title: Effects of education, self-care instruction and physical exercise on patients with chronic heart failure.
abstract: BACKGROUND
  Evidence is now evolving of the importance of team management for patients with chronic heart failure. This includes education, patient self-care and physical exercise training. How such programs should be implemented is still under discussion.
  
  
  OBJECTIVE
  To assess the efficacy of an in-hospital rehabilitation clinic-based program, we studied its influence on cardiopulmonary parameters and quality of life in an outpatient setting.
  
  
  RESULTS
  75 patients (62 male, 13 female, mean age 65+/-8 years) underwent an exercise program including education, bicycle ergometer, muscle strength training and the 6-min walk test as a training unit for 4 weeks. Patients were studied at baseline (T1), before discharge (T2) and after a follow-up period of 29.9+/-5.5 weeks (T3). Baseline data (T1): left ventricular ejection fraction (LVEF): 33.8+/-7.6%, left ventricular end-diastolic volume (LVEDV): 130+/-51 ml, peak VO(2): 12.3+/-4.3 ml/kg, maximum work load (Watt max): 71+/-27 W. At discharge (T2) and follow-up (T3) LVEF increased to 36.8+/-8% and 41.8+/-9.2%, LVEDV decreased to 127+/-43 ml and 114+/-40 ml, peak VO(2) increased to 14.1+/-5.1 ml/kg and 15.2+/-5 ml/kg, and Watt max increased to 84+/-28 Wand 98+/-42 W (all p<0.01). Quality of life improved significantly at discharge and follow-up in nearly all domains and in the summary score for physical health. There were no significant changes for anxiety and depression at T2 and T3.
  
  
  CONCLUSIONS
  A specialized in hospital rehabilitation program including education, patient self management and training has a sustained positive effect on cardiopulmonary parameters and physical well-being.
authors.affiliation: Rehabilitationszentrum Gernsbach, Langer Weg 3, 76593 Gernsbach, Germany. cardiol@hkz-gernsbach.de
authors.forename: E
authors.initials: E
authors.lastname: Miche
authors.forename: G
authors.initials: G
authors.lastname: Herrmann
authors.forename: U
authors.initials: U
authors.lastname: Wirtz
authors.forename: H
authors.initials: H
authors.lastname: Laki
authors.forename: M
authors.initials: M
authors.lastname: Barth
authors.forename: A
authors.initials: A
authors.lastname: Radzewitz
mesh_terms: D000368:Aged; D002306:Cardiac Volume / Q000502:physiology; D002908:Chronic Disease; D015897:Comorbidity; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010348:Patient Care Team; D010353:Patient Education as Topic; D011788:Quality of Life / Q000523:psychology; D012047:Rehabilitation Centers; D012648:Self Care; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology