Utilizing Circuit Training for a Patient with CHF in the Home
Environment to Demonstrate Increased Strength and Endurance
by Rachel Waugh, Student PT; Andrew Bartlett, PT, PhD; Teresa Kaiser, PT
Introduction
In the United States alone, chronic heart failure (CHF) continues to increase with an estimated 670,000 new cases diagnosed per year. 1 When patients are diagnosed with CHF, the projected five year survival rate is 50% with 25% dying in the first year. 1 Patients with chronic heart failure present with decreased endurance, decreased strength, low exercise tolerance, lower extremity edema, shortness of breath, and coughing.
Circuit training has been operationally defined as an aerobic and resistive exercise program designed to build strength and muscular endurance with the amount of exercises varying based on purpose. Circuit training has been shown to be safe and effective while improving exercise tolerance and quality of life in patients with chronic heart failure. 2.3 The combination of both aerobic and resistive training has shown to increase peak oxygen consumption (VO ) and reduce the risk for rehospitailizations.4-6
Although there is substantial research on circuit training in patients with chronic heart failure in supervised clinical environments, there is limited research on circuit training within the home care setting. Studies have shown that home based exercises are just as effective as supervised exercises and have had significant improvements in quality oflife, depression symptoms, and functional capacity. 7,8
The purpose of this case study is to describe the importance of implementing a circuit training program with close monitoring for a patient with chronic heart failure in the home environment.
Subject Description And History
Medical history/demographics: Patient is a 91 y. o.
Caucasian male seen in the home care setting (VNS of Rochester, NY) post hospitalization from CHF exacerbation with accompanying heart attack while in the hospital. At the hospital his O, saturation was 95% and an ejection fraction of 25%. Ejection fraction is the amount of blood that a person's heart pumps out with each beat. Normal ejection values range from 55-70% and anything less than 40% is indicative of heart failure. Patient's hospital stay was one month and he was discharged home on 2 L of O,. Patient had a history of CHF, HTN, malignant melanoma, left maxillary lesion, anemia, and chronic kidney disease. Other services included home health nurse and aide, OT, and telehealth. Patient was noted to use an incentive spirometer 3-5 times a day. Medications: Lasik, Ferrous Gluconate, Lipitor, Nitroglycerin, Plavix, Protoxin. Social History/Home Environment: Patient is retired and lives with his supportive wife in a one story home with three steps to enter. Prior Functional Status: Patient reports being independent without the use of
an assistive device in all aspects of mobility, ADLs, and ability to drive. Patient Goals: Patient verbalized wanting to decrease O, use, return to driving and level ofindependence prior to hospitalization.
Examination, Evaluation, Diagnosis, And Prognosis
System Review- Cardiovascular and Pulmonary: Vitals: baseline measurements were taken by home nurse on 7/14/12. BP: On left arm 120/50 mm Hg sitting, 110/52 mm Hg standing; Pulse: 64 beats per minute regular; Respiration Rate: 20 beats per minute; Oxygen Saturation 97% on 1 L; Edema: LLE +1 pitting, no TED stockings noted. Integumentary: Intact. Pain: Patient noted no pain on PT evaluation. Examination- Strength: On 7/24/12, strength was assessed at 4/5 bilaterally for knee extension and Aexion; hip Aexion 4-15 bilaterally; and ankle DF and PF 4/5 bilaterally. Ambulation: Patient ambulated using a rolling walker with contact guard assist on 1 L
of O, for 40 feet and pts O, dropped to 82% needing 1-2 minutes to return to 94%. During ambulation, patient was observed to have increased thoracic kyphosis and shortened step length bilaterally. Patient needed multiple cues to breathe in order to maintain safe oxygen saturation levels. Transfers: Patient was independent in all transfers. Refer Tables 1-4 for the normative values for the following tests. TUG: 31.57 seconds, with standby supervision. Oxygen saturation was 97% on 2 L and HR 71 beats per minute. 5 Times Sit to Stand: 35.57 seconds with standby supervision. Oxygen saturation was 96% on 2 L and HR 74 beats 26