Working…
ClinicalTrials.gov
ClinicalTrials.gov Menu

Complex Exercises of the Respiratory Muscles Plus Aerobic Training vs. Aerobic Training in Patients With СHF (AEROFIT-HF)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03726905
Recruitment Status : Recruiting
First Posted : November 1, 2018
Last Update Posted : February 27, 2019
Sponsor:
Collaborator:
Russian Heart Failure Society
Information provided by (Responsible Party):
Lomonosov Moscow State University Medical Research and Educational Center

Brief Summary:
The aim of the study is to test the hypothesis that the physical rehabilitation starting with respiratory training followed by the aerobic exercises will have a more pronounced effect on clinical and functional indicators than the currently used physical rehabilitation based on aerobic training alone

Condition or disease Intervention/treatment Phase
Heart Failure Other: respiratory muscles training Other: sham respiratory muscles training Other: aerobic training Not Applicable

Detailed Description:
Changes in the respiratory muscles play an important role in the pathophysiology of exercise intolerance in CHF patients. The weakness of the respiratory muscles leads to a decrease in the efficiency of breathing and the formation of a pathological type of breathing, in which the inhalation time is prolonged, and the expiration time is shortened. Patients with weak respiratory muscles have impaired functional status, as determined by peak oxygen consumption. The violation of the ratio of inspiratory time / to the total time of the respiratory cycle is associated with an increase in the activity of the sympathoadrenal system. The positive effect of respiratory muscle training on MIP, MEP, peak VО 2, VE, VE / VCO 2 slope, VE oscillation, rhythm variability, and quality of life parameters is shown. Decreased oxygenation of the respiratory muscles during intense physical exertion in patients with CHF may increase respiratory failure and provoke hyperactivation of the inspiratory metaboreflex, thereby aggravating exercise intolerance due to a decrease in muscular-muscular system perfusion due to redistribution of blood flow. In addition, it was shown that fatigue of the respiratory muscles increases the activity of the sympathetic nervous system and reduces blood flow in the muscles of the inactive limb due to adrenergic vasoconstriction. This response is most likely associated with metabolic stimulation of small afferent type III and IV fibers of the respiratory muscles, especially the diaphragm. Respiratory muscle training can minimize the effects of inspiration metaboreflex activation and prolong the duration of exercise. In addition, several studies have shown that the strength of the respiratory muscles in patients with HF correlates with central hemodynamic indices at rest, including cardiac output, mean pulmonary pressure and pulmonary vascular resistance. Several studies have shown that the mechanism that improves exercise tolerance in patients with HF after training the respiratory muscles is to increase the blood supply to the muscles of the limbs at rest and during exercise. Thus, the mechanisms of the effect of the weakness of the respiratory muscles on the pathogenesis of a decrease in the functional ability of patients are well studied. Both respiratory muscular and aerobic exercises of moderate effectiveness are recommended by leading medical communities as an effective means to improve the functional ability of patients, improve quality of life parameters, improve symptoms and reduce hospital admissions (level of evidence Level 1). At the same time, respiratory muscle training is recommended as the beginning of physical rehabilitation in patients with IV FC HF, and moderate-intensity aerobic training is recommended for patients with FC I-III FC. Also, in individual works abroad, the effects of respiratory muscle training on clinical CHF. However, according to the investigator's information, no studies have been carried out on the study of the method of functional training, including training of the respiratory muscles, as an obligatory initial stage of physical rehabilitation of patients with any functional class of HF.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Parallel assignment
Masking: Double (Participant, Outcomes Assessor)
Masking Description: The control group will be assigned an imitation of respiratory muscles training with the help of breathing simulators, with a breathing resistance level set at 0
Primary Purpose: Treatment
Official Title: Effectiveness and Safety of Complex Exercises of the Respiratory Muscles Plus Aerobic Training vs. Aerobic Training in Patients With CHF and II-IV NYHA FC: Prospective Randomized Clinical Trial With Sham Control
Actual Study Start Date : November 30, 2018
Estimated Primary Completion Date : December 1, 2019
Estimated Study Completion Date : December 1, 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: respiratory muscles training
4 weeks guided respiratory muscles training followed by 12 weeks guided aerobic training - (treadmill walking)
Other: respiratory muscles training
4 weeks respiratory muscles training aimed on respiratory muscles endurance and lengthening expiration time

Other: aerobic training
12 weeks treadmill walking

Sham Comparator: sham respiratory muscles training
4 weeks sham respiratory muscles training (THRESHOLD® IMT breathing trainer with "0" pressure level) followed by 12 weeks guided aerobic training - (treadmill walking)
Other: sham respiratory muscles training
4 weeks sham respiratory muscles training with the help of breathing simulators, with a breathing resistance level set at 0

Other: aerobic training
12 weeks treadmill walking




Primary Outcome Measures :
  1. Functional Capacity [ Time Frame: 16 weeks ]
    Change in Peak VO2


Secondary Outcome Measures :
  1. proBNP [ Time Frame: 4 weeks ]
    Change in concentration of NT- proBNP from baseline

  2. proBNP [ Time Frame: 16 weeks ]
    Change in concentration of NT- proBNP from baseline

