The article describes a series of studies of the efficacy of the method of electromyostimulation, developed under the leadership of Inesa Benediktovna Kozlovskaya for the system of countermeasures against negative space flight effects on the muscular system, in the rehabilitation of patients hospitalized with decompensated chronic heart failure. It has been shown that low-frequency neuromuscular electrical stimulation of leg muscles has a favorable effect on exercise capacity and activity of patients and the assessment of their quality of life and general well-being. The efficacy of electrical stimulation significantly exceeds placebo and is comparable to low- to medium-intensity interval bicycle exercise training. It is well tolerated, does not induce significant changes in central hemodynamics, carbohydrate and lipid metabolism, renal function, and markers of muscle damage. The method can be used in the rehabilitation of patients with heart failure who are unable or unwilling to perform conventional exercise training.

Neuromuscular electrical stimulation (NMES) of large muscle groups in patients with stable chronic heart failure (CHF) increases physical work capacity and muscle strength. The safety and efficacy of short courses of NMES in patients with decompensated CHF has not been studied. The aim of the study was to compare the impact of leg NMES, interval bicycle training, and conventional treatment on the functional capacity and quality of life in patients hospitalized with decompensation of CHF. A total of 51 patients (84.3% of men; mean age, 62.5 ± 3.3 years) hospitalized with decompensated CHF were divided into three groups: optimal pharmacological therapy (OPT) + three weeks of NMES of thigh and shin muscles starting within the first three days after admission (n = 10), OPT + three weeks of bicycle exercise training (BET) starting on the fifth to seventh day (n = 20), and the control group of OPT only (n = 21). At baseline and after the three-week symptom-limited cardiopulmonary exercise test, 6-min walk test, Duke Activity Status Index (DASI) and quality of life assessment by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were performed. Patients in the NMES and BET groups presented with similar increases in the 6-min walk distance, plus 65.0 (50.0; 112.5) and 53.0 (51.0; 78; 0) m; DASI, plus 8.6 (5.5; 11.8) and 8.0 (4.5; 9.0) points; and VO2peak, plus 1.9 (0.3; 3.2) and 2.2 (0.7; 3.2) mL/(min kg), respectively. In the control group, only the 6-min walk distance increased significantly (+21 m). The improvement in the MLHFQ score was observed in all the three groups: maximal in the BET group and minimal in the NMES group. Three weeks of leg muscle electrical stimulation and bicycle training provide similar improvement in physical capacity, daily activity, and the quality of life in patients hospitalized for severe CHF. The efficacy of NMES is comparable with low to moderate intensity interval bicycle training and well tolerated by patients.

Aim: to specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection, fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER)>= 1,0. Materials and methods: 111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9% - permanent atrial fibrillation (AFib). Average follow-up was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis. Results. CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO(2)peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RER >= 1,0 was achieved only in 40.5% patients. In patients with RER<1.0 significant relationship between VO2 peak and combined endpoint was observed. Conclusions. Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO(2) peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age <65 years, patients with LVEF <45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RER >= 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.

Purpose: To compare the impact of functional electrical stimulation (FES) of skeletal muscles and conventional aerobic training on functional capacity and quality of life early after decompensation of chronic heart failure (CHF). Methods: A total of 51 patients (42 male, 9 female, mean age 62.49±3.28 years) hospitalized for decompensated CHF of various etiology were enrolled in the study. The patients were randomized to 3 groups: group of optimal pharmacologic therapy (OPT) + 3 weeks of FES of thigh and shin muscles starting within first 3 days after admission (n=10), group of OPT + 3 weeks of bicycle exercise training (BET) starting on the 5th-7th day (n=21), and control group of OPT only (n=20). Groups were comparable in gender, age, LVEF and comorbidities, though patients of FES group presented with initially lower exercise tolerance. At baseline and after 3 weeks symptom-limited cardiopulmonary exercise test, 6-minute walk test, Duke Activity Status Index (DASI) and quality of life assessment by Minnesota Living with Heart Failure Questionnaire (MLHFQ) were performed. Results: Patients in the FES group presented with increases in 6-min walk distance (from 235.0±84.0 to 314.0±52.8 m; Δ=79.0m, p=0.019) and non-significant increases of peak VO2 (from 10.7±3.8 to 12.8±2.7ml/kg/min; Δ=2.1ml/kg/min, p=0.081) and exercise time (+ 92.9s, p>0.05). In the BET group there was an increase of peak VO2 (from 13.0±2.9 to 15.5±3.7ml/kg/min; Δ=2.5ml/kg/min, p=0.043) and non-significant increases of 6-min walk distance (from 364.4±107.7 to 426.8±104.2m; Δ=32.9m, p=0.057) and exercise time (+113.5s, p>0.05). DASI score improvement was significant in both FES and BET groups (+ 8.9, p=0.008 and +7.7, p=0.002). There was no significant difference in the increments of all measures of functional capacity between FES and BET groups. In the control group the increases of peak V02 (+0.9ml/kg/min), 6-minute walk distance (+32.9m) exercise time (+47.4s) and DASI score (+2.9) were non-significant (p>0.05 for all indices). The improvement of MLHFQ score was observed in all three groups (-12.6, p<0.0001; -29,4, p<0.0001 and -20.8, p=0.0001 respectively) without significant difference between groups. Conclusion: 3 weeks of functional electric stimulation of leg muscles and bicycle exercise training provide similar improvement of exercise capacity and quality of life in patients hospitalized for severe CHF. FES may be started earlier and provide a good alternative to conventional aerobic training for CHF patients in decompensated state.