Heart Failure and Preserved Ejection Fraction
Conditions
Keywords
heart failure, dancing, cardiorespiratory fitness, quality of life, muscle strength, fall risk
Brief summary
According to the Global Burden of Disease Study (2017) 64 million people worldwide are living with Heart Failure (HF). Risk factors of HF include age, history of coronary heart disease, atrial fibrillation, hypertension, diabetes mellitus, smoking and low physical activity. There is clear evidence that regular physical activity can increase life expectancy and improve cognitive function, and delay functional disabilities associated with aging. Physical Activity and exercise training is considered as one of the components cardiovascular disease prevention and rehabilitation program. There is a growing scientific support that cardiac rehabilitation (CR) slows, stabilizes or regresses cardiovascular disease (CVD). In addition, it has been shown that CR programs significantly reduce re-hospitalisation and death from CVDs by up to 25%. Despite of strong evidence of the positive effects of exercise training in Chronic HF patients, the adherence to the exercise component of CR is still not at the level recommended by the international physical activity guidelines. Patients participating in physical activity programs are faced with several obstacles, such as orthopaedic limitations to exercise, or being severely overweight. Another most common barriers for participating in CR are family and employment obligation, psychological well-being and age ("CR is only for adults"). Participation of older adults in physical exercises programs is highly influenced by their personal interest in activity type, engagement and perceived advantages. The author is also mentioned that engaging in different types of activities or adding new elements to the traditional exercises may increase and maintain individuals' interest and engagement in physical activity. This will improve their commitment t the regular exercise and leading to improved health outcomes. World Health Organisation defines dance as a type of physical activity and recommends its implementation to develop physical skills, especially in the least active population groups. Scientists highlight the advantages of dancing over traditional strength and balance exercises that are often performed individually, whereas dance is predominantly a group activity. According to the Ministry of Culture of the Republic Azerbaijan, Azerbaijani traditional dances represent the ancient culture of the country and are popular activity among both young and older people. Azerbaijani dancing has a major social role in bringing people together during celebration of National Holidays and family events. However, use of traditional dancing in general, and Azerbaijani dances particularly, as an intervention in CR programs has not been well established. Screening of reports published since 2015, revealed only randomized control studies which identified the dance intervention as national/cultural dancing style. All those studies demonstrated positive impact of traditional dancing on the functional capacity and psychological condition of people with chronic diseases. More research on the use of the cultural dancing as an alternative to traditional exercise programs as a part of CR could provide clearer evidence about the role and effectiveness of traditional dance in CR. The aim of this research is to investigate the impact of Azerbaijani Cultural Dances on cardiorespiratory fitness and quality of life of patients with chronic HF.
Interventions
Dance sessions will be delivered by the professional dance instructor who trained to work with older adults. Exercise session - by physiotherapist who is trained and has a bachelor's degree in Sport and Exercise Science. Considering that sessions are going to be conducted with one MD and one Nurse on site, 5-7 participants per each session are permitted for the easy observation and help in case of necessity. Only one dance/exercise instructor will attend the session. Certified MD and nurse will observe the whole session. They both BLS and AED application trained. There is an EAD on site. Each dancing and exercising sessions will consist of three phases: 15 min warm-up, 30 min dance/exercise session, 15 minutes cooldown period. Exercise sessions are going to be designed based on the 2020 ESC Guidelines on sports cardiology and exercise in pat
Exercise sessions are going to be designed based on the 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. According to the exercise recommendations in individuals with chronic heart failure, session will consist of aerobic/endurance exercises with low intensity about 40% of VO2 peak. This will continue for about 2 weeks. After 2 weeks the intensity will be gradually increased to 50-65% if tolerated with aiming to reach 70-75% by the end of the 12th week. In addition to the aerobic/endurance training, resistance training exercises will also be added to the structure of the sessions (the intensity level will be kept the same as with aerobic). Warm-up is going to start with very low intensity aerobic/endurance training. Cool-down is stretching exercises and respiratory exercises (10-15 minutes). Before and after each session blood pressure, resting HR and oxygen saturation will be measured.
Sponsors
Study design
Masking description
Assessors will be blinded to participant arm and intervention
Intervention model description
The study is going to be designed as a randomized-controlled trial. Participants will be randomised using studyrandomizer.com program which is recommended to use for small studies with up to few hundred participants. 3 arm design will be undertaken with experimental 1 (dancing, DG), experimental 2 (exercising, EG) and control (CG) groups. The intervention will last for 12 weeks, with a twice weekly session lasting 60 min.
Eligibility
Inclusion criteria
Key Inclusion Criteria: * Echocardiography detected ejection fraction - 40-49% to justify the heart failure * Age between 65-85.
Exclusion criteria
* Age below 65 * Ejection fraction less than 40% and higher than 49% * Structural changes of the myocardium (aneurysms, scars, valvular diseases). * Signs of pleural or pericardial effusions * Clinically manifested comorbidities (unstable angina) * Uncontrolled Cardiac Arrhythmias
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiorespiratory fitness | Day 1 and after 12 weeks of the dancing or exercising intervention. Day 1 after 12 weeks for the control group participants. | Maximal Oxygen Capacity (VO2 max) is consiedered a gold standard in measuring cardiorespiratory fitness. Cardiopulmonary exercise testing will be conducted to all participants to measure cardiorespiratory fitness. |
| Quality of Life assessment | Day 1 and after 12 weeks of the dancing or exercising intervention. Day 1 after 12 weeks for the control group participants. | Quality of life (QoL) is one of the factors that is highly impacted in the older adult population and defined as individuals' perception of their position in life in relation to their goals, expectations, standards, and concerns. Research shows that chronic heart failure (CHF) patients experience depression and sleeping disorders, resulting in poor QoL. The QoL will be measured with The Minnesota Living with Heart Failure Questionnaire (MLHFQ). Minimum value for this scale is 0 and maximum value is 105. The lower the score the better the outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Muscle Strength | Day 1 and after 12 weeks of the dancing or exercising intervention. Day 1 after 12 weeks for the control group participants. | All participnats will go through muscle strength measurements using hand-held dynamometers. Hand grip strength (HGS), measured with a hand-held dynamometer, is suggested as a new clinical vital sign and is recommended for use as a measurement to identify older adults at risk of poor health status. Low HGS is associated with higher rates of hospitalization, mortality, and low QoL. HGS is also identified as a physical, behavioural, and psychological factor and is proposed as a health status indicator. |
| Fall Risk Assessment | Day 1 and after 12 weeks of the dancing or exercising intervention. Day 1 after 12 weeks for the control group participants. | Fall risk will be assessed on Biodex Balance machine. |
Countries
Azerbaijan