TY - JOUR
T1 - Training fisico domiciliare nello scompenso cardiaco cronico
T2 - Studio osservazionale sui fattori condizionanti l'aderenza al programma
AU - Capomolla, Soccorso
AU - Ceresa, Monica
AU - Civardi, Agostina
AU - Lupo, Angela
AU - Ventura, Anna
AU - Scabini, Milena
AU - Leonelli, Patrizia
AU - Salvaneschi, Giulia
AU - Petocchi, Alessandra
AU - Pinna, GianDomenico
AU - Ferrari, Marina
AU - Febo, Oreste
AU - Caporotondi, Angelo
AU - Guazzotti, Giampaolo
AU - La Rovere, Maria Teresa
AU - Gnemmi, Marco
AU - Maestri, Roberto
AU - Cobelli, Franco
PY - 2002/11
Y1 - 2002/11
N2 - Background. Physical training has proven to be a valid and effective therapeutic tool capable of counteracting muscle changes that occur in chronic heart failure (CHF) patients. Nevertheless, few studies have analyzed the frequency of use of this therapy and the reasons for any reduced compliance and adherence to the prescription. The aim of this study was to quantify the frequency of the participation of CHF patients in a program of domiciliary physical training and to analyze the factors that can influence adherence to the program. Methods. Three hundred and twenty-two consecutive CHF patients (ejection fraction 28 ± 7%) in a stable condition with optimized medical therapy performed a cardiopulmonary test, including determination of peak oxygen consumption, at baseline and after 9 ± 3 months. All the patients had participated in sessions of health education on the relationship between illness/physical activity. The prescription of physiotherapy was decided by the physician on the basis of each patient's clinical need assessed in the diagnostic-therapeutic management. The patient referred for physiotherapy entered a therapeutic strategy that included sessions of training on anaerobic threshold, self-management of the session, and formulation of a domiciliary physical training program. During the follow-up evaluation the patients were asked to complete a questionnaire, which investigated the relationship between several factors and the patient's adherence to the physical training program, which was objectively evaluated by the change in peak oxygen consumption recorded at the end of the training, taking into account the spontaneous variations found in the control group. Results. Two hundred and eighty-two of the patients (88%) satisfied the criteria for inclusion in the study. Only 61 (22%) of them were judged to have adhered to the recommended physical training. Type of employment (X2 = 7.08, p <0.02), the state of retirement (X2 = 8.9, p <0.01), ischemic etiology (X2 = 5.91, p <0.01), compatibility with employment (X2 = 15.8, p <0.0004), availability of suitable domestic conditions (X2 = 14.5, p <0.0008), the structure of the training program (X2 = 22.33, p <0.0001) and a learning phase in a gym (X2 = 71.33, p <0.0001) were significantly correlated at univariate analysis with the performance of the physical training. Multivariate analysis identified the structure of the training program (odds ratio 9.6, 95% confidence interval 2.8-33) and a learning phase in a gym (odds ratio 49.6, 95% confidence interval 11-210.8) as independent factors (r2 = 0.48) determining adherence to the physical training program. Conclusions. Adherence to unmonitored, recommended domiciliary physical training appears to be modest even in patients who have been in-patients in a cardiac rehabilitation center. Various factors seem to influence the adherence of the patient to this therapy, but structural factors, such as the organization and learning of the program, more strongly influenced the patient's subsequent compliance.
AB - Background. Physical training has proven to be a valid and effective therapeutic tool capable of counteracting muscle changes that occur in chronic heart failure (CHF) patients. Nevertheless, few studies have analyzed the frequency of use of this therapy and the reasons for any reduced compliance and adherence to the prescription. The aim of this study was to quantify the frequency of the participation of CHF patients in a program of domiciliary physical training and to analyze the factors that can influence adherence to the program. Methods. Three hundred and twenty-two consecutive CHF patients (ejection fraction 28 ± 7%) in a stable condition with optimized medical therapy performed a cardiopulmonary test, including determination of peak oxygen consumption, at baseline and after 9 ± 3 months. All the patients had participated in sessions of health education on the relationship between illness/physical activity. The prescription of physiotherapy was decided by the physician on the basis of each patient's clinical need assessed in the diagnostic-therapeutic management. The patient referred for physiotherapy entered a therapeutic strategy that included sessions of training on anaerobic threshold, self-management of the session, and formulation of a domiciliary physical training program. During the follow-up evaluation the patients were asked to complete a questionnaire, which investigated the relationship between several factors and the patient's adherence to the physical training program, which was objectively evaluated by the change in peak oxygen consumption recorded at the end of the training, taking into account the spontaneous variations found in the control group. Results. Two hundred and eighty-two of the patients (88%) satisfied the criteria for inclusion in the study. Only 61 (22%) of them were judged to have adhered to the recommended physical training. Type of employment (X2 = 7.08, p <0.02), the state of retirement (X2 = 8.9, p <0.01), ischemic etiology (X2 = 5.91, p <0.01), compatibility with employment (X2 = 15.8, p <0.0004), availability of suitable domestic conditions (X2 = 14.5, p <0.0008), the structure of the training program (X2 = 22.33, p <0.0001) and a learning phase in a gym (X2 = 71.33, p <0.0001) were significantly correlated at univariate analysis with the performance of the physical training. Multivariate analysis identified the structure of the training program (odds ratio 9.6, 95% confidence interval 2.8-33) and a learning phase in a gym (odds ratio 49.6, 95% confidence interval 11-210.8) as independent factors (r2 = 0.48) determining adherence to the physical training program. Conclusions. Adherence to unmonitored, recommended domiciliary physical training appears to be modest even in patients who have been in-patients in a cardiac rehabilitation center. Various factors seem to influence the adherence of the patient to this therapy, but structural factors, such as the organization and learning of the program, more strongly influenced the patient's subsequent compliance.
KW - Chronic heart failure
KW - Exercise
KW - Outpatients
KW - Rehabilitation
KW - Therapy
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M3 - Articolo
AN - SCOPUS:0242330839
VL - 3
SP - 1098
EP - 1105
JO - Italian Heart Journal Supplement
JF - Italian Heart Journal Supplement
SN - 1129-4728
IS - 11
ER -