Background. The prescription of physical exercise and the determination of appropriate training intensities and frequencies in patients with cardiomyopathy have long been a topic of debate in sports cardiology, and evidence on the matter remains limited. The Regional Reference Center for Sports in Young People with Heart Disease was established with the goal of creating a middle ground between a sedentary lifestyle, a risk factor for various chronic diseases, and competitive sports, which can expose patients to the risk of major arrhythmic events. Patients referred to the Center receive comprehensive care (medical, psychological, and sports-related), which culminates in a monitored training period and a return to sports activities with modalities and intensities compatible with the patient's condition. Aim of the study. The study aims to verify the safety of prescribing a personalized exercise program in ex-athletes with cardiomyopathy in terms of major events during follow-up. Additionally, the study seeks to evaluate the impact of such training on functional capacity (measured with cardiopulmonary exercise testing) and disease progression (examined through echocardiography and Holter monitoring). Another objective of the study is to assess patients' adherence to the program. Materials and Methods. A total of 59 patients with cardiomyopathy were enrolled (47 men and 12 women), including 23 with hypertrophic cardiomyopathy with a median age of 49 years (30.5, 56.5), 27 with arrhythmogenic cardiomyopathy with a median age of 26 years (17, 54), and 9 with dilated cardiomyopathy with a median age of 19 years (15, 22). After thorough risk stratification, two counseling sessions, cardiopulmonary exercise testing, and a monitored training period at our Center’s gym, each patient received a personalized exercise prescription and was followed up regularly. Data were collected using the REDCap platform. The Wilcoxon signed-rank test was used to assess the difference in continuous parameters at the first and second visits compared to baseline. Results. During the supervised training period and the subsequent follow-up with a median duration of 18 months (8.50, 37.00), no major cardiovascular events were recorded. Among the patients who strictly adhered to our recommendations, none showed a worsening of their condition in terms of arrhythmic burden (PVC percentage on Holter monitoring) and ventricular function (ejection fraction, FAC, and TAPSE measured by echocardiogram). Additionally, there was no recorded deterioration in patients' functional capacity (measured as maximum oxygen consumption, both absolute and percentage, and thresholds in cardiopulmonary exercise testing) during the follow-up. Twelve patients discontinued the program early. Conclusions. The prescription of physical exercise and a safe training program for patients with cardiomyopathy appears not to result in adverse outcomes or statistically significant deterioration in cardiac morpho-functional characteristics and functional capacity. However, these findings should be confirmed by studies with longer follow-ups and larger sample sizes.
Presupposti dello studio. La prescrizione di esercizio fisico e la determinazione delle appropriate intensità e frequenze di allenamento nel paziente con cardiomiopatia sono state a lungo un argomento di dibattito in cardiologia dello sport, e ancora oggi le evidenze a riguardo sono limitate. Il Centro di Riferimento Regionale per lo sport nei giovani con cardiopatia nasce dalla volontà di creare una soluzione a metà strada tra la sedentarietà, fattore di rischio per diverse patologie croniche, e lo sport agonistico, che può esporre il paziente al rischio di eventi aritmici maggiori. Ai pazienti afferenti al Centro viene fornita una presa in carico completa (medica, psicologica e sportiva) che termina con un periodo di training monitorato e il ritorno all’attività sportiva con modalità e intensità compatibili con la patologia del paziente. Scopo. L’obiettivo dello studio è verificare la sicurezza della prescrizione di un programma di esercizio fisico personalizzato nel paziente ex-atleta con cardiomiopatia in termini di eventi maggiori durante il follow-up. Si vuole inoltre valutare l’impatto di tale modalità di allenamento in termini di capacità funzionale (misurata con il test da sforzo cardiopolmonare) e di progressione di patologia (esaminata tramite ecocardiografia ed ECG dinamico secondo Holter). Un ulteriore obiettivo dello studio è la valutazione dell’aderenza dei pazienti al programma. Materiali e metodi. Sono stati arruolati 59 pazienti con cardiomiopatie, (47 uomini e 12 donne), di cui 23 con cardiomiopatia ipertrofica ed età mediana 49 anni (30.5, 56.5), 27 con cardiomiopatia aritmogena ed età mediana 26 anni (17, 54) e 9 con cardiomiopatia dilatativa ed età mediana 19 anni (15, 22). Dopo un'accurata stratificazione del rischio, due momenti di counselling, l’esecuzione di un test da sforzo cardiopolmonare e un periodo di training monitorato presso la palestra del nostro Centro, ogni paziente ha ricevuto una prescrizione di esercizio fisico personalizzata ed è stato seguito con follow-up a cadenza regolare. I dati sono stati raccolti tramite la piattaforma REDCap. Il test dei segni per ranghi di Wilcoxon è stato utilizzato per valutare la differenza dei parametri continui alla prima e seconda visita, rispetto alla baseline. Risultati. Durante il periodo di allenamento supervisionato e il successivo follow-up della durata mediana di 18 mesi (8.50, 37.00), non sono stati registrati eventi cardiovascolari maggiori. Tra i pazienti che si sono attenuti scrupolosamente alle nostre raccomandazioni, nessuno ha mostrato un peggioramento delle proprie condizioni in termini di burden aritmico (BEV in percentuale rispetto al totale all’ECG dinamico secondo Holter) e funzione ventricolare (frazione di eiezione, frazione d’accorciamento del ventricolo destro e TAPSE misurati all’ecocardiogramma). Inoltre, durante il follow-up non si è registrato un peggioramento della capacità funzionale dei pazienti (misurata come consumo d’ossigeno massimo, sia assoluto che percentuale, e alle soglie al test da sforzo cardiopolmonare). 12 pazienti hanno interrotto precocemente il percorso. Conclusioni. La prescrizione di esercizio fisico e di un programma di allenamento in sicurezza in pazienti con cardiomiopatia sembra non portare a esiti avversi e non determinare un peggioramento statisticamente significativo delle caratteristiche morfo-funzionali cardiache e della capacità funzionale, sebbene questi dati debbano essere confermati da studi con follow-up di maggiore durata e con numerosità campionarie maggiori.
Prescrizione di esercizio fisico e di un programma di allenamento in sicurezza in pazienti con cardiomiopatie: due anni di esperienza del centro di riferimento regionale per lo sport nei giovani con cardiopatia.
PANDOLFO, ALBERTO
2023/2024
Abstract
Background. The prescription of physical exercise and the determination of appropriate training intensities and frequencies in patients with cardiomyopathy have long been a topic of debate in sports cardiology, and evidence on the matter remains limited. The Regional Reference Center for Sports in Young People with Heart Disease was established with the goal of creating a middle ground between a sedentary lifestyle, a risk factor for various chronic diseases, and competitive sports, which can expose patients to the risk of major arrhythmic events. Patients referred to the Center receive comprehensive care (medical, psychological, and sports-related), which culminates in a monitored training period and a return to sports activities with modalities and intensities compatible with the patient's condition. Aim of the study. The study aims to verify the safety of prescribing a personalized exercise program in ex-athletes with cardiomyopathy in terms of major events during follow-up. Additionally, the study seeks to evaluate the impact of such training on functional capacity (measured with cardiopulmonary exercise testing) and disease progression (examined through echocardiography and Holter monitoring). Another objective of the study is to assess patients' adherence to the program. Materials and Methods. A total of 59 patients with cardiomyopathy were enrolled (47 men and 12 women), including 23 with hypertrophic cardiomyopathy with a median age of 49 years (30.5, 56.5), 27 with arrhythmogenic cardiomyopathy with a median age of 26 years (17, 54), and 9 with dilated cardiomyopathy with a median age of 19 years (15, 22). After thorough risk stratification, two counseling sessions, cardiopulmonary exercise testing, and a monitored training period at our Center’s gym, each patient received a personalized exercise prescription and was followed up regularly. Data were collected using the REDCap platform. The Wilcoxon signed-rank test was used to assess the difference in continuous parameters at the first and second visits compared to baseline. Results. During the supervised training period and the subsequent follow-up with a median duration of 18 months (8.50, 37.00), no major cardiovascular events were recorded. Among the patients who strictly adhered to our recommendations, none showed a worsening of their condition in terms of arrhythmic burden (PVC percentage on Holter monitoring) and ventricular function (ejection fraction, FAC, and TAPSE measured by echocardiogram). Additionally, there was no recorded deterioration in patients' functional capacity (measured as maximum oxygen consumption, both absolute and percentage, and thresholds in cardiopulmonary exercise testing) during the follow-up. Twelve patients discontinued the program early. Conclusions. The prescription of physical exercise and a safe training program for patients with cardiomyopathy appears not to result in adverse outcomes or statistically significant deterioration in cardiac morpho-functional characteristics and functional capacity. However, these findings should be confirmed by studies with longer follow-ups and larger sample sizes.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/67191