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Abstract
Purpose
The purpose of this study was to identify the effects of reinforced walking exercise on dyspnea-fatigue symptoms, daily activities, walking ability and health related quality of life (HRQoL) in heart failure patients.
Methods
This study used a randomized controlled trial design. The participants (experimental group=16, control group=25) were recruited from a university hospital in Kyeong-nam area. Data were collected from March to September, 2015. The reinforced walking exercise included goal setting and feedback (telephone and text message) provided for 12 weeks. Dyspnea-Fatigue Index, Korean Activity Scale/Index (KASI), six-minute walking distance (6MWD) and HRQoL were measured. Data were analyzed using descriptive statistics, t-test, Fisher's exact test, χ² test, and Kolmogrove-Smirnov test.
Results
Prior to the intervention there were no differences in the research variables between two groups. The exercise compliance in the experimental group was 100% (walking for 50 minutes per day, 5 times per week). The experimental group had improved dyspnea-fatigue symptoms (t=8.63, p<.001), daily activities (t=-4.92, p<.001), longer 6MWD (t=-5.66, p<.001), and increased HRQoL (t=-9.05, p<.001) compared to the control group.
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Table 1.
Reinforced Walking Exercise Program
Table 2.
Characteristics and Homogeneity Test between Control and Experimental Groups (N=41)
| Characteristics | Categories | Total | Control (n=25) | Exp. (n=16) | x2 or t (p) | |
|---|---|---|---|---|---|---|
| n (%) or M±SD | D n (%) or M±SD | n (%) or M±SD | ||||
| Age (year) (range 40~77) | ＜65 | 30 (73.2) | 17 (68.0) | 13 (81.3) | 0.87 (.287)§ | |
| ≥65 | 11 (26.8) | 8 (32.0) | 3 (18.8) | -0.86 (.393) | ||
| 58.02±12.04 | 56.72±14.38 | 60.06±6.97 | ||||
| Gender | Male | 30 (73.2) | 17 (68.0) | 13 (81.3) | 0.87 (.478)§ | |
| Female | 11 (26.8) | 8 (32.0) | 3 (18.8) | |||
| Spouse | No | 2 (4.9) | 0 (0.0) | 2 (12.5) | 3.29 (.146)§ | |
| Yes | 39 (95.1) | 25 (100.0) | 14 (87.5) | |||
| Level of education | ≤Junior high school | 9 (22.0) | 7 (28.0) | 2 (12.5) | 6.61 (.085) | |
| High school | 13 (31.7) | 5 (20.0) | 8 (50.0) | |||
| ≥College | 19 (46.3) | 13 (52.0) | 6 (37.5) | |||
| Regular exercise | No | 41 (100.0) | 25 (100.0) | 16 (100.0) | ||
| Monthly household income (10,000 won) | ＜100 | 4 (9.8) | 2 (8.0) | 2 (12.5) | 0.32 (.854) | |
| 100~199 | 7 (17.1) | 4 (16.0) | 3 (18.8) | |||
| ≥200 | 30 (73.2) | 19 (76.0) | 11 (68.8) | |||
| Left ventricular ejection fraction (%) | 31.15±6.92 | 31.88±6.98 | 30.00±6.88 | 0.85 (.403) | ||
| NYHA class | II | 36 (87.8) | 22 (88.8) | 14 (87.5) | 0.01 (＞.999)§ | |
| III | 5 (12.2) | 3 (12.0) | 2 (12.5) | |||
| Comorbidity | No | 16 (39.0) | 11 (44.0) | 5 (31.3) | 0.67 (.519)§ | |
| Yes† | 25 (61.0) | 14 (56.0) | 11 (68.8) | |||
| Hypertension | 25 (100.0) | 14 (56.0) | 11 (44.0) | |||
| Diabetes mellitus | 6 (24.0) | 2 (8.0) | 4 (16.0) | |||
| Etc.‡ | 7 (28.0) | 3 (12.0) | 4 (16.0) | |||
| Medication | Beta-blocker | Yes | 35 (85.4) | 21 (84.0) | 14 (87.5) | 0.10 (＞.999)§ |
| No | 6 (14.6) | 4 (16.0) | 2 (12.5) | |||
| ACE inhibitor | Yes | 29 (70.7) | 17 (68.0) | 12 (75.0) | 0.23 (.734)§ | |
| No | 12 (29.3) | 8 (32.0) | 4 (25.0) | |||
| Diuretics | Yes | 31 (75.6) | 19 (76.0) | 12 (75.0) | 0.01 (＞.999)§ | |
| No | 10 (24.4) | 6 (24.0) | 4 (25.0) | |||
| Physical activity (MET-minutes/week) | Inactive | 26 (63.4) | 18 (72.0) | 8 (50.0) | 3.11 (.211) | |
| Minimally active | 11 (26.8) | 6 (24.0) | 3 (31.3) | |||
| HEPA | 4 (9.8) | 1 (2.4) | 3 (18.8) |
Table 3.
