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The Use of a New Type of Heart Rate-Controlled Training System Heartgo® for Patients with Chronic Heart Failure on the Pedelec

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The Use of a New Type of Heart Rate-Controlled Training System Heartgo® for Patients with Chronic Heart Failure on the Pedelec https://www.scientificarchives.com/journal/archives-of-orthopaedics Archives of Orthopaedics Research article The Use of a New Type of Heart Rate-controlled Training System HeartGo® for Patients with Chronic Heart Failure on the Pedelec Erik B. Friedrich1, Herbert Löllgen2, Helmut Röder3, Wolfgang Baltes4, Oliver Adam5, Martin Schlickel6, Günter Hennersdorf7* 1Überörtliche Gemeinschaftspraxis, St. Annenstr. 10a, 66606 St. Wendel, Germany 2Praxis für Sportkardiologie, Bermesgasse 32b, 42897 Remscheid, Germany 3Zum Stausee 60, 66679 Losheim am See, Germany 4Franzstr. 14, 66287 Quierschied, Germany 5Kreiskrankenhaus St.Ingbert, Klaus-Tussing str. 1, Germany 6Im Wittum 7, 66709 Weiskirchen, Germany 7Traubenweg 2, 66359 Bous, Germany *Correspondence should be addressed to Günter Hennersdorf; [email protected] Received date: September 15, 2020, Accepted date: December 02, 2020 Copyright: © 2020 Friedrich EB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Exercise Training is beneficial in heart failure patients, while training opportunities are limited. Pedelecs represent a novel training possibility for these patients, while safety and efficacy of pedelec training in heart failure is unknown. Therefore, we conducted a pilot study to address these issues. The study “HI-Herz.BIKE Saar” (August 2017 - September 2019) examined the health benefits and training effects of e-bikes (pedelecs) in patients from ambulatory heart groups with moderate chronic heart failure (CHI). Methods: Ten subjects with a strictly defined NYHA stage II-III heart failure and a LVEF of ≤50% were selected. The presented clinical study is explicitly marked as a pilot study, as a new, so far not tested technique was used for exercise control. When selecting the heart failure patients defined in this way, a higher number of subjects could not be reached at only one study center. Participants cycled once weekly for 60-150 min and 20-50 km with a follow-up of 2 years as detailed in the Methods section. The new HeartGo® system used here for the first time allows heart rate- controlled training on a special pedelec via a smartphone app. The groups were accompanied during the training rides by a doctor and a paramedic. The training units were increased in duration, distance, and target frequency every six months. Frequency behavior, pedaling and motor load on the pedelec as well as clinical data such as ejection fraction, a biomarker (NT-pro BNP), risk factors, arterial blood pressure, and ergometric tests were measured. Results: Pedelec training in heart failure subjects resulted in significant increases of the index of well-being (p<0.05) and of left- ventricular ejection fraction by 29% (p<0.05). This was paralleled by a significant decrease in the heart failure parameter NT-pro BNP by 27% (p<0.05), and a significant increase in performance (ergometric power +44%, p<0.05). Moreover, systolic blood pressure decreased significantly by 11% (p<0.05). In contrast, Body Mass Index and cholesterol levels showed no significant changes. No cardiac complications occurred. Conclusions: These results suggest that pedaling is not only safe for stable heart NYHA II-III failure patients with an EF ≤50%, but can induce significant improvements in cardiac performance indices. The subjects were enthusiastic and satisfied with this form of training. The results of this pilot study with its methodological weaknesses should be verified in a larger follow-up study. Keywords: Heart rate-controlled training, HeartGo® system, Chronic heart failure, Pedelec Arch Orthop. 2020 Volume 1, Issue 4 115 Friedrich EB, Löllgen H, Röder H, Baltes W, Adam O, Schlickel M, et al. The Use of a New Type of Heart Rate- controlled Training System HeartGo® for Patients with Chronic Heart Failure on the Pedelec. Arch Orthop. 2020; 1(4): 115-125. Introduction Reports on the use and value of such pedelec assistance systems have not yet been published, apart from some Secondary prevention of cardiovascular disease such publications on the general use of pedelecs by athletes and as heart failure includes regular physical activity with seniors with diabetes mellitus [6]. endurance and strength training, which is used for this purpose with high prevalence [1,2]. Early rehabilitation We hypothesized that pedelec training is safe for patients should begin in hospital (phase I), be continued in a with stable, mild to moderate heart failure, and that it rehabilitation clinic or as an outpatient close to home may result in beneficial cardiovascular effects. To test our (phase II), and then (phase III) preferably in outpatient hypothesis, ten subjects with a strictly defined NYHA stage heart groups (AHG). II-III and a LVEF of ≤ 50% were selected. The presented clinical study is explicitly marked as a pilot study, as a new, A