In people with both heart failure and atrial fibrillation, physical capacity improves if individualized, therapist-led, exercise-based training is provided. This method yields better results than prescribing physical activity for these patient groups, a thesis shows.
People with chronic heart failure quickly get out of breath and can frequently walk only short distances. Atrial fibrillation, too, results in impaired physical fitness, and often prompts anxiety about overloading the heart. It is mainly older people who are affected by these diseases.
“Many patients avoid moving and training for fear of overstraining the heart. I believe they get vital social support from being able to train with others in cardiac rehabilitation. There, they dare exert themselves more in training, since it’s individualized and supervised by a physical therapist.”
The speaker is Maria Borland, who has a PhD from Sahlgrenska Academy, University of Gothenburg, and is a clinical physical therapist in primary care in Västra Götaland, southwest Sweden. One paper forming part of her thesis relates to 42 elderly patients with heart failure who also had other diseases, including diabetes and high blood pressure. Under a physical therapist’s supervision, these patients underwent training that comprised both cyclings with individualized loads and strength training to exercise specific muscles with weights.
“Training one muscle at a time doesn’t load the heart as much, but still strengthens the muscles. I could see that the patients were able to exercise more vigorously, with a better work capacity and greater muscular stamina. Their own perception was also that the training made them more active,” Borland says.
Previous research has shown that improved fitness and muscle strength for older people with heart failure gives them a better prognosis and results in fewer hospital admissions. Where atrial fibrillation is concerned, the scientific basis is weaker; but current research shows that, if the right requirements are met, fitness and strength training helps this group as well.
A paper included in Borland’s thesis describes how 96 patients with permanent atrial fibrillation were divided into two groups. One group underwent training with a physical therapist in a cardiac rehabilitation centre. The other received prescriptions for physical activity, in these cases in the form of getting walks prescribed.
“Those who trained with a physical therapist in the cardiac rehabilitation centre achieved a clear improvement in physical capacity, but there was no effect at all for those who went for walks on their own. The walking simply didn’t involve sufficient intensity to give results,” Borland says.
Although there is no central recommendation from the Swedish National Board of Health and Welfare on physical training in cardiac rehabilitation for atrial fibrillation, this training is offered at the hospital in Alingsås where Maria Borland works. There, the patients get individualized training led by a physical therapist.
“Patients with atrial fibrillation are a large group that we could really help. But at many other places today they don’t have the option of taking part in cardiac habilitation at all,” Maria Borland says.
Some 200,000 people in Sweden are estimated to have heart failure, and roughly 300,000 have atrial fibrillation.
Title: Exercise-based cardiac rehabilitation, physical fitness, and physical activity in cardiac disease