Building Strength Through Rehabilitation for Heart Failure Patients (BISTRO-STUDY)

In the U.S., 5.7 million people have heart failure (HF), 915,000 new cases are diagnosed each
year, and both incidence and prevalence are increasing due to the aging of the population and
to better survival from ischemic heart disease. A hallmark of HF, is poor functional status
that, characteristically, deteriorates as the condition progresses, negatively affecting
patients' quality of life. Poor functional status is associated with increased risk of
hospitalization for exacerbations of HF and with increased mortality. Optimization of drug
therapy and appropriate use of resynchronization therapy can improve functional status, as
can patient engagement in exercise. Although exercise is recommended as a component of HF
management, adherence is consistently low. This is particularly troubling because exercise
has great potential as a low-risk, low-cost intervention to improve functional status and
quality of life while decreasing HF symptoms and hospitalizations in patients with HF. Low
adherence is due in part to inadequate strength and inability to tolerate or sustain even low
levels of activity. In this study, we propose to use neuromuscular electrical stimulation
(NMES) to assist patient initiation of quadriceps strengthening in order to progressively
increase low exercise tolerance. NMES has been shown to improve muscle strength, exercise
capacity and quality of life, in samples less than 20 of male patients with HF. Larger sample
studies are needed to demonstrate efficacy of this practice to jump start patients' abilities
to benefit from formalized exercise program. The purpose of this double blinded, randomized,
controlled, longitudinal study is to determine if NMES will increase muscle mass and
strength, decrease sedentary time, and improve HF symptoms and exercise capacity, thus
improving quality of life in patients with HF. It is hypothesized that with this increase in
muscle mass, patients will improve overall exercise tolerance and capacity. In addition,
after the intervention patients will be better able to tolerate an exercise program thus
improving adherence to exercise recommendations. After 6 weeks of intervention, patients will
be encouraged to participate in a formalized exercise program.