Clinical trial NCT03780803: Effect of Home Rehabilitation on State of Patients With PAH, HFREF and IHD
Official title: Evaluation of Influence of Home Physical Training Program and Respiratory Rehabilitation on Quality of Life, Body Composition, and Function of Respiratory Muscles in Patients With Primary PAH, HFREF and IHD
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Pulmonary Hypertension
Heart Failure With Reduced Ejection Fraction
Ischemic Heart Disease
Keywords: cardiac rehabilitation
pulmonary rehabilitation
Lead sponsor: Medical University of Bialystok
Sponsor class: OTHER
First posted: 2018-12-19
Enrollment: 93
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: The aim of the study is to evaluate the influence of physical training and respiratory rehabilitation performed by patients at home on quality of life, symptoms, physical endurance, force of respiratory and skeletal muscles and body mass composition in patients with pulmonary arterial hypertension (PAH) or left ventricular heart failure with reduced ejection fraction - HFREF), or ischemic heart disease and evaluation the number of stem cells, natural lymphoid cells and distribution of subpopulations of monocytes (including proangiogenic monocytes) in examined persons and evaluation of theirs eventual influence of the course of disease.

Detailed description: The study will be conducted on total group of 100 participants, from which 75 will be the patients with PAH (pulmonary arterial hypertension), HF-REF (heart failure with reduced ejection fraction) or IHD (ischemic heart disease).

In all participants medical anamnesis, physical examination, anthropometric measures, 6-minute walking distance (6MWD six minute walking distance) will be performed and initial functional class according WHO (World Health Organisation)/NYHA (New York Health Association)/CCS (Canadian Cardiovascular Society) classification will be evaluated. Medical history will consist of questions regarding coexisting diseases, treatment, lifestyle, family burden, etc. Quality of life will be assessed with use of The Short Form (36) Health Survey - SF-36) and Fatigue Severity Scale - FSS. Biochemical measures will be performed including, among others. brain natriuretic peptide (BNP), blood morphology, P-selectin, concentrations of cytokines such as : Interleukin 6 (IL-6), soluble Interleukin 6 receptor (sIL-6R), stromal derived factor-1 (SDF-1, CXCL12) and soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK).

Among lab parameters routinely measured in groups of patients with PAH, HFREF, IHD performed in Cardiology Department of University Clinical Hospital during hospitalization will be used: creatinine level, uric acid level, total cholesterol, LDL (low density lipoprotein), HDL (high density lipoprotein), triglycerides levels, troponin I level, CRP (C reactive protein), BNP (brain natriuretic peptide), fasting glucose, TSH (thyroid stimulating hormone), blood morphology and arterial geometry. Fasting venous blood will be collected in 4 tubes each a 10 ml. Two tubes a 10ml (one dedicated to obtain serum ("on clot"), second with heparin) to perform biochemical analyses, tube a 10ml with EDTA (ethylenediaminetetraacetic acid) will be used to evaluate PBMC (peripheral blood mononuclear cell) (density gradient centrifugation), tube a 10ml with citrate will be used to obtain platelet lysate.

Additionally fasting venous blood will be obtained - 2 tubes a 10ml in order to assess number of stem cells, natural lymphoid cells, and distribution of subpopulations of lymphocytes.

In clinical evaluation measurement of respiratory (inspiratory and expiratory) muscles force with use of device MicroRPM (respiratory pressure meter), analysis of body mass composition with special regard to muscular mass with use of bioelectrical impedance analysis method (BIA) (Maltron) and measurement of hand grip strength with use of hand dynamometer will be performed.

During first visit also ECG (electrocardiogram) and echocardiography will be done.

The safe protocol of home physical training and respiratory rehabilitation adjusted to the clinical state of patients will be developed in the form of brochure with photos and precise description of exercises and the diary of self-control of patient in order to collect data regarding daily physical activity will be given to participants. Patients willing to take part in stage of exercises (circa 45 persons) will be trained in Rehabilitation Department how to perform exercises at homes. Easy to use devices dedicated to respiratory exercises (Pulmogain Respitrain) enabling respiratory muscles training with various degree of intensity and pedometers to assess daily motor activity will be given to patients.