moderate training of 5x30 min or 150 min/week as an so far not tested technique was used for exercise control. effective training goal is aimed at, but often not achieved When selecting the heart failure patients defined in this in heart groups. Endurance sports like walking, running way, a higher number of subjects could not be reached at or swimming are recommended. Cycling in heart groups only one study center. is done less frequently because the performance in the groups is different. Numerous studies have shown that Materials and Methods cycling improves endurance, coordination, flexibility, and strength; at the same time, the body weight is not carried, In this clinical pilot study, the novel system HeartGo®, so that this sport is also used very well in the case of which was tested for practicability by preliminary overweight and is advantageous for heart patients [2,3]. investigations, was used. This frequency-based system There is no structured offer for cycling as a rehabilitation automatically controls the training process. Training sport, especially for patients with heart failure. Here, and clinical parameters were measured. Training was the recommendations were reserved, since patients with carried out in summer on level paths along the Saar river heart failure are usually older participants and because of (“outdoor” training), in winter inside a sports hall (“indoor” possible cardiac incidents or accidents, it is assumed that training). From August 22nd, 2017 until September 10th, cycling training is dangerous. 2019, we carried out 93 training sessions (31 “indoor”, 62 “outdoor”). The participation frequency of the ten study Here, electrically assisted cycling is a good option, subjects was always >90%. The mean age was 61.5 years especially since the pedelec is becoming increasingly (range 43-82), 2 participants were female and 8 were male, popular with seniors. Initial studies show that in the average BMI was 27 (range 21-37). The default training overweight people, an improvement in spiroergometric or target frequency averaged 96 beats/min (range 83-116). readings is possible using e-bikes [3]. Objectives and significance of the study The disadvantage is that older riders usually choose a high pedaling power support because it is “easier” to ride. Research question: Is a heart rate-based training This reduces the actually desired training effect; there is system using pedelecs in heart group participants with “gentle riding”. heart failure suitable to demonstrate effects on safety of the training process, acceptance of the system, clinical and With a heart rate-controlled system, this relieving prognostic parameters? behavior is avoided. This results in individual stress and comparable loads. This makes controlled endurance In a prospective clinical pilot study with 10 patients training on the pedelec, similar to stationary ergometry, from Saarland heart groups diagnosed with heart failure possible as an option in addition to regular training. NYHA II to III, the novel system HeartGo®, which was Studies on this method are not available. tested for practicability by preliminary examinations [7], was used. Not only parameters of the training process Also, a scientific evaluation is then easier to realize, were measured, but also clinical parameters, which were especially since the benefits and risks of regular training of intended to provide information about the course of health the rehabilitation phase III in outpatient heart groups have and thus about the prognosis of the disease. not been sufficiently scientifically investigated. Haberecht et al. [4] report on insufficient lifestyle changes and Study design about too little physical activity in heart groups, which is, however, considered sufficient by others [5]. It should be 10 volunteers with chronic heart failure were recruited noted that participation in a heart group once a week and with the following requirements: often less than 45 minutes is insufficient for an efficient training program. 1. Study duration 2 years, Arch Orthop. 2020 Volume 1, Issue 4 116 Friedrich EB, Löllgen H, Röder H, Baltes W, Adam O, Schlickel M, et al. The Use of a New Type of Heart Rate- controlled Training System HeartGo® for Patients with Chronic Heart Failure on the Pedelec. Arch Orthop. 2020; 1(4): 115-125. 2. 6 months of belonging to a heart group, The chest belt sensors continuously recorded heart rate 3. Stable clinical condition, (HF) and ECG signal “real time” (standard). For this purpose, the test person was given a target heart rate, 4. Stable medication (see Table 4), which usually corresponded to a previously determined 5. NYHA II - III, training heart rate [9]. 6. LVEF ≤50% (HfrEF), The app offers the possibility of selecting four driving 7. 0.5 watts/kg power, modes: 8. Training 1/week 60 - 150 min, 1. Free ride (free selection of assistance via control 9. Training heart rate 60-70% of maximum heart rate, element) 10. Summer and winter mode, 2. Tour (support automatically determined by the system by terrain rise or fall: GPS altitude) 11. Distances 2x10 to 2x25 (20 - 50) km.
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