Levels of Dyspnea-fatigue Symptoms, Daily Activities, Walking Ability and Health related QoL and Homogeneity Test (N=41)
| Characteristics | Total | Cont. (n=25) | Exp. (n=16) | t (p) | ||
|---|---|---|---|---|---|---|
| M±SD | M±SD | Z† (p) | M±SD | Z† (p) | ||
| Dyspnea-fatigue symptoms | 5.90±1.88 | 6.20±1.78 | 0.967 (.307) | 5.44±2.00 | .943 (.336) | 1.28 (.210) |
| Daily activities (KASI) | 34.76±11.75 | 35.02±11.57 | 0.646 (.798) | 34.35±12.40 | .817 (.517) | 0.18 (.861) |
| Walking ability (6MWD; m) | 337.32±71.03 | 339.20±79.11 | 1.019 (.251) | 334.38±58.53 | .388 (.998) | 0.21 (.835) |
| HRQoL | 69.80±11.69 | 72.54±11.77 | 1.052 (.219) | 65.53±10.53 | .823 (.508) | 1.94 (.060) |
Table 4.
Walking Compliance and Levels of Physical Activity in Experimental Group (N=16)
| Characteristics | Pretest | Posttest | t (p) |
|---|---|---|---|
| n (%) or M±SD | n (%) or M±SD | ||
| Walking compliance (MET-minute/week)† | |||
| ＜825 | 15 (93.8) | 0 (0.0) | |
| ≥825 | 1 (6.3) | 16 (100.0) | |
| Physical activity‡ | 2110.50±1693.79 | 3611.25±2513.51 | 3.45 (.041) |
| Inactive | 8 (50.0) | 0 (0.0) | |
| Minimally active | 5 (31.3) | 12 (75.0) | |
| HEPA | 3 (18.8) | 4 (25.0) | |
Table 5.
Effects of Reinforced Walking Exercise Program on Patients Outcomes (N=41)
| Variables | Groups | Pretest | Posttest | t (p)† | Mean differences | t (p) |
|---|---|---|---|---|---|---|
| M±SD | M±SD | |||||
| Global perceived improvement in dyspnea-fatigue | Cont. (n=25) | - | 4.08±0.57 | 8.63 | ||
| Exp. (n=16) | - | 2.56±0.51 | (＜.001)‡ | |||
| Daily activities (KASI) | Cont. (n=25) | 35.02±11.57 | 35.38±12.00 | 0.60 (.553) | 0.36±3.02 | -4.92 (＜.001) |
| Exp. (n=16) | 34.35±12.40 | 39.80±13.03 | 6.16 (＜.001) | 5.45±3.53 | ||
| Walking ability (6MWD, m) | Cont. (n=25) | 339.20±79.11 | 349.60±78.87 | -1.64 (.114) | 10.40±31.69 | -5.66 (＜.001) |
| Exp. (n=16) | 334.38±58.53 | 403.13±52.50 | -8.23 (＜.001) | 68.75±33.04 | ||
| Health related quality of life | Cont. (n=25) | 72.54±11.77 | 72.77±12.48 | -0.37 (.709) | 0.23±3.04 | -9.05 (＜.001) |
| Exp. (n=16) | 65.53±10.53 | 79.79±7.340 | -9.99 (＜.001) | 14.26±5.71 |
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