The aim of the study is to evaluate whether a tailored cardiac rehabilitation program, initiated during hospitalization and continued after discharge, can improve functional capacity, mobility, and quality of life in patients over 65 years old with heart failure.
If you meet the inclusion criteria and wish to participate, an initial assessment of your clinical and functional status will be conducted during your hospital stay. A computer system will then randomly assign you to one of the following groups: Cardiac Rehabilitation Group (treatment group): You will participate in a mild exercise program during hospitalization (Phase I), including mobility and respiratory exercises adapted to your clinical condition. After discharge, you will enter a structured in-person cardiac rehabilitation program (Phase II) lasting 3 months, consisting of two 1-hour exercise sessions per week (aerobic, strength, inspiratory, and proprioceptive exercises) plus one weekly educational session. Usual Care Group (control group): You will receive standard recommendations for physical activity and general care. At the end of the study, a final consultation will be conducted to assess differences between the two groups in functional capacity and quality of life.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
114
Cardiac rehabilitation program, in which patients will attend in person twice weekly (Mondays and Wednesdays or Tuesdays and Thursdays), in groups of up to 8 patients, for 1-hour exercise sessions including aerobic, resistance, respiratory, and balance/proprioceptive components. Sessions will be monitored and supervised by cardiologists, rehabilitation physicians, and physiotherapists. In addition, patients will attend one weekly in-person educational session throughout the 3-month program.
Hospital Universitario Puerta de Hierro
Majadahonda, Madrid, Spain
Primary Endpoint: Change in Peak Oxygen Uptake
Change in peak oxygen uptake measured by treadmill cardiopulmonary exercise testing (peak VO₂, measured in ml/kg/min).
Time frame: 3 months
Change in Functional Permormance assessed by the Short Physical Performance Battery (SPPB) score
Change in the Short Physical Performance Battery (SPPB) score, ranging from 0 (worst physical performance) to 12 (best physical performance).
Time frame: 3 months
Change in the Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) score
Change in the Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) overall summary score, ranging from 0 (worst health status) to 100 (best health status)
Time frame: 3 and 6 months
Change in distance walked (meters) in the 6-Minute Walk Test (6MWT).
Change in distance walked (meters) in the 6-Minute Walk Test (6MWT).
Time frame: 3 and 6 months
Change in caregiver burden assessed by the Zarit scale
Change in caregiver burden assessed by the 22-item Zarit Burden Interview (ZBI-22) score (range 0-88, with higher scores indicating greater caregiver burden)
Time frame: 3 and 6 months
Change in body composition parameters assessed by bioelectrical impedance analysis (BIA)
Change in body composition parameters expressed as percentages (%), assessed by bioelectrical impedance analysis (BIA)
Time frame: 3 and 6 months
Number of participants experiencing all-cause mortality, heart failure decompensation, or heart failure-related hospitalization during follow-up
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All-cause mortality will be confirmed by medical records or death certificate. Heart failure decompensation will be defined as worsening of heart failure symptoms requiring urgent medical visit, treatment adjustment, or hospital admission. Heart failure-related hospitalizations will be collected from hospital records. Data will be aggregated as the number and percentage of participants experiencing each event during the study period
Time frame: 3 and 6 months
Change in Frailty status assessed by FRAIL scale
Change in FRAIL scale (range 0-5, higher scores indicate greater frailty)
Time frame: 3 and 6 months
Change in emotional status assessed by the Hospital Anxiety and Depression Scale (HADS)
Change in emotional status, measured using the Hospital Anxiety and Depression Scale (HADS), with subscales for anxiety and depression ranging from 0 to 21, where higher scores indicate greater symptom severity
Time frame: 3 and 6 months
Change in Nutritional Status assessed using the Mini Nutritional Assessment (MNA) score
Change in nutritional status, assessed using the Mini Nutritional Assessment (MNA) score (range 0-30, with higher scores indicating better nutritional status)
Time frame: 3 and 6 months
Change in Maximal Inspiratory Pressure (MIP)
Change in maximal inspiratory pressure (MIP) measured in cmH₂O, with higher values indicating greater respiratory muscle strength
Time frame: 3 and 6 months
Patient satisfaction
Patient satisfaction with the cardiac rehabilitation program, rated from 0 to 10, being 10 the highest mark
Time frame: 6 months
Patient adherence
Patient adherence to cardiac rehabilitation sessions, rated from 0 to 100%, being 100% the highest mark
Time frame: 3 months
Change in basic functional independence assessed by the Barthel Index
Change in basic functional independence assessed by the Barthel Index (range 0-100, with higher scores indicating greater independence)
Time frame: 3 and 6 months
Change in maximal expiratory pressure (MEP)
Change in maximal expiratory pressure (MEP) measured in cmH₂O, with higher values indicating greater respiratory muscle strength
Time frame: 3 ad 6 months