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Individualisierung der Belastungssteuerung in der kardiologischen stationären Rehabilitation

Entwicklung und Evaluation eines HRV-gesteuerten Interventionsprogramms für Patienten mit ischämisch bedingter Herzinsuffizienz

Individualization of exercise load control for inpatient cardiac rehabilitation

Development and evaluation of a HRV-based intervention program for patients with ischemic heart failure

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Zusammenfassung

Hintergrund

Die effektive Nutzung zur Verfügung stehender Rehabilitationsmaßnahmen ist von elementarer Bedeutung, um die Leistungsfähigkeit von Patienten zu verbessern. Unter diesen Gesichtspunkten ist ein modulares Interventionsprogramm entwickelt worden, das bestehende sporttherapeutische Maßnahmen neu strukturiert und an die individuellen Voraussetzungen der Patienten anpasst. Eine Individualisierung sollte auf Basis einer umfangreichen Eingangsdiagnostik und täglicher Messungen der Herzfrequenzvariabilität (HRV) gesichert werden.

Methode

Es wurden 30 Patienten mit ischämisch bedingter Herzinsuffizienz im Zeitraum der stationären Rehabilitation betreut. Die Interventionsgruppe (IG) absolvierte das modulare Interventionsprogramm. Die Kontrollgruppe (KG) nutzte die standardüblichen Rehabilitationsangebote. Im Prä-Post-Vergleich wurden eine Spiroergometrie sowie ein Sechsminutengehtest (6-MWT) durchgeführt. Standardisierte 10-minütige HRV-Ruhemessungen fanden morgens statt. Das Trainingsprogramm wurde den Ergebnissen der Eingangsdiagnostik und der HRV-Analyse entsprechend individuell angepasst.

Ergebnisse

Die IG steigerte die relative maximale Sauerstoffaufnahme (VO2max) hochsignifikant, wogegen sich diese bei der KG nicht änderte. Trainingsbegleitende Analysen zeigten, dass die IG sich statistisch bedeutsam verbesserte, obwohl sie weniger Ausdauertrainingseinheiten absolvierte als die KG.

Diskussion

Die Ergebnisse belegen die höhere Effektivität des Interventionsprogramms. Die Resultate unterstreichen, dass Rehabilitationsprogramme nicht als maximale Leistungsmatrix gestaltet werden sollten. Vielmehr sollte jeder Patient nur die Maßnahmen durchführen, für die nach Eingangsdiagnostik und therapiebegleitenden Analysen Bedarf besteht.

Abstract

Background

The effective use of rehabilitation programs is of primary importance in order to improve the physical performance of cardiac disease patients. A modular program has been developed which is intended to structure and individualize conventional, exercise-based rehabilitation programs according to the individual needs and physical condition of each patient. The individualization of the program is based on detailed diagnostics before patients enter the program and daily measurements of heart rate variability (HRV) during cardiac rehabilitation.

Methods

A total of 30 patients with ischemic heart disease were randomly assigned either to the intervention group (IG), completing the modular individualized rehabilitation program [n=15, mean age 54.4±4.2 years and mean left ventricular ejection fraction (LVEF) 28.53±6.25%) or to the control group (CG) taking part in the conventional rehabilitation program (n=15, mean age 56.4±4.4 years and mean LVEF 27.63±5.62). Before and after the intervention, cardiorespiratory fitness was assessed by measurement of maximal oxygen consumption (relative VO2max) during bicycle ergometry and the 6-minute walk test (6-MWT). Pre-post comparisons of cardiorespiratory fitness indicators were used to evaluate the effectiveness of the rehabilitation program. In addition to the results of the basic clinical investigations and the cardiorespiratory testing, results of standardized HRV measurements of 10 min at morning rest served as criteria for program individualization.

Results

The relative VO2max increased significantly (p<0.05) in the IG whereas no change was found in the CG. Similar results were found for maximum power output during bicycle ergometry (p<0.01) and for 6-MWT distance (p<0.001). Although patients in the IG completed less aerobic exercise sessions than those in the CG (p<0.001) the physical performance of the IG improved significantly.

Discussion

The results prove the effectiveness and efficacy of the modular individualized rehabilitation program. They further suggest the need for an individual program matrix instead of a maximum performance matrix in cardiac rehabilitation. Individualization should be based on clinical and performance diagnostics before and accompanying assessments of training condition, e.g. by HRV measurements, during rehabilitation programs. Each patient should only perform those intervention programs which match the results of the basic clinical investigation and additional analyses during rehabilitation.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Behrens, K. Hottenrott, M. Weippert, H. Montanus, S. Kreuzfeld, A. Rieger, J. Lübke, K. Werdan und R. Stoll geben an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Institut für Präventivmedizin, Universitätsmedizin Rostock, St.-Georg-Str. 108, 18055, Rostock, Deutschland

    K. Behrens, M. Weippert, S. Kreuzfeld, A. Rieger, J. Lübke & R. Stoll

  2. Department Sportwissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland

    K. Hottenrott

  3. Elbe-Saale Klinik, Barby (Elbe), Deutschland

    H. Montanus

  4. Department für Innere Medizin, Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    K. Werdan

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  1. K. Behrens
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Behrens, K., Hottenrott, K., Weippert, M. et al. Individualisierung der Belastungssteuerung in der kardiologischen stationären Rehabilitation. Herz 40 (Suppl 1), 61–69 (2015). https://doi.org/10.1007/s00059-013-4037-2

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