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Heart failure affects not only the cardiovascular system with structural abnormalities of the heart, but also the musculoskeletal system, leading to exercise intolerance. Objective: To evaluate the effects of a short-term exercise protocol and phototherapy, on the functional capacity and inflammatory markers in patients with heart failure. In addition, the investigators will investigate pulmonary function, peripheral and respiratory muscle strength and quality of life. Methods: Heart failure patients (left ventricular ejection fraction < 40%) will be selected from the outpatient clinic of the myocardium of the Department of Cardiology of Unifesp and randomized among two groups: patients who will be submitted to placebo phototherapy and cycle ergometer exercise; and patients who will be submitted to active phototherapy and cycle ergometer exercise. All groups will receive treatment twice a week for four weeks. Patients will be instructed to conduct home-based walking program at least twice a week. Patients will be evaluated before and after protocols regarding the pulmonary function, peripheral and respiratory muscle strength, functionality, quality of life and evaluation of systemic inflammatory mediators.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Exercise and placebo phototherapy | Experimental | Placebo phototherapy and Cycle ergometer exercise rehabilitation protocol |
|
| Exercise and active phototherapy | Experimental | Active phototherapy and Cycle ergometer exercise rehabilitation protocol |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exercise | Other | The exercise will be performed in a cycle ergometer, intermittently, during 40 minutes, in a moderate intensity and prescribed by the perceived exertion Borg (PEB) scale. |
| Measure | Description | Time Frame |
|---|---|---|
| Six-minute walk test to measure functional capacity change | According to the baseline distance walked, we will evaluate the improvement in functional capacity after the period of the rehabilitation programs | Pre and post 4 weeks of rehabilitation programs |
| Inflammatory markers | Evaluate the change in levels of interleukin (IL): IL-1 and IL-10, and tumor necrosis factor-alpha (TNF-α) | Pre and post 4 weeks of rehabilitation programs |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory muscle strength | By manovacuometry, assessing the change in inspiratory muscle pressure and expiratory muscle pressure | Pre and post 4 weeks of rehabilitation programs |
| Peripheral muscle strength |
| Measure | Description | Time Frame |
|---|---|---|
| Six-minute walk test to measure functional capacity change | Evaluate the improvement in functional capacity | Follow up after 3 months of the end of the rehabilitation programs |
| Respiratory muscle strength |
Inclusion Criteria:
Exclusion Criteria:
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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| Placebo Phototherapy | Other | Patients will receive the placebo application of low level laser therapy (parameters: 808nm, 100mW, 28J) in the rectus Femoris and gastrocnemius muscles of both lower limbs before the performance of the cycle ergometer exercise protocol. |
|
| Active Phototherapy | Other | Patients will receive the active application of low level laser therapy (parameters: 808nm, 100mW, 28J) in the rectus Femoris and gastrocnemius muscles of both lower limbs before the performance of the cycle ergometer exercise protocol. |
|
By dynamometry, assessing the change in the peak force of quadriceps femoris muscle
| Pre and post 4 weeks of rehabilitation programs |
| Quality of life | By Minnesota Living with Heart Failure Questionnaire assessing the change in quality of life | Pre and post 4 weeks of rehabilitation programs |
By manovacuometry, assessing the change in inspiratory muscle pressure and expiratory muscle pressure
| Follow up after 3 months of the end of the rehabilitation programs |
| Peripheral muscle strength | By dynamometry, assessing the change in the peak force of quadriceps | Follow up after 3 months of the end of the rehabilitation programs |
| Quality of life | By Minnesota Living with Heart Failure Questionnaire assessing the change in quality of life | Follow up after 3 months of the end of the rehabilitation programs |