A Walking Program Plus High Intensity Breathing Exercise May Enhance Quality of Life in Individuals with Heart Failure—a Preliminary Report

Background: With heart failure (HF), individuals often develop dyspnea with physical activities, fatigue, and deconditioning. These impairements eventually lead to poor quality of life. Respiratory muscle weakness may contribute to their dyspnea with exertion. There is a well established positive dose-response relationship between physical activity and quality of life. Self-care management is strongly advocated in this population with the goal of reducing hospital readmissions. Benefits of exercise programs or inspiratory muscle training (IMT) were well reported; however, the effects of combining physical activity promotion and IMT have yet to be determined. Objective: To determine if a self-monitored progressive walking program and high-intensity IMT could result in more improvements than the walking program alone on exercise capacity, breathing strength, and health-related quality of life in individuals with HF. Study Design: a pilot study with single-blinded randomized control trial. Methods: Sixteen Participants were enrolled (Age 55 yrs ±12; 4 women & 12 men, NYHA: II:11, III 5; PImax 48 ± 25 cmH2O). The following outcomes were obtained pre- and post- 6 weeks of interventions: Six Minute Walk Test, Minnesota Living with Heart Failure (MLHF) Questionnaire, and Inspiratory muscle strength indicated by the Maximal Inspiratory Pressure (PImax). Participants were randomly allocated to the control group (walking program and IMT at 15% PImax) or the experimental group (walking program and IMT at 60% PImax). All of them were instructed on the use of a simple pedometer, a Polar heart rate monitor, and a physical activity diary. At weekly follow up, they were given a new target daily step counts based on the average of their previous 7-day step counts. The IMT intensity was readjusted weekly after re-test of PImax. Results: Eight participants completed the study. In the 6 Minute Walk Test, the experimental and control groups showed a clinical improvement of 10.9% and 2.8% change, respectively, from pre-test values. For the MLHF Questionnaire, the experimental group improved quality of life by 23.8% from pre-test values while the control group decreased quality of life. For PImax, both groups averaged an overall improvement of 57% and 9.6%, respectively, from pre-test scores. Conclusion: The trend of the data suggests that high-intensity IMT combined with home-based progressive walking may help improve functional capacity, PImax, and quality of life more than the progressive walking program alone; however, these results are preliminary due to the high drop out rate and the study is ongoing. Clinical Relevance: Utilization of a home-based, self-monitored walking program in addition to high-intensity inspiratory muscle training may have positive effects on inspiratory muscle strength, exercise tolerance, and quality of life in individuals with HF. Acknowledgments: The HF Clinics of Texas Health Resources of Dallas and Baylor Scott & White Hospital, McKinney, TX.