Razi Journal of Medical Sciences

fa بررسی تاثیر ورزش درمانی در منزل بر ظرفیت عملکردی و کیفیت زندگی بیماران مبتلا به نارسایی قلبی The Effect of Home-Based Exercise Training on Functional Capacity and Quality of Life in Patients with Heart Failure طب ورزش Sports Medicine پژوهشي Research زمینه و هدف: بازتوانی قلبی به عنوان بخشی از فرایند درمانی در بیماران نارسایی قلبی شناخته شده است. با این وجود برای بسیاری از بیماران امکان شرکت در جلسات توان‌بخشی قلبی دربیمارستان یا در منزل همراه با تله مانیتورینگ وجود ندارد. به همین منظور این مطالعه به بررسی تأثیر آموزش ورزش درمانی در منزل بر ظرفیت عملکردی و کیفیت زندگی بیماران مبتلا به نارسایی قلبی مرکز قلب و عروق شهید رجایی تهران پرداخت. روش کار: در این مطالعه نیمه تجربی، 69 بیمار با سن 18 تا 65 سال مبتلا به نارسایی قلبی کلاس I و II در بیمارستان شهید رجایی تهران طی سال ۱۳۹۷ با روش نمونه‌گیری آسان ومستمر انتخاب شدند و به صورت تصادفی در دو گروه ازمون (35 = n) و کنترل (34 = n) قرار گرفتند. ابزار گردآوری داده‌ها شامل فرم اطلاعات دموگرافیک، پرسشنامه کیفیت زندگی (HF-QOL) و تست قدم زدن 6 دقیقه‌ای برای سنجش ظرفیت عملکردی بیماران بود. برنامه ورزشی پیاده‌روی با شدت متوسط در بیماران گروه آزمون همه روزه تا ۸ هفته انجام گرفت. یافته‌ها: کیفیت زندگی با پرسش‌نامه HF-QOL و ظرفیت عملکردی براساس مسافت پیموده شده در تست 6 دقیقه‌ای تنها درگروه مداخله در مراجعه دوم  نسبت به اول با آزمون تی زوجی دارای اختلاف آماری معناداری می‌باشد. در مقایسه‌ی کیفیت زندگی و ظرفیت عملکردی در انتهای مطالعه بین گروه مداخله و کنترل، اختلاف معناداری را در نمرات کیفیت زندگی و مسافت پیموده شده در تست 6 دقیقه‌ای گروه مداخله نسبت به گروه کنترل نشان داد (به ترتیب 001/0 P< و 001/0 P<). نتیجه‌گیری: این مطالعه نشان داد که برنامه ورزش پیاده‌روی در منزل می‌تواند بر شاخص‌های کیفیت زندگی و ظرفیت عملکردی بیماران مبتلا به نارسایی قلبی تأثیر مثبت داشته باشد.   Background & Aims: With the improvement of the quality of care for patients with heart failure, the number of these patients in the world is increasing (1). The quality of life of patients with heart failure is low and inadequate due to physical limitations, reduced functional capacity and frequent hospitalizations (2, 3), Cardiac rehabilitation (CR) is a well - recognized part of the treatment for heart failure that helps to control the symptoms, improve the quality of life of patients, prevent disease progression and reduce mortality (4-8). Also it improves myocardial function, ventricular filling in the diastolic phase, vascular endothelial function and coronary vasodilation, and is recommended as a safe and beneficial therapeutic intervention in patients with heart failure (9, 10). Intensity, duration and repetition of exercise should be standard (11). In some study demonstrate that the exercise therapy program at the hospital or at home with tele-monitoring is a safe treatment option (12), but many patients are not able to participate in CR sessions in heart centers. On the other hand, home - based CR with tele-monitoring has not become available in our country. Cardiac rehabilitation at home was first reported in 1980 (13), and its use increased because it was more acceptable and convenient for some patients to perform. Some studies have shown that home- based exercise therapy can probably be as beneficial as hospital- based exercise therapy in patients with heart failure (14) and improve functional capacity and quality of life (15). Thus, the aim of this study was to investigate the effect of home - base exercise therapy on functional capacity and quality of life of patient with heart failure in Shahid Rajaie Cardiovascular, Medical and Research Center. Methods: In this semi - experimental study, 69 patients with New York Heart Association class II and III heart failure with ejection fraction less than 40%, were divided into two groups of control (n = 34) and intervention (n = 35) at Shahid Rajaie Center in 2018. Patients in the intervention group were asked to walk with moderate - intensity on a flat surface daily for 8 weeks so that the walking duration lasted more than 150 minutes per week. Patients who had ICDs were asked to have a pulse rate 10 beats less than the number set by the pacemaker during walking. The control group was not trained to walk and only received routine medication. The Heart Failure Quality of Life (HF - QOL) questionnaire (16) and 6 minute walking test were