Volume 28, Issue 9 (12-2021)                   RJMS 2021, 28(9): 58-67 | Back to browse issues page

Research code: رساله دکتری
Ethics code: 9801
Clinical trials code: نداره

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Talebifard H, Asgharpour H, Rezaeeshirazi R, Saiiari A. The effect of eight weeks of combined continuous aerobic training with inspiratory muscle training on maximal oxygen consumption, cardiac function indices and pulmonary volumes in patients with heart failure. RJMS 2021; 28 (9) :58-67
URL: http://rjms.iums.ac.ir/article-1-6663-en.html
, habibasgharpour@gmail.com
Abstract:   (2147 Views)
Background & Aims: Heart failure (HF) is a complex clinical syndrome caused by various structural or functional abnormalities of the heart and impairs the capacity to fill the ventricles (1). The prevalence of this disease in Iran is reported 8%, the highest rate of which is in Khuzestan and Gilan provinces (6). Despite numerous treatments depending on the pathology of the disease and the patient's condition, the mortality rate after the diagnosis of HF is still high (7). Although the pathogenesis of HF is largely unclear, it is widely accepted that neurohormonal changes and inflammatory processes are involved in the structural and functional destruction of vital organs including the heart, kidneys, and lungs (2). One of the clinical complications of HF is pulmonary diseases. The association between HF and COPD has been extensively investigated in recent years. It has been shown that about 30% of patients with HF have COPD and a similar HF prevalence has been reported in a large population of patients with COPD (9, 10). Impairment of aerobic function due to negative cardiopulmonary and muscular interactions is an important determinant factor in exercise intolerance in the heart failure patients with COPD (12). Considering heart and pulmonary disorders and problems of lack of oxygen in different tissues of the body, also considering the role of exercise in improving cardiorespiratory function and improving oxygen delivery to the body, it seems that exercise is very useful for these patients. On the other hand, due to the low respiratory capacity in patients with HF, one of the treatment priorities for these patients is to increase lung capacity in these people. It has been shown that the use of breathing exercises can be a complementary therapy to improve pulmonary function in patients with HF (16). Despite the relationship between pulmonary disorders in HF, so far no research has been conducted to investigate the effect of simultaneous combined exercise training (aerobic-resistance) on improving the structure and function of the heart as well as pulmonary volumes in these people, which shows the necessity of the present research. Therefore, the aim of this study was to determine the effect of eight weeks of simultaneous combined training (aerobic- inhalation resistance) on cardiovascular and pulmonary functional volumes in men with HF.
Methods:  In the present semi-experimental study, 20 men with heart failure referred to the Cardiac Rehabilitation Center of Imam Khomeini Hospital in Ahvaz were selected by snowball sampling method. Randomly were divided into 2 groups of 10 people including exercise training group (mean age: 47.5 ± 7.84; body mass index: 29.27 ± 1.99) and control group (mean age: 48.8 ± 8.03; body mass index 26.93 ± 2.14). The training intervention consisted of eight weeks of training in three sessions per week. The training program included increasing continuous aerobic exercise with 40-85% of the subjects' reserve heart rate; Inhalation resistance exercises were performed 5 minutes after aerobic exercises with an intensity of 40-70% of the training load. No training intervention was performed in the control group. Cardiovascular and pulmonary variables were measured 48 hours before and 48 hours after the intervention period. Dependent t-test and analysis of covariance were used for statistical analysis of the obtained data. Statistical analysis was performed using SPSS software version 26 and a significance level of P <0.05 was considered.
Results: In the study of intragroup changes, the results of dependent t-test showed that after exercise intervention, a significant decrease in the levels of systolic blood pressure and resting heart rate variables and a significant increase in SV, EF, VO2Peak, FVC and FEV1 variables were observed in the exercise group, but no significant difference was observed in diastolic blood pressure levels. In the control group, no significant difference was observed in any of the measured variables.
In examining intergroup changes, the results of covariance test showed that changes in systolic blood pressure and resting heart rate, SV, EF, VO2Peak, FVC and FEV1 were significant in the exercise group compared to the control group.
Conclusion: Due to the positive changes in cardiac function, which were seen as an increase in functional heart volumes (SV and EF) and a decrease in resting heart rate and systolic blood pressure, part of the improvement in exercise performance capacity (VO2Peak) can be attributed to cardiac adaptation to aerobic exercise (20). Also, after the training period, a significant decrease in resting heart rate was observed. Since high resting heart rate is associated with adverse consequences of HF with reduced mutations (23) and due to the increase in stroke volume after exercise, changes in resting heart rate can be justified. Other factors affecting the improvement of cardiorespiratory function include increased pulmonary functional volumes (FVC and FEV1) (24). FVC and FEV1 are two common indicators in assessing pulmonary function and are used in research and clinical therapy as indications for response to treatment and clinical research (28,29). Considering that the exercises used in the present study included both aerobic and inhalation resistance training exercises, so the increase in FVC and FEV1 volumes can be attributed to the interaction of the two training methods on increasing the strength of the respiratory muscles as well as the adaptations resulting from aerobic exercise. Overall, the results of the present study showed that a combination of continuous aerobic exercise and respiratory resistance training can improve cardiorespiratory function and performance capacity in men with heart failure through improving cardiovascular function by increase in cardiac function (SV and EF) and reduction in resting heart rate and systolic blood pressure with increased pulmonary function FVC and FEV1). Considering that one of the complications of chronic heart failure, in addition to structural and functional problems of the heart, is a decrease in pulmonary capacity as one of the serious complications of heart failure, so, a combination of aerobic exercise and respiratory resistance training can be used to reduce HF complications and cardiorespiratory rehabilitation in these people. In general, it can be said that combined training, including a combination of increasing aerobic training and inhalation muscles resistance training with improved cardiopulmonary function, plays an important role in the rehabilitation of patients with HF, and these patients can use this training protocol for cardiopulmonary rehabilitation and reduction in complications of the disease.

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Type of Study: Research | Subject: Exercise Physiology

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