Stage of exercises during which the next series of tests will be performed will last 6 months. Exercising patients will come to Rehabilitation Department on first and third month after start of rehabilitation in order to control the correctness of training performance, filling self-control diary assessment of patients compliance and eventual corrections of training program. Patients will be also under continuous phone supervision (minimally once a week) and in the case of doubts and need for consultation. After finishing exercises stage and performed clinical evaluation, patients will by themselves decide if they are willing to continue rehabilitation (will have possibility of further use of physiotherapists care), and follow up assessment will take place after 6 months from finishing exercises stage.

Comparative group will consist of patients with PAH, HF-REF, IHD who agreed to participate in study but were not qualified to the exercises stage. Control group will consist of patients of Cardiology Department and Cardiology Outpatient Clinic and Rehabilitation Department (without cardiovascular diseases). Range of examinations in control group will consists of medical anamnesis, physical examination, anthropometric measures, individually filled questionnaires SF-36 and FSS, evaluation of respiratory muscles force, hand grip strength and analysis of body mass composition BIA.

Eligibility criteria: Inclusion Criteria:

* age \>18 years
* informed consent signed by patient to conduct the study
* no diseases excluding rehabilitation
* pts with idiopathic, inherited PAH (pulmonary arterial hypertension), or in the course of connective tissue diseases, portal hypertension, congenital heart diseases.
* PAH confirmed in catheterisation of right side of heart mPAP (mean pulmonary arterial pressure) ≥25 mmHg, PCWP (pulmonary capillary wedge pressure) ≤15mmHg.
* Chronic heart failure - left ventricle ejection fraction \<40% in echocardiography, NYHA \*New York Health Association) class II-III
* stable ischaemic heart disease in CCS (Canadian Cardiovascular Society) class II-III

Exclusion Criteria:

* Other types of pulmonary hypertension
* COPD (chronic obstructive pulmonary disease), asthma
* malignancies
* Acute inflammatory state up to 4 weeks before inclusion to the study
* Acute coronary syndrome up to 3 months before inclusion to the study
* Heart failure in NYHA IV class
* severe anaemia (Hgb \<11g/dl for men \<10g/dl for women)
* electrolyte and hormonal disturbances in period of 1 month before inclusion to the study
* substantial modification of treatment of main disease within last 3 months
* ischaemic heart disease in CCS class IV
* Other clinical situations excluding to perform controlled program of rehabilitation

Primary outcomes:
measure: Clinical improvement assesment of 6 MWT distance
timeFrame: 6 months
Secondary outcomes:
measure: Evaluation of quality of life
timeFrame: 6 months
measure: Force of respiratory muscles
timeFrame: 6 months
measure: Clinical improvement - evaluation of WHO class
timeFrame: 6 months
measure: Evaluation of NYHA class
timeFrame: 6 months
measure: Evaluation of CCS class
timeFrame: 6 months
Other outcomes:
measure: Body mass composition in patients with PAH
timeFrame: 6 months
measure: Weight
timeFrame: 6 months
measure: Concentration of BNP (brain natriuretic peptide)
timeFrame: 6 months
measure: Concentration of creatinine
timeFrame: 6 months
measure: Concentration of uric acid
timeFrame: 6 months
measure: Concentration of total cholesterol
timeFrame: 6 months
measure: Concentration of LDL
timeFrame: 6 months
measure: Concentration of HDL
timeFrame: 6 months
measure: Concentration of triglycerides
timeFrame: 6 months
measure: Concentration of CRP
timeFrame: 6 months
measure: Concentration of fasting glucose
timeFrame: 6 months
measure: Activity of TSH
timeFrame: 6 months
measure: Concentration of Troponin I
timeFrame: 6 months
measure: Number of WBC
timeFrame: 6 months
measure: Number of RBC
timeFrame: 6 months
measure: Concentration of Hemoglobin
timeFrame: 6 months
measure: Concentration of P selectin
timeFrame: 6 months
measure: Concentration of Il-6
timeFrame: 6 months
measure: Concentration of sIl-6 R
timeFrame: 6 months
measure: Concentration of SDF-1
timeFrame: 6 months
measure: Concentration of sTWEAK
timeFrame: 6 months
measure: Percentage of stem cells
timeFrame: 6 months
measure: percentage of subpopulations of monocytes
timeFrame: 6 months
Locations:
city: Białystok
country: Poland
facility: Medical University of Bialystok, Department of Rehabilitation
state: Podlaskie
Study officials:
affiliation: Medical University of Bialystok
name: Karol Kamiński, Professor
role: STUDY_CHAIR
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