performed for each patient at entry and after 8weeks. After collecting data, SPSS software was used to analyze the data. Significance level was considered P = 0.05. Results: There was no significant difference between the two groups in terms of baseline demographic and clinical characteristics of patients except for the incidence of diabetes. Comparison of changes in blood pressure and heart rate and oxygen saturation in the intervention and control groups did not show a significant difference. Only diastolic blood pressure was statistically significant difference in the second visit after the 6-minute walk test between the control and intervention groups (P = 0.03) which is not clinically significant. At the beginning of the study, the comparison of quality of life (P = 0.07) and distance traveled in the 6-minute test (P = 0.16) between the control and intervention groups was not statistically significant. Quality of life and functional capacity only in the intervention group in the second visit compared to the first has a statistically significant difference. In comparing quality of life and functional capacity at the end of study showed a significant difference between the intervention and control groups in the scores of quality of life and distance traveled in the 6-minute test of the intervention group compared to the control group (P <0.001 and P <0.001, respectively). Conclusion: For convenience, the study results are presented in two parts: findings related to quality of life and findings related to the results of the 6-minute walk test. Regarding the effect of home exercise therapy training on quality of life in patients with heart failure, our study showed that home exercise therapy significantly increased the quality of life score in the intervention group and the difference was significant compared to the control group. The most clinically important finding regarding the effect of exercise therapy training is the functional capacity of patients with heart failure. Our study showed that the travelled distance in the six-minute walk test and as a result the functional capacity of the intervention group has improved significantly. The results of the present study confirm that home exercise therapy is a safe, low-cost, useful and appropriate intervention to improve the quality of life and functional capacity of patients with heart failure. Due to the impossibility of attending and performing cardiac rehabilitation in the hospital under the supervision and with tele-monitoring for all patients with heart failure and the possibility of decreased functional capacity and quality of life in them, home education and exercise therapy programs are recommended for these patients.   توانبخشی قلبی, ورزش درمانی, نارسایی قلبی, کیفیت زندگی Cardiac Rehabilitation, Exercise Therapy, Heart Failure, Quality of Life 249 258 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5492-1&slc_lang=fa&sid=1 Maryam Talebi مریم طالبی maryamt099@gmail.com 3900319475328460083687 3900319475328460083687 No MSc, Critical Care Nursing, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran کارشناسی ارشد پرستاری مراقبت‌های ویژه، بیمارستان قلب و عروق شهید رجایی، تهران، ایران Sara Lotfian سارا لطفیان sara.lotfian@gmai.com 3900319475328460083688 3900319475328460083688 No Associate Professor, Department of Sports and Exercise Medicine, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran استایار تخصص پزشکی اجتماعی، بیمارستان قلب و عروق شهید رجایی، تهران، ایران Yasaman Khalili یاسمن خلیلی khalili3706@yahoo.com 3900319475328460083689 3900319475328460083689 No Assistant Professor, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran متخصص قلب و عروق و فلوشیپ نارسایی قلب، بیمارستان قلب و عروق شهید رجایی، تهران، ایران sepideh taghavi سپیده تقوی sepide1349@yahoo.com 3900319475328460083690 3900319475328460083690 No MD, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran دستیار تخصصی پزشکی ورزشی، دانشگاه علوم پزشکی ایران، بیمارستان رسول اکرم، تهران، ایران Soheila Masoudi سهیلا مسعودی somir17302@gmail.com 3900319475328460083691 3900319475328460083691 Yes MD, Department of Sports Medicine, School of Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran دانشیار تخصص پزشکی ورزشی، دانشگاه علوم پزشکی ایران، بیمارستان قلب و عروق شهید رجایی، تهران، ایران