Efficacy of a Home-Based Exercise Program in the Management of Heart Failure: An Evidenced-Based Multi-Disciplinary Approach

This study is IRB approved at Catholic Home Care and at New York Institute of Technology due to collaboration between Catholic Home Care and New York Institute of Technology. Subjects will be volunteers, recruited during the initial therapy visit from 10 trained CHC staff and subsequently randomized based on their patient identification number into an experimental group or experimental group after consent has been obtained.

Subjects will sign a consent form to enter the study. Two groups of 40 subjects will be required to finish in order to obtain power of 80 at an alpha of .05. The subjects will be living at home with a reliable caregiver. The nurse will provide current best practice to all CHF patients in the study which includes educating the patient and caregiver regarding diet, medication regime, monitoring for signs and symptoms to report and provide coordination of other disciplines such as social work for those with depression requiring additional management during OASIS screening.

During the initial physical therapy visit, the usual care assessment will be performed, in addition, to obtaining pre-test baseline data for the experimental and control groups. A preliminary home exercise program will be assigned. A handout on pacing activity and deep breathing will be given. The importance of and reason for the perceived exertion scale will be explained to experimental group subjects and a handout will be given that will be part of the study packet.

All subjects will be encouraged to complete the home aerobic portion a minimum of 2 times per day and will be given an activity log from which to check off the same and enter the number and distance achieved when walking for exercise. Resistance exercises will be done at least twice per week with one day of rest between sessions. For the control group subsequent sessions will include usual home care physical therapy consisting of breathing exercises, therapeutic exercise, transfer, gait training, and home exercise programs. Baseline measurements (field testing) will be completed at the initial evaluation and discharge from therapy. In addition, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and questions about re-hospitalizations, activity logs, falls follow up will be collected and reviewed at 6 and 12 months after the program.

Baseline measurements: The 2-Minute step test (2MST) is an aerobic measure that has been used with older adults.17 The subject is instructed to raise the knee joint to a point halfway between the patella and iliac crest at a comfortable pace for 2 minutes. It is scored by counting the number of times the right knee reaches the point described for 2 minutes. Vital signs including BP, PR, RR, RPE, pulse ox, and signs and symptoms of decompensation are monitored before, during and after test administration. The 2MST has been validated to several other measurement tools of aerobic capacity/endurance.