| Objectives1.To construct a multi-component exercise training program for elderly patients with chronic heart failure and frailty.2.To investigate the effects of a multi-component exercise intervention on frailty,activities of daily living and quality of life in elderly patients with chronic heart failure and frailty.Method1.This study systematically reviewed the prevalence of frailty in elderly patients with chronic heart failure,and summarized the relevant evidence which focused on the intervention strategy of exercise training and physical activity for elderly patients with heart failure and frailty from various guideline websites and databases.Then,a first draft of the intervention plan was constructed based on the best evidence summary of the current exercise prescription for the elderly patients with heart failure and frailty,and the disease characteristics of heart failure.Finally,the multi-component exercise training intervention plan was further revised and improved by panel meeting,which consists of five experienced clinical experts,and preliminary test.A total of 8 patients meeting the inclusion criteria were selected to carry out the preliminary experiment in this study.2.Randomized controlled trial was applied in this study.A total of 71 elderly patients with chronic heart failure who met the inclusion criteria in a tertiary hospital in Shandong Province were randomly divided into an intervention group(35 cases)and a control group(36 cases)by flipping a coin.The control group received usual care,while the intervention group received an additional 12 weeks of multi-component exercise training.The differences in Tilburg Frailty Indicator(TFI)score,Barthel Index score and the short form-12 health survey(SF-12)scores were compared between the two groups after 4 and 12 weeks of intervention.SPSS 22.0 software was used for statistical analysis.We tested the application effect of multi-component exercise training using Generalized Estimated Equation(GEE).Results1.A total of 8 literature were included through systematic search and evaluation,involving 2 clinical practice guidelines,1 clinical decision,3 expert consensus and 2 randomized controlled trials.Finally,22 evidence items were summarized from seven aspects,including the necessity,principle,time,mode,intensity,amount and frequency and the matters needing attention of exercise,to provide reference for the construction of intervention programs.And a multi-component exercise training intervention plan was developed through panel meeting and pilot experiment.2.In the baseline,there was no significant difference on the general information,TFI score,Barthel index score and SF-12 score of patients between the intervention group and the control group(all P>0.05).(1)The inter-group effect,time effect and interaction effect of the TFI score and its score of physical dimension,psychological dimension and social dimension were statistically significant(all P<0.05).(2)The inter-group effect,time effect and interaction effect of the barthel index score and SF-12 score were statistically significant(all P<0.05).(3)At 4 weeks and 12 weeks of intervention,the TFI score and its score of all dimensions in the intervention group were significantly lower than those before intervention(all P<0.05).At 12 weeks,the TFI score and its score of physical dimension and social dimension were lower than those at 4 weeks(all P<0.05),but there was no statistical significance in psychological dimension score(P=0.237),After 4 weeks of intervention,the TFI score and its score of somatic dimension and social dimension of the control group were significantly lower than those before intervention(all P<0.05),but there was no statistical significance in psychological dimension scores(P=0.381),and the TFI score and its score of somatic dimension scores at 12 weeks of intervention were lower than those before intervention(all P<0.05).However,there was no significant difference between psychological dimension and social dimension score(P>0.05).After the intervention,the total score of TFI and all scores of its dimension in the intervention group were significantly lower than those in the control group(all P<0.05).(4)At 4 weeks and 12 weeks of intervention,Barthel index score,SF-12 physical component summary score and mental component summary score were significantly increased compared with pre-intervention(all P<0.05).Barthel index score and SF-12 mental component summary score at 12 weeks of intervention were higher than those at 4 weeks of intervention(P<0.05),but there was no significant difference in SF-12 physical component summary score(P=0.189).After the intervention,the Barthel index score,SF-12 physical component summary score and mental component summary score of the intervention group were significantly higher than those of the control group(all P<0.05).Conclusions1.The multi-component exercise training program constructed in this study is scientific and feasible,which can effectively improve frailty,ability of daily living activities and quality of life for elderly patients with chronic heart failure.2.Multi-component exercise training is simple and feasible,providing an effective way for the management of debilitating symptoms in patients with heart failure. |
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