| Objective: To evaluate the effect of ABC slow rehabilitation physical training program on left ventricular diastolic function and physical function in frail elderly patients with heart failure.Methods: A single-blind randomized controlled trial was conducted.A total of60 frail elderly patients with heart failure were recruited and divided into the intervention group and the control group.The intervention group was treated with ABC slow rehabilitation training program on the basis of conventional treatment,and the control group was only treated with conventional treatment.The rehabilitation effect of patients was observed by echocardiography,SPPB and other indicators.Results: A total of 60 patients were enrolled at baseline,and 49 patients completed follow-up.There were 26 patients in the slow rehabilitation training group,16(56.4%)males,with an average age of 72.69±7.32 years.There were 23 cases in the control group,15(65.2%)males,with an average age of 68.61±5.32 years.There were no statistically significant differences between the two groups in terms of age,gender,BMI,coronary heart disease,hypertension,diabetes,hyperlipidemia,atrial flutter or atrial fibrillation,and the results were comparable.Results for the primary and secondary efficacy measures were as follows:1 Primary efficacy index1.1 Left ventricular diastolic functionE/e’ value results:(1)Comparison of data between the control group and the intervention group: there was no significant difference at baseline and after the intervention(P>0.05).There was no significant difference in the difference between the two groups before and after intervention(intervention group-0.60 vs control group-1.00,P=0.588 > 0.05).(2)There was no significant difference in E/e’ between control group and intervention group before and after intervention(P>0.05).e’ value results:(1)Comparison of data between the control group and the intervention group: there was no statistically significant difference(P>0.05).There was no significant difference in the difference between the two groups(P=0.096 >0.05).(2)There was no significant difference in e’ between the control group and the intervention group before and after intervention(P>0.05).Subgroup analysis: Subgroup analysis was further performed in heart failure patients with baseline ejection fraction ≥50%(heart failure with preserved ejection fraction).E/e’ results:(1)Comparison of data between the control group and the intervention group: there was no significant difference at baseline and after the intervention(P>0.05).There was no significant difference in the difference between the two groups(intervention group 0.89 vs control group-0.10,P=0.08 > 0.05).(2)There was no significant difference in E/e’ between control group and intervention group before and after intervention(P>0.05).e’ value results:(1)Comparison of data between the control group and the intervention group: there was no statistically significant difference(P>0.05).The difference between the intervention group(1.91cm/s)and the control group(-3.33cm/s)was statistically significant(P=0.02 < 0.05).(2)There was no significant difference in e’ between the control group and the intervention group before and after intervention(P>0.05).1.2 SPPB results:(1)Comparison of data between the control group and the intervention group: after the intervention,the intervention group(9.42±1.63)vs the control group(7.87±1.89),P=0.003 < 0.05.The difference between the two groups was(2.96±2.16)in the intervention group and(1.65±2.17)in the control group,and the difference was statistically significant(P < 0.05).(2)Comparison between baseline and after intervention in the intervention group: the SPPB score in the intervention group was statistically significant(P < 0.05).2 Secondary efficacy measures2.1 Scale EvaluationGAD-7 results:(1)Comparison between the intervention group and the control group: there was no significant difference between the intervention group and the control group at 1.5 months and 3 months(P1.5 months =0.879;P3 month =0.381).The difference between the control group(0)and the intervention group(-1.5)was statistically significant(P=0.014 < 0.05).(2)Comparison of baseline and post-intervention in the intervention group: after 1.5 and 3 months of intervention,the values of patients in the slow rehabilitation training group at 1.5 and 3 months were significantly lower than those at baseline(P1.5 months =0.047;P3 month =0.014).PHQ-9 results:(1)Comparison between the intervention group and the control group: the PHQ-9 data of the patients after 1.5 months of intervention were not statistically significant(P=0.200>0.05);After 3 months of intervention,there was no significant difference between the intervention group(3 points)and the control group(6 points)(P=0.001 < 0.05).The difference between the intervention group(-3.5)and the control group(0)was statistically significant(P=0.03 < 0.05).(2)Comparison of baseline and post-intervention in the intervention group: the values of patients in the slow rehabilitation training group at 1.5 months and 3 months were significantly lower than those at baseline(P1.5 months =0.002;P3 month =0.001).PSQI results:(1)Comparison between the intervention group and the control group: after 1.5 months of intervention,the intervention group(6 points)vs the control group(13 points),the difference was statistically significant(P=0.001<0.05).After 3 months of intervention,the intervention group(5 points)vs the control group(12 points).There was statistical significance(P=0.00<0.05).The difference between the intervention group(-3.5)and the control group(0)was statistically significant(P=0.03 < 0.05).(2)Comparison of baseline and post-intervention in the intervention group: the values of patients in the slow rehabilitation training group at 1.5 months and 3 months were significantly lower than those at baseline(P1.5 months =0.025;P3month =0.003).Results of SF-12:(1)Comparison between the intervention group and the control group: there was no statistically significant difference in SF-12 data after 1.5months of intervention(P=0.225>0.05);After 3 months of intervention,the intervention group(72.50)vs the control group(56.25)was statistically significant(P=0.013 < 0.05).Compared with the control group(-3),the intervention group(20.94)had a significant difference(P=0.044 < 0.05).