심부전 환자의 노르딕 워킹 대 표준 심장 재활의 무작위 시험

실험적: 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

행동: 노르딕 워킹

노르딕 워킹 그룹의 참가자에게는 연구 기간 동안 워킹 폴(GymstickTM Nordic Walking Poles, Gymstick International OY, Lahti, Finland)이 제공됩니다. 그들은 12주 동안 일주일에 두 번 현장 운동 수업에 참석할 것입니다. 현장 운동 교육 수업은 1시간 동안 진행되며 다음 구성 요소가 포함됩니다. 저항 운동을 제외한 15분 의자 워밍업; 처음 3주 동안 노르딕 워킹 폴을 사용하여 10-15분 걷기, 나머지 9주 동안 폴을 사용하여 30분 연속 걷기로 진행; 그리고 15분간 쿨다운 운동을 합니다. 참가자는 워킹 폴을 집으로 가져가서 12주 동안 매주 200-400분의 노르딕 워킹을 수행하도록 지시받게 됩니다.

간섭 없음: 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)