Can exercise improve the functional status of patients with heart failure and ultimately their overall quality of life?
And, once they learn how to exercise, how can those same patients be encouraged to stick with it?
Co-investigators Bunny Pozehl, Ph.D., Kathleen Duncan, Ph.D., Joseph Norman, Ph.D., and Melody Hertzog, Ph.D., will spend the next two years searching for answers to these questions with support from a National Institute of Nursing Research grant totaling $220,500.
Drs. Pozehl and Duncan are both associate professors and Dr. Hertzog is an assistant professor with the UNMC’s College of Nursing Lincoln Division, and Dr. Norman is an associate professor with the School of Allied Health Professions at UNMC.
“Exercise has been shown to improve heart function,” Dr. Norman said. “However, the biggest benefit of exercise for individuals with heart failure is the peripheral conditioning that occurs – the enhanced ability of muscles to take oxygen out of the blood stream.”
This two-fold effect of exercise, he said, is vitally important for patients with heart failure because of the limitations in the heart’s ability to pump oxygen-rich blood to the body’s muscles in order to carry out daily activities.
Oxygen is important in muscle metabolism for energy development, which allows muscles to work for prolonged periods of time.
“With appropriate aerobic training,” Dr. Norman said, “the muscles become more efficient at being able to take greater amounts of oxygen out of the blood and the heart is more efficient at pumping blood than before training.”
These are key ways to enhance oxygen delivery to the muscles and thus allow people with heart failure to maximize their functional abilities, he said.
“Every tissue in our body needs oxygen to live,” said Dr. Pozehl, who also is the principal investigator of the grant. “Our blood is the primary source of that oxygen.”
When a person is diagnosed with heart failure, it means part of their heart has been damaged, she said, either by a heart attack or viral infection and no longer able to pump blood at full capacity.
This leads to fatigue, shortness of breath and an over-all lower quality of life, Dr. Pozehl said.
To find out how exercise helps the heart and how to help patients commit to exercising Dr. Pozehl came up with the idea of HEART (Heart Failure Exercise and Resistance Training) Camp.
Over a 24-week period, Drs. Pozehl, Duncan, Norman and Hertzog will monitor the progress of 48 patients with heart failure.
The patients will be divided into two groups of 24.
One group will be given explicit instructions on what exercises to do and how to correctly perform them, as well as be shown charts of their progress and attend weekly meetings for encouragement and support.
The second group – the attention control group – will only be given general information about heart disease, the kinds of foods they should eat and how to relax.
Pozehl said she hopes the study will improve the patients’ ability to exercise and maintain lifelong exercise behavior. “The thinking 25 years ago was ‘don’t over exercise,’ but that has changed as research has shown the benefits for people with heart failure,” she said.
Pozehl’s interest in this topic comes from working with patients who have heart failure once a week at BryanLGH Heart Institute in Lincoln. “I see their struggles and I want to help them have a better quality of life,” Pozehl said.
Five million Americans have heart failure, Dr. Duncan said. And as more people get older, heart failure is going to become an even bigger problem. “Based on data from the American Heart Association the lifetime risk of developing heart failure by the age of 40 is one in five, for both men and women,” Dr. Duncan said. The survival rate for people with heart failure is dismal with many only living eight years after the initial diagnosis.
“While heart failure is a progressive condition,” said the co-investigators. “There is evidence that exercise can improve a person’s functional ability and their quality of life. The key is learning exercise behavior and maintaining this behavior over time.”