  3. Respiratory muscle strength [ Time Frame: 4 weeks ]
    Change in maximal inspiratory and expiratory pressures (PImax and PEmax) from baseline

  4. Respiratory muscle strength [ Time Frame: 16 weeks ]
    Change in maximal inspiratory and expiratory pressures (PImax and PEmax) from baseline

  5. Neurohormone activity [ Time Frame: 4 weeks ]
    Difference between Active and Control groups in Angiotensin II (A II) concentration from baseline

  6. Neurohormone activity [ Time Frame: 16 weeks ]
    Change in concentration of Angiotensin II (A II) from baseline


Other Outcome Measures:
  1. Change in health-related quality of life [ Time Frame: 4 weeks ]
    Minnesota Living with Heart Failure Questionnaire/ The quality of life between study groups and the change in quality of life over time between study groups.

  2. Change in health-related quality of life [ Time Frame: 16 weeks ]
    Minnesota Living with Heart Failure Questionnaire. Assessed from baseline visit to 16 weeks follow-up visit.The quality of life between study groups and the change in quality of life over time between study groups using clinically accepted quality of life measures. MLHFQ

  3. Anxiety and Depression [ Time Frame: 4 weeks ]
    Hospital Anxiety sand Depression Scale (HADS) The questionnaire comprises seven questions for anxiety and seven questions for depression.Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21. The cut off for both scales in 11.

  4. Anxiety and Depression [ Time Frame: 16 weeks ]
    Hospital Anxiety sand Depression Scale (HADS) The questionnaire comprises seven questions for anxiety and seven questions for depression.Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21. The cut off for both scales in 11.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male and female patients aged 18 years and older (inclusive)
  • Patients with stable heart failure of the II-III functional class.
  • Signed patient informed consent to participate in the study.
  • Left ventricular ejection fraction ≤40%, confirmed by the results of EchoCG no more than 3 months before the start of the study.
  • Patients who can understand the objectives of this study and comply with the requirements of the Protocol.

Exclusion Criteria:

  • • Heart failure I and VI functional class

    • Left ventricular ejection fraction> 41% or no confirmed data on the left ventricular EF.
    • Myocardial infarction, ACS, heart surgery, percutaneous coronary intervention, or coronary artery bypass surgery performed less than 3 months prior to randomization.
    • Unstable or refractory angina.
    • Pulmonary heart.
    • Constrictive pericarditis.
    • Hypertrophic cardiomyopathy.
    • Amyloid cardiomyopathy.
    • Syndrome of premature excitation of the ventricles.
    • The need for percutaneous coronary intervention or coronary bypass surgery in the near future.
    • Sinus node dysfunction syndrome.
    • The presence of a pacemaker.
    • The presence of diagnosed non-cardiac causes of CHF.
    • Any non-cardiac disease that reduces the expected duration to less than 2 years from the moment of randomization.
    • A stroke less than 1 month prior to randomization or a stroke with marked continuing neurological disorders less than 12 months before randomization
    • Orthopedic disorders that prevent physical training
    • COPD, Bronchial asthma. Another lung disease that can affect CSTP results
    • Significant impaired renal function (plasma creatinine 220 µmol / L or higher).
    • Significant abnormal liver function (increased ALT or AST more than 3 times relative to the upper limit of normal).
    • Acute coronary syndrome less than 3 months before randomization.
    • Obstructive or restrictive cardiomyopathy.
    • Acute myocarditis.
    • Hemodynamically significant organic lesions of valves requiring surgical intervention.
    • A history of heart transplantation or current waiting for a heart transplant.
    • Drug addiction, substance abuse, alcoholism, drug use in history.
    • Mental, physical and other reasons that do not allow to adequately assess their behavior and correctly fulfill the conditions of the study protocol.
    • A history of any significant, in the opinion of the physician-researcher, condition / disease or circumstances that prevent the inclusion in the study.
    • Inability / reluctance of the patient to provide signed informed consent to participate in the study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03726905


Contacts
Layout table for location contacts
Contact: Julia L Begrambekova, Phd +79854679273 julia.begrambekova@ossn.ru
Contact: Nino A Karanadze, MD +79032003352 dr.karanadze@gmail.com

Locations
Layout table for location information
Russian Federation
Julia Begrambekova Recruiting
Moscow, Moscow Region, Russian Federation, 119620
Contact: Julia Begrambekova, Phd       begrambekova@ossn.ru   
Contact: Nino Koranadze    +79032003352      
Sponsors and Collaborators
Lomonosov Moscow State University Medical Research and Educational Center
Russian Heart Failure Society
Investigators
Layout table for investigator information
Study Chair: Yana A Orlova, Professor Moscow State University

Layout table for additonal information
Responsible Party: Lomonosov Moscow State University Medical Research and Educational Center
ClinicalTrials.gov Identifier: NCT03726905     History of Changes
Other Study ID Numbers: mcmsuaadd001
First Posted: November 1, 2018    Key Record Dates
Last Update Posted: February 27, 2019
Last Verified: February 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Lomonosov Moscow State University Medical Research and Educational Center:
CHF
exercise
aerobic
respiratory muscle training
Additional relevant MeSH terms:
Layout table for MeSH terms
Heart Failure
Heart Diseases
Cardiovascular Diseases