Related Experiment Video
Updated: Aug 7, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction
Ahmad Mroué1, Stéphane Roueff, Isabella Vanorio-Vega
1Department of Nephrology, Georges Pompidou European Hospital, APHP, Paris, France (Drs Mroué, Roueff, Lazareth, Flahault, and Thervet); Direction de la stratégie des études et des statistiques, Caisse nationale de l'assurance maladie (CNAM), Paris, France (Drs Vanorio-Vega and Tuppin); Agence de la biomédecine, Saint-Denis, France (Dr Vanorio-Vega); Université Paris Cité, Paris, France (Drs Lazareth, Flahault, and Thervet); and Department of Cardiac Rehabilitation and Secondary Prevention, Corentin Celton Hospital, APHP, Paris, France (Drs Kovalska and Iliou).
Insights
Cardiac rehabilitation (CR) improves cardiorespiratory fitness in heart failure (HF) patients with reduced ejection fraction (HFrEF), even those with chronic kidney disease (CKD). CKD stage does not impact the benefits of CR for HFrEF patients.
Area of Science:
- Cardiology
- Nephrology
- Exercise Physiology
Background:
- Chronic kidney disease (CKD) is prevalent in heart failure (HF) patients, often worsening prognosis and complicating management.
- CKD is frequently associated with sarcopenia, potentially limiting the efficacy of cardiac rehabilitation (CR).
Purpose of the Study:
- To assess the impact of CR on cardiorespiratory fitness in heart failure with reduced ejection fraction (HFrEF) patients stratified by CKD stage.
- To determine if CKD influences the benefits derived from CR in HFrEF.
Main Methods:
- A retrospective analysis of 567 HFrEF patients undergoing a 4-week CR program.
- Cardiorespiratory exercise testing was performed pre- and post-CR, with patients stratified by estimated glomerular filtration rate (eGFR).
- Multivariate analysis identified factors associated with improvements in peak oxygen uptake (V˙ o2peak).
Main Results:
- 38% of patients had eGFR <60 mL/min/1.73m², showing poorer baseline fitness and higher brain natriuretic peptide levels.
- Following CR, significant improvements in V˙ o2peak, ventilatory threshold (VT1), workload, and reduced brain natriuretic peptide were observed across all CKD stages.
- Renal function did not emerge as a significant factor influencing V˙ o2peak improvement post-CR.
Conclusions:
- Cardiac rehabilitation demonstrates significant benefits for HFrEF patients with CKD, irrespective of the CKD stage.
- The presence of CKD should not be a contraindication for prescribing CR to HFrEF patients.
Purpose:
Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage.
Methods:
We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ).
Results:
Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results.
Conclusions:
Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
08:35Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Heart Failure V: Medical Management
01:22Heart Failure Drugs: Diuretics
01:22Heart Failure VI: Adjunct Therapies
01:17Pathophysiology of Heart Failure
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...