Rationale:
Heart failure affects approximately 5 million Americans, it is the leading cause of death in the United States, and it is the single most costly health care challenge. Roughly 550,000 new cases of HF occur each year. In the U.S. in 2004, the estimated direct and indirect costs for HF are estimated to be $28.7 billion. Rehabilitation efforts are aimed at improving health status and quality of life (QOL), while reducing healthcare costs and hospitalizations. The American College of Cardiology/American Heart Association evidence-based practice guidelines identified exercise as a key factor for managing HF. Exercise intolerance is a fundamental symptom with HF, presenting limitations on functional status and QOL. However, implementation of rehabilitation programs for HF populations have been challenging, and adherence is a problem. A user-centered telehealth-supported home-based exercise program, with frequent feedback, may enhance adherence and improve exercise tolerance, HF symptoms, and QOL.
Objectives and Methodology:
The purpose of this prospective 2-group experimental study is to compare the effects of a 12-week telehealth home exercise rehabilitation program with usual treatment. Thirty-six subjects with Class II or III HF will be enrolled (18 per group). Subjects in both the experimental and control groups undergo submaximal exercise testing and are provided with an exercise prescription. Experimental subjects receive a recumbent stationary bike, Polar heart rate monitors, exercise logs, and telemonitoring equipment. Daily monitoring of heart rate (HR), blood pressure (BP), oxygenation (SPO2), and weight is conducted for those in the experimental group, in order to insure that they are safe to exercise and assist in disease management. Regularly scheduled televisits are held with experimental subjects providing telecoaching and telesupport. Dependent variables include the Minnesota Living with Heart Failure Questionnaire, 6-minute walk test, Specific Activity Scale, Profile of Moods States, HR, BP, SPO2, and heart rate variability.
Results:
Preliminary findings provide empirical evidence for the efficacy and effectiveness of a telehealth based home exercise program for persons with moderate heart failure. Participant satisfaction has been high with no attrition, to date.