Eccentric Resistance Training Among Individuals With Chronic Heart Failure

Study Overview
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Brief Summary
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To determine the effects of eccentric resistive training on ventricle functions and aerobic capacity as compared to a resistance and aerobic training among Heart failure (HF)

Official Title
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Effects of Eccentric Resistance Training on Ventricle Functions and Aerobic Capacity Among Individuals With Chronic Heart Failure

Conditions
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Heart Failure

Intervention / Treatment
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* Other: Eccentric Resistive Training + Aerobic training Group
* Other: Resistance Training + Aerobic training Group
* Other: Aerobic training Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient able to safely perform lower limb exercise will be check by six- minute walk test (6 MWT) Diagnosis of Chronic HF and currently on optimal medical therapy Exclusion Criteria: Already participating in cardiac rehabilitation New York Heart Association (NYHA) Classification of HF class IV HF symptoms Co-existent other disease such as asthma/ COPD/interstitial lung disease. Symptomatic Second degree or third degree heart block. ECG with uncontrolled ventricular arrhythmia limited Exercise ability due to neurologic or orthopedic impairments of the legs (will cross-check with 6 MWT)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Eccentric Resistive Training + Aerobic training Group<br> | Other: Eccentric Resistive Training + Aerobic training Group<br>* Eccentric Resistive training includes upper limb (biceps and triceps) and lower limb large muscle training (quadriceps and hamstrings) 2 sets of 12 repetitions (reps) for each group of muscles in lengthened position for eccentric training in approx. 20 minutes (min). Intensity will be based on 1 repetition maximum (1RM) starting from 20% of (1RM) and its intensity in percentage will be progress by 10% after every two weeks. Stair descending training and squatting position and eccentric hamstring curls with weights at ankle for lower limb eccentric training progressive as per tolerance in response to modified Borg scale (with cut off of showing dyspnea of 4 somewhat hard) and Numeric Pain rating scale (with cut off of showing 7 on scale, crossing moderate pain) . (approx. 20 min). + Aerobic training as a control will be given to this group as well for approximately 30 minutes per session.<br>|
| Active Comparator: Resistance Training + Aerobic training Group<br> | Other: Resistance Training + Aerobic training Group<br>* Resistive training (concentric) includes Upper limb (biceps and triceps) and lower limb large muscle training (quadriceps and hamstrings), 2 sets of 12 reps for each group of muscles in approx. 30 min. Intensity will be based on 1 repetition maximum (1RM) starting from 20% of (1RM) and its intensity in percentage will be progress by 10% after every two weeks. Stair climbing training and quadriceps training + standing hamstring curls with weight at ankle for lower limb concentric training progressive as per tolerance in response to modified Borg scale (with cut off of showing dyspnea of 4 somewhat hard) and Numeric Pain rating scale (with cut off of showing 7 on scale, crossing moderate pain) + Aerobic training as a control will be given to this group as well for approximately 30 minutes per session.<br>|
| Active Comparator: Aerobic training Group<br> | Other: Aerobic training Group<br>* Aerobic training as a control will be given to this group as well for approximately 60 minutes per session. Aerobic training exercise will be completed via a ergometer/stationary cycle; type will be continuous aerobic exercise and intensity of 60% of max HR (or peak VO2) in HF individuals.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ventricle Functions | Changes from the baseline will be measured. Doppler resting echocardiography will be performed to measure ventricle functions. Standard views, including the parasternal long-axis, short-axis at the papillary muscle level, and apical 4- and 2-chamber views will be recorded. Left ventricular ejection fraction (LVEF) and end systolic and end-diastolic diameters (LVESD and LVEDD) will be measured using formula (Tiecholz formula i-e spherical volume of the heart multiplied by a correction factor). Any structural changes will also be recorded. | 12 week | 
| Aerobic Capacity | Changes will be measured at baseline, 4th week, 8th week and 12th week. The 6-min walk test provides an indirect measure of cardiovascular functional/aerobic capacity. Six Minute Walk test (6MWT) will be used to assess the functional capacity of the individuals with HF. The subjects will be instructed to walk for 6 minutes at a given time along a 30-m line at an interval of 1.5 m in an outdoor corridor, and the distance walked will be recorded in meters. The participants will be encouraged to continue walking as fast as possible. Then a generalized equation will be used to predict peak VO2 from 6 minute walk distance (6MWD) with the help of formula. Mean Peak VO2 (ml/kg/Mean) = 4.948 + 0.023 *Mean 6MWD (meters) | 12 week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of life (Minnesota Living with Heart Failure Questionnaire) | Changes from the baseline will be measured. Quality of life will be measured through Minnesota Living with Heart Failure Questionnaire (MLHFQ). It is one of the most widely used health-related quality of life questionnaires for individuals with HF. It provides scores for two dimensions, physical and emotional, and a total score. The MLHFQ is a self-administered, 21-item disease-specific instrument for individuals with HF. Each item is scored in a 6-point Likert Scale (0 to 5), thus the total score could range from 0 to 105, with higher scores indicating more significant impairment in health-related quality of life. The MLHFQ has two domains; physical domain (eight items, score range from 0 to 40) and emotional domain (five items, score range from 0 to 25). | 12 week | 
| Strength | Changes will be measured at baseline, 4th week, 8th week and 12th week. Maximum muscle strength of the all major muscles biceps, triceps, quadriceps and hamstring, will be measured in sitting position with (MicroFET2 Digital Handheld Dynamometer muscle tester). | 12 week | 
| Maximal strength of respiratory muscles | Changes will be measured at baseline, 4th week, 8th week and 12th week. Maximum Inspiratory pressure (MIP) and Maximal Expiratory pressure (MEP) will be assessed through a handheld mouth pressure meter. | 12 week | 
| Forced Expiratory Volume in 1 second (FEV1) | Changes will be measured at baseline, 4th week, 8th week and 12th week, the digital spirometer is used in clinical setting to analyze Forced Expiratory Volume in 1 second FEV1 in Liters | 12 week | 
| Forced vital Capacity (FVC) | Changes will be measured at baseline, 4th week, 8th week and 12th week, the digital spirometer is used in clinical setting to analyze Forced vital Capacity in Liters | 12 week | 
| Peak Expiratory Flow (PEF) | Changes will be measured at baseline, 4th week, 8th week and 12th week, the digital spirometer is used in clinical setting to analyze peak expiratory flow PEF in Liter/second. | 12 week | 
| Cardiac Risk Factors - Blood Pressure | Changes from the Baseline, Blood pressure (Bp) (both systolic/diastolic) will be measured in mmHg. It will be measured manually through sphygmomanometer by trained assessor in sitting position at baseline and at end of training on each week (for safety check). | 12 week | 
| Cardiac Risk Factors - Body mass index | Changes will be measured at baseline, 6th week and at 12th week. Weight in kilograms (kg) and Height in meters (m) will be combined to report BMI in kg/m^2 to measure the Body mass index | 12 week | 
| Cardiac Risk Factors - Lipid profile | Changes form the baseline, The lipid profile includes total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG). All units are in mmol/L. | 12 week |