Exercise-based cardiac rehabilitation (CR) has been shown to significantly improve cardiovascular health and overall well-being in patients with congestive heart failure (CHF). However, a substantial number of CHF patients also suffer from comorbid conditions, such as knee osteoarthritis (OA), which can impede their ability to engage in physical activity and, consequently, derive full benefits from CR. Knee OA is characterized by pain, stiffness, and reduced joint mobility, which can significantly limit exercise capacity and adherence to CR programs. This dual burden poses a unique challenge, necessitating tailored rehabilitation approaches that accommodate both cardiovascular and musculoskeletal limitations. This study aims to evaluate the effectiveness of an exercise-based CR program specifically adapted for patients with CHF and coexisting knee OA, focusing on improvements in cardiovascular function, joint mobility, pain management, and overall quality of life. This study will employ a randomized controlled trial (RCT) design involving 100 patients diagnosed with both CHF and knee OA. Participants will be randomly assigned to either an intervention group or a control group. The intervention group will undergo a 12-week exercise-based CR program tailored to accommodate their knee OA, incorporating low-impact aerobic exercises, strength training, and flexibility exercises specifically designed to minimize knee joint stress. The control group will receive standard medical care without the structured exercise program. Primary outcomes will include changes in cardiovascular fitness, assessed by peak oxygen uptake (VO2 peak), and knee function, measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes will assess pain levels, quality of life using the SF-36 questionnaire, and adherence rates to the rehabilitation program. Data will be collected at baseline, post-intervention (12 weeks), and at a 6-month follow-up to evaluate both immediate and long-term effects. Statistical analyses will be conducted to compare the outcomes between the two groups and determine the efficacy of the tailored CR program. Keywords: Exercised-based cardiac rehabilitation, Congestive heart failure, knee osteoarthritis, low impact aerobic exercise, strength training
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
94
Exercise Prescription: Aerobic Exercise: walking, stationary cycling, Resistance / strength training, Flxibility and Range of motion, Balance and proprioception Strength Training: Lower limb strengthening focus: Quadriceps, Hamstrings, Gluteals Upper body Shoulders, Arms (light resistance) Exercises using Thera Bands, light dumbbells, or body weight Isometric exercises initially if active movement is painful Type: Resistance exercises focusing on major muscle groups, especially lower extremities to support knee function,e.g. Quadriceps, Hamstrings, Gluteal muscles, Hip adductors, abductors and Calf muscles using weights, resistance bands, or machines. Flexibility and Balance Exercises: Static stretching of major lower limb muscle groups: Quadriceps, Hamstrings, Calf muscles, Hip flexors, Gentle knee range of motion exercises within pain-free limits
Education and Counseling consisting of Regular sessions on disease education, self-management strategies, nutrition, and adherence to medication.
1. Behria International Hospital 2. Punjab Institute of Cardiology
Lahore, Punjab Province, Pakistan
6 MWT functional capacity
The 6-minute walk test (6MWT) serves as a valuable and widely used data collection tool in research, particularly in studies assessing functional capacity, exercise tolerance, and overall physical performance. it was used to collect data pre-post exercise
Time frame: 8 weeks
ECHO (left ventricle Ejection fraction)
Left Ventricular Ejection Fraction (LVEF) is a key measurement used in echocardiography (ECHO) to assess the heart's function, particularly its ability to pump blood. LVEF represents the percentage of blood that is ejected from the left ventricle (the heart's main pumping chamber) with each heartbeat. pre-post data was collected
Time frame: 8 weeks
WOMAC Questionnaire
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used, validated questionnaire designed to evaluate the condition of patients with osteoarthritis (OA) of the knee and hip. Developed in the 1980s, the WOMAC is specifically tailored to measure three key dimensions: pain, stiffness, and physical function. The questionnaire comprises 24 items divided into three subscales: 5 items for pain, 2 items for stiffness, and 17 items for physical function. pre-post data was collected
Time frame: 8 weeks
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