SEGMENTAL REHABILITATION IN PATIENTS WITH CARDIAC-FAILURE - SHORT ANDLONG-TERM RESULTS

Many patients with chronic cardiac failure may benefit from exercise r ehabilitation. However, the usual protocols, which may lead to haemody namic disturbances or induce arrhythmias, are rarely applicable in the most severe cases. Therefore, the authors developed a protocol of seg mental rehabilitation where the same muscle groups as in global readap tation are involved, but successively and not simultaneously. This stu dy included 25 patients in the NYHA class III. Many parameters were an alysed before and after forty sessions. Although the resting isotopic ejection fraction (0.26 +/- 0.1 vs 0.27 +/- 0.11; p = NS), oxygen cons umption at the ventilatory threshold (14.3 +/- 3.5 vs 18.3 +/- 5.2 ml/ kg/min; p = NS) or at peak effort (17.4 +/- 4.7 versus 18.3 +/- 5.2 ml /kg/min, p = NS) were unchanged, three other parameters were significa ntly improved : the duration of exercise (9.2 +/- 2.4 vs 10.4 +/- 3.4 min; p < 0.02) maximum work load (3 046 +/- 1 510 vs 3 992 +/- 2 482; p < 0.01) and muscular force (151 +/- 35 versus 220 +/- 41 kg; p < 0.0 001). In addition, after a follow-up period of 43 +/- 18 months, a clo se inverse relationship was observed between the gains obtained in ter ms of duration of exercise and maximum work load and the number of hos pital readmissions. Similarly, the 10 patients having undergone rehabi litation with this protocol had 11.7 times fewer hospital readmissions than the other 15. Segmental rehabilitation would therefore seem to b e a safe technique for patients with severe cardiac for significantly increasing exercise capacity and lowering the number of readmissions t o hospital.