(2)Comparison of intervention group at baseline and after intervention: after 1.5 months of intervention,SF-12 data were not statistically significant(P>0.05).After 3 months of intervention,the SF-12 data of patients with ABC slow rehabilitation training were statistically significant compared with the baseline(P=0.001<0.05).FIM results:(1)Comparison between the intervention group and the control group: at 1.5 months,the scores of the intervention group(114)and the control group(115)were not statistically significant(P=0.778>0.05);In March,the intervention group(116 points)vs the control group(105 points),the difference was statistically significant(P=0.027<0.05).The difference between the intervention group(7.5)and the control group(-3)was statistically significant(P=0.032<0.05).(2)Comparison between baseline and post-intervention in the intervention group: FIM scores increased significantly at 1.5 months and 3 months(P1.5 months = 0.004;P3 month=0.001).MOCA results:(1)Comparison between the intervention group and the control group: after the intervention,the intervention group(24 points)vs the control group(24 points),there was no statistically significant(P=0.942>0.05).The difference between intervention group(2 points)and control group(1 point)was not statistically significant(P=0.624>0.05).(2)Comparison between baseline and after intervention in the intervention group: the MOCA assessment of the slow rehabilitation training group after intervention was higher than that of the baseline value,and the difference was statistically significant(Z=-2.252,P=0.024<0.05).2.2 Results of six-minute walk distance:(1)After the intervention,the intervention group(300m)vs the control group(281m),with no statistical significance(P=0.609>0.05).The difference between the intervention group(69m)and the control group(45m)was statistically significant(P=0.041 < 0.05).(2)Comparison of intervention group at baseline and after intervention: the difference was not statistically significant.2.3 Results of echocardiographyLVEF results:(1)Comparison between the intervention group and the control group: after the intervention,the intervention group(64%)vs the control group(56.1%),P=0.012 < 0.05.The difference between the intervention group(2.7%)and the control group(0.45%)was statistically significant(P=0.021 < 0.05).(2)Comparison between baseline and after intervention in intervention group: LVEF in ABC slow rehabilitation training group(Z=-2.556,P=0.011 < 0.05),the difference was statistically significant.End diastolic volume,end systolic volume,end diastolic diameter,end systolic diameter and E/A Results:(1)Comparison between the intervention group and the control group: after intervention,there was no statistically significant difference in end diastolic volume,end systolic volume,end diastolic diameter,end systolic diameter and E/A(P>0.05).The difference of end-systolic volume between the intervention group(-2.9ml)and the control group(3.75ml)was statistically significant(P=0.005 < 0.05).The differences of other indicators were not statistically significant.(2)Comparison of intervention group at baseline and after intervention: the differences of all indicators were not statistically significant.The comparison between baseline and after intervention in the control group: the end-systolic volume at baseline(59.75ml)was significantly lower than that after intervention(57.5ml)(P <0.05);The differences of other indicators were not statistically significant.2.4 NT-pro BNP results:(1)Comparison between the intervention group and the control group: after the intervention,the intervention group(764pg/ml)vs the control group(587pg/ml),there was no statistically significant(P=0.198>0.05).The difference between intervention group(-194.9pg/ml)and control group(5.1pg/ml)was statistically significant(P=0.033 < 0.05).(2)Comparison between baseline and after intervention in intervention group: the difference was not statistically significant(P>0.05).2.5 Frailty: after 3 months of intervention,there were 4(15.4%)frail patients in the slow rehabilitation training group and 20(87%)in the control group.The number of frail patients in the two groups showed a downward trend,but the number of frail patients in the slow rehabilitation training group was significantly lower than that in the control group,X2=25.02,P<0.05.2.6 Adverse events: No adverse events occurred in both groups during exercise rehabilitation,and the compliance of slow rehabilitation training group(73.08%)was significantly higher than that of control group(39.13%).2.7 Reasons for patients lost to follow-up:(1)Cause of the epidemic;(2)traffic and site reasons;(3)patients moved to other places;(4)Patients’ expectations and goal setting are the reasons that affect patients’ adherence to participate in follow-up and continue training.Conclusions:1.ABC slow rehabilitation training for 3 months can improve the left ventricular diastolic function and physical function of elderly frail heart failure patients with preserved ejection fraction,and can improve the frailty state of elderly frail heart failure patients,which has good clinical significance.2.ABC slow rehabilitation training for 3 months can significantly improve left ventricular systolic function and aerobic endurance in elderly patients with frail heart failure.3.ABC slow rehabilitation training for 3 months can significantly improve anxiety,depression,sleep quality and quality of life in elderly patients with frailty and heart failure.4.ABC slow rehabilitation training program is highly accepted by patients,with good compliance and good safety. |
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