exercises; 10-15 minutes of walking with Nordic walking poles for the first 3 weeks, progressing to 30 minutes of continuous walking with poles for the remaining 9 weeks; and 15 minutes of cool down exercises. Participants will be instructed to take the walking poles home and perform 200-400 minutes of Nordic walking per week for 12 weeks

行動：ノルディックウォーキング

ノルディック ウォーキング グループの参加者には、研究期間中、ウォーキング ポール (GymstickTM ノルディック ウォーキング ポール、Gymstick International OY、フィンランド、ラハティ) が提供されます。 彼らは 12 週間、週 2 回、オンサイトのエクササイズ クラスに参加します。 オンサイトのエクササイズ トレーニング クラスは 1 時間の長さで、次のコンポーネントが含まれます。最初の 3 週間はノルディック ウォーキング ポールを使って 10 ～ 15 分間ウォーキングし、残りの 9 週間はポールを使って 30 分間継続してウォーキングします。 15分間のクールダウンエクササイズ。 参加者は、ウォーキング ポールを家に持ち帰って、12 週間、週に 200 ～ 400 分のノルディック ウォーキングを行うように指示されます。

介入なし：Standard Exercise Therapy

Individuals assigned to standard exercise therapy will attend on-site exercise classes twice weekly for 12 weeks. Each on-site class will be one hour in duration and consist of: a 15-minute chair-based warm-up that includes 6-8 upper and lower body resistance training exercises using either hand-held weights or therabands at an intensity of 50-60% of 1- RM with the patient completing one set of 10-12 repetitions progressing to 15 repetitions before increasing the intensity by 5-10%; 10-15 minutes of walking for the first 3 weeks, progressing to 30 minutes of continuous walking for the remaining 9 weeks; and 15 minutes of cool down exercises. A strength training program will be provided to participants and they will be encouraged to do one additional strength training session at home. Participants will also be instructed to complete additional walking sessions at home so that they can accumulate a total of 200-400 minutes of exercise per week.

Changes in Exercise Capacity Measured by 6 Minute Walk Test

The 6 minute walk test was selected as a primary outcome because this sub-maximal test is a good indicator of the capacity to undertake day-to-day activities in patients with Heart Failure

Minnesota Living With Heart Failure Questionnaire (MLHFQ)

The MLHFQ is a 21-item scale that measures the effects of HF-related symptoms, functional limitations, and psychological distress on an individual's quality of life. Participants are asked to indicate using a 6-point, zero to five, Likert scale how much each of 21 factors prevent them from living as they desire. Each item is scored 0-5, and the total scores is the summed score of all items, totaling 0 - 105. Higher scores represent lower quality of life.

Health Related Quality of Live Using the Medical Outcomes Study Short Form (SF-36)

Total scale is split into 2 subscales: physical component summary (PCS) and mental composition summary (MCS). Each subscale ranges from 0-100. Higher scores represent better quality of life.

Hospital Anxiety and Depression Scale (HADS)

Split into 2 subscales: anxiety and depression. Each subscale has 7 items, scored from 0-3, with the total score of each subscale being 0-21 each. Higher scores indicate greater anxiety or depression. 0-7 indicates a normal range.

Physical Activity

Physical activity includes any type of exercise. For example, walking, swimming, biking etc. Identification of "light", "moderate" or "vigourous" activity is determined by the participant based on perceived effort. Results are collected from exercise journals.

Left Ventricular Filling Pressures

The left ventricular filling pressure is the pressure inside the left ventricle of the heart during the resting phase of the heart beat when the chamber fills with blood. It is assessed by echocardiography and calculate as an E/e' ratio, where E = the peak velocity of early diastolic blood flow across the mitral valve, and e' = the peak velocity of mitral valve annulus during early diastole, which is a measure of how fast the heart muscle relaxes.

Valus <8 are considered normal, 8-14 indicates potentially normal, but is baseline and requires further evaluation and >/= 15 suggests elevated pressures and presence of diastolic dysfunction or heart failure with preserved ejection fraction.

Cardiopulmonary Fitness by VO2 Peak

assessed using CPET

Body Mass Index

Calf Circumference

Waist Circumference

Blood Levels of N-terminal Pro B-type Natriuretic Peptide (NTproBNP)