Home-based Exercise Program Using Mobile Technology After Left Ventricular Assist Device Implantation

越来越多的晚期心力衰竭患者正在接受HeartMate 3(HM3；Abbott，Abbott 伊利诺伊州帕克)在世界各地植入了左心室辅助装置(LVAD)。尽管当代耐用 心脏的机械支持，LVAD接受者继续表现出低水平的体力活动和 功能能力，以每天步行和6分钟步行试验(6MWT)距离为特征，即使在1年后也是如此 做手术。此外，LVAD接受者经常符合易碎/脆弱和相关的石棺减少的标准， 包括肌肉力量和肌量偏低。这些赤字可能会导致医疗保健增加 在这一高危人群中的使用情况。 步行和强化运动有助于提高肌肉的力量和质量。 体力活动和能力，但运动干预在LVAD接受者中尚未得到很好的确立。大号 接受LVAD治疗的人中，有一部分没有参加以中心为基础的、有监督的心脏康复治疗(CR)，以及 参与CR治疗的患者平均在出院后3个月开始治疗.以家庭为基础的锻炼 使用移动技术的计划可能会使患者在左冠状动脉成形术后更早开始运动康复 植入。我们正在进行一项关于家庭锻炼计划的随机对照试点研究 包括步行和强化运动，并使用标准化的协议来指导运动处方和 基于从活动跟踪手表和智能手机应用程序获得的数据的运动进度。我们的试点数据 表明我们创新的居家锻炼计划是可行的、安全的，并可能与更大的 新植入HM3LVAD患者的日常体力活动增加。 使用移动技术的家庭锻炼计划对日常体力活动和 LVAD受者的能力、虚弱和骨质疏松症以及生活质量以前没有进行过研究 多中心研究。我们提出了一项随机研究，对4个LVAD中心的80名新植入的HM3 LVAD患者进行研究。 根据LVAD植入后的出院指标，患者将被纳入并随机分配到6- 使用移动技术或日常护理(UC)的月新运动计划。我们将评估以下具体的 目的：具体目标#1是比较运动干预和UC对体力活动和 容量由a)每日步数(由活动监视器捕获)和b)6MWT距离测量。具体目标2 是比较运动干预和UC对虚弱和骨质疏松症的影响，通过评估虚弱 状态和b)肌肉数量。具体目标#3是比较运动干预和UC对 生活质量(由堪萨斯城心肌病问卷-12测量)。具体目标#4是评估 运动干预与UC的成本效益。这项研究的发现有可能改善Low 体力活动和体力、身体虚弱和骨骼减少、生活质量以及医疗保健利用率的提高 在不断增长的左冠状动脉旁路移植术受者中。

A growing number of patients with advanced heart failure are undergoing HeartMate 3 (HM3; Abbott, Abbott Park, IL) left ventricular assist device (LVAD) implantation around the world. Despite contemporary durable mechanical support of the heart, LVAD recipients continue to demonstrate low levels of physical activity and functional capacity, characterized by daily steps and six-minute walk test (6MWT) distance, even 1-year after surgery. In addition, LVAD recipients frequently meet criteria for prefrailty/frailty and associated sarcopenia, including low muscle strength and muscle quantity. These deficits may contribute to increased healthcare utilization in this high-risk population. Walking and strengthening exercises can help to improve muscle strength and quantity as well as physical activity and capacity, but exercise interventions in LVAD recipients are not well established. A large proportion of LVAD recipients do not participate in center-based, supervised cardiac rehabilitation (CR), and patients participating in CR initiate therapy a mean of 3 months after hospital discharge. A home-based exercise program using mobile technology may allow patients to begin exercise rehabilitation at an earlier time after LVAD implantation. We are conducting a randomized, controlled pilot study of a home-based exercise program including walking and strengthening exercises with a standardized protocol to guide exercise prescription and exercise progression based on data obtained from an activity tracking watch and smartphone app. Our pilot data suggest that our innovative home-based exercise program is feasible, safe, and may be associated with a greater increase in daily physical activity in patients newly implanted with a HM3 LVAD. The effects of a home-based exercise program using mobile technology on daily physical activity and capacity, frailty and sarcopenia, and quality of life in LVAD recipients have not been previously studied in a multicenter study. We propose a randomized study of 80 newly implanted HM3 LVAD patients at 4 LVAD centers. Following index hospital discharge after LVAD implantation, patients will be enrolled and randomized to a 6- month novel exercise program using mobile technology or usual care (UC). We will evaluate the following specific aims: Specific Aim #1 is to compare the effects of the exercise intervention vs. UC on physical activity and capacity measured by a) daily steps (captured by the activity monitor) and b) 6MWT distance. Specific Aim #2 is to compare the effects of the exercise intervention vs. UC on frailty and sarcopenia, by evaluating a) frailty status and b) muscle quantity. Specific Aim #3 is to compare the effects of the exercise intervention vs. UC on quality of life (measured by the Kansas City Cardiomyopathy Questionnaire-12). Specific Aim #4 is to evaluate the cost-benefit of the exercise intervention vs. UC. Findings from this study have the potential to improve low physical activity and capacity, frailty and sarcopenia, quality of life, and increased rates of healthcare utilization in the growing population of LVAD recipients.