title: Home-based telemonitored Nordic walking training is well accepted, safe, effective and has high adherence among heart failure patients, including those with cardiovascular implantable electronic devices: a randomised controlled study.
abstract: BACKGROUND
  The benefits of rehabilitation in heart failure (HF) patients are well established. Little is known about Nordic walking (NW) training in HF patients especially in those with cardiovascular implantable electronic devices (CIEDs).
  
  
  OBJECTIVE
  The purpose of this study was to assess safety, effectiveness, adherence to and acceptance of home-based telemonitored NW in HF patients, including those with CIEDs (i.e. cardiac resynchronisation therapy, implantable cardioverter-defibrillator).
  
  
  METHODS
  The study design was a single-centre, prospective, parallel-group, randomised (2:1), controlled trial among 111 HF patients, New York Heart Association (NYHA) II-III; left ventricular ejection fraction (EF) ≤ 40%. The intervention was a home-based telemonitored eight-week NW (training group (TG) n = 77) five times weekly vs usual care alone (control group (CG) n = 34). Outcome measures included a primary end point of functional capacity assessed by peak oxygen consumption (VO2peak). Secondary end points included: workload duration (t) in cardiopulmonary exercise test (CPET), six-minute walking test (6-MWT) distance and quality of life (QoL), Medical Outcome Survey Short Form 36 (SF-36); safety; adherence to and acceptance of NW. Measurements were made before and after intervention.
  
  
  RESULTS
  NW resulted in significant improvement in: VO2peak (16.1 ± 4.0 vs 18.4 ± 4.1(ml/kg/min), p = 0.0001), t (471 ± 141 vs 577 ± 158 (s), p = 0.0001), 6-MWT(428 ± 93 vs 480 ± 87 (m), p = 0.0001) and QoL (79.0 ± 31.3 vs 70.8 ± 30.3 (score), p = 0.0001). We did not observe favourable results in the CG. The differences between the TG and CG were significant in: ΔVO2peak (Δ2.0 ± 2.4 vs Δ-0.2 ± 2.1, p = 0.0004); Δt (Δ108 ± 108 vs Δ0.94 ± 109, p = 0.0031); Δ6-MWT (Δ53.8 ± 63.9 vs Δ22.0 ± 68.7, p = 0.0483). In neither group were there deaths nor necessity for hospitalisation. We did not observe any intervention from CIEDs during NW. All patients in the TG completed rehabilitation and accepted it well.
  
  
  CONCLUSIONS
  In HF patients, including those with CIEDs, home-based telemonitored NW is safe and effective. NW was well accepted by patients and adherence was high and promising.
authors.affiliation: Telecardiology Center, Institute of Cardiology, Poland epiotrowicz@ikard.pl.
authors.forename: Ewa
authors.initials: E
authors.lastname: Piotrowicz
authors.affiliation: Department of Heart Failure and Transplantology, Institute of Cardiology, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zieliński
authors.affiliation: Department of Arrhythmia, Institute of Cardiology, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Bodalski
authors.affiliation: Department of Heart Failure and Transplantology, Institute of Cardiology, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rywik
authors.affiliation: Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Dobraszkiewicz-Wasilewska
authors.affiliation: Department of Heart Failure and Transplantology, Institute of Cardiology, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Sobieszczańska-Małek
authors.affiliation: Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Stepnowska
authors.affiliation: Department of Arrhythmia, Institute of Cardiology, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Przybylski
authors.affiliation: Department of Heart Failure and Transplantology, Institute of Cardiology, Poland.
authors.forename: Aldona
authors.initials: A
authors.lastname: Browarek
authors.affiliation: Department of Arrhythmia, Institute of Cardiology, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Szumowski
authors.affiliation: Statistics Laboratory, Institute of Cardiology, Poland.
authors.forename: Walerian
authors.initials: W
authors.lastname: Piotrowski
authors.affiliation: Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Piotrowicz
mesh_terms: D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010349:Patient Compliance; D011044:Poland; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D000069350:Telerehabilitation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016138:Walking
keywords: Nordic walking training; Telerehabilitation; heart failure