The impact of home-based physiotherapy on functional capacity and quality of life in patients with severe heart failure

Vijayaragavan vaiyapuri1

1Physiotherapist, Kauvery Hospital, Vadapalani, Chennai, Tamil Nadu

Abstract: Heart failure (HF) is a chronic condition characterized by reduced cardiac function, leading to impaired physical activity and decreased quality of life. Physiotherapy plays an essential role in comprehensive HF management, improving functional capacity, quality of life, and reducing hospital readmissions. This study explores the impact of a structured home-based physiotherapy program on a 47-year-old male diagnosed with severe heart failure, aiming to enhance his activity of daily living (ADL) and symptom management. Outcomes were assessed through functional capacity tests, symptom reporting, and quality of life measures. The case demonstrates the effectiveness of physiotherapy in managing heart failure within this age group and highlights the importance of individualized, home-based rehabilitation strategies.

Keywords: Heart failure, physiotherapy, middle-aged, cardiac rehabilitation, case study, exercise tolerance.

Introduction: Heart failure significantly affects an individual’s ability to perform ADLs due to dyspnea, fatigue, and reduced exercise tolerance.1 Physiotherapy is an integral part of multidisciplinary heart failure care. It aims to improve cardiorespiratory fitness, reduce symptom burden, and enhance the patient’s ability to perform daily activities.2 This article presents a case study illustrating the implementation and outcomes of physiotherapy in a middle-aged heart failure patient. Traditional rehabilitation programs often require hospital visits, which can be challenging for severely affected individuals. Home-based physiotherapy provides a feasible alternative by offering personalized interventions within a comfortable environment.3-4

Case Presentation

Patient Information

Age & Gender: 47 years/Male

Occupation: Accountant

Medical History

  • Known case of Ischaemic cardiomyopathy on medical management.
  • Known case of Type 2 diabetes mellitus on regular medication.
  • Known case of coronary artery disease on regular medication
  • S/P CAG- Double vessel disease (09.09.2024)
  • S/P PCI done from ostio-proximal to distal RCA using 3 DES (13.09.2024)
  • S/P PCI done to PLB using 1 DEB (13.03.2024)

Personal history: Normal sleep and diet pattern

Family history: No relevant family history related to diagnosis.

Economical status: Upper middle class

Present drug history

Tab. Ecosprin , Tab. Brilinta, Tab. Cordarone, Tab. Concor, Tab. Verquvo, Tab. Sacurise, Tab. Dytor, Tab. Oxra, Tab. Kerendia, Tab. Thyronorm.

On Observation

Patient is conscious, oriented and alert.

  • Body build: Endomorphic
  • Attitude of limb: Extension on bilateral lower limb.

On Palpation

  • Tenderness: Present over both thigh and calf region.
  • Oedema: Pitting edema presents over both thigh and calf region.
  • Warmth: Present over both thigh region.

Pain Assessment

  • Side& Site: Bilateral lower limb over on thigh and calf region.
  • Type: Aching pain.
  • Aggravating factor: During any lower limb movement.
  • Relieving factor: Resting position (Extension of bilateral lower limb)

VAS pain scale

  • On assessment (18/11/2024): 8/10.
  • 6th week Follow up (05/01/2025): 4/10.
  • Last session (25/02/2025): 2/10.

Initial Functional Assessment

  • Vital Signs: Resting HR: 66 bpm, BP: 120/85 mmHg, SpO2: 98% (room air)
  • Exercise Capacity: 6-Minute Walk Test (6MWT): 280 meters
  • Dyspnea Level: Modified Borg Scale: 7/10 on exertion
  • Modified Borg Scale: 07 (somewhat hard) after walk test.
  • Psychological Status: Mild anxiety (GAD-7 score = 8)
  • Balance & Strength: Weakness in lower limbs, Timed Up and Go (TUG): 24 seconds.

On Examination

Range of Motion

ROM on day of assessment (18/11/2024)

RightLeft
Upper limbNormalNormal
Lower limbReduced Knee flexion ROM due to edema & pain.Reduced Hip flexion and Knee flexion ROM due to edema & pain.

ROM on last Session (25/02/2025):

RIGHTLEFT
Upper limbNormalNormal
Lower limbNormalNormal

Muscle tone: Resistance of muscles to passive stretch during resting state.

Manual muscle testing

MMT on day of assessment (18/11/2024)

RIGHTLEFT
Upper limb5/55/5
Lower limb3+/53+/5

MMT on last Session (25/02/2025)

RIGHTLEFT
Upper limb5/55/5
Lower limb4+/54+/5

Diagnosis

  • Heart failure
  • Coronary artery disease- post PTCA
  • Critical illness polyneuropathy
  • Critical illness myopathy
  • Multiple episodes of hypoglycaemia
  • Acute kidney injury
  • Type 2 diabetes mellitus
  • Hypothyroidism

Short term goal

  • To prevent bed sore.
  • To reduce the oedema over the B/L Lower limb.
  • To improve strength of quadriceps, hip extensors and abductors from Grade 3 to Grade 3+.
  • To improve fair sitting and Poor standing balance.

Long term goal

  • To make the patient independent in out of bed activities.
  • To improve the lung capacity.
  • To bring back patient in optimal walking pattern.
  • To put him back in the community and regain his occupation.

Physiotherapy Rehabilitation Protocol

This home-based program follows AHA guidelines to help heart patients recover safely and improve their heart health. It focuses on gradual physical activity, breathing exercises, and lifestyle modifications while monitoring symptoms.

Phase 01: Acute phase (Week 1-4)

  • Bed mobility & positioning- Avoid prolonged sitting/lying in one position.
  • Breathing exercises- Incentive spirometry, Diaphragmatic breathing exercise 10 reps*2 sets.
  • Ankle pumps & gentle ROM Exercises (AAROM to B/L UL &LL)– 10 reps*2 sets
  • Pelvic bridging 5 seconds hold, 10 reps, 2 sets.
  • PNF stretch for adductor muscle- 10 seconds hold, 20 seconds of stretch, 3 sets

Goals

  • To prevent bed complication (DVT, pneumonia, muscle atrophy)
  • Promote circulation and reduce oedema.
  • Begin light functional activities.

Phase 02: Subacute phase (weeks 5-8)

  • Lower limb strengthening- seated knee extension, heel raises.
  • High sitting edge of bed quadriceps extension facilitation.
  • Trunk rotation in sitting.
  • Initiated slow walking with walker support 10 reps.
  • Goals:
  • Improve cardiovascular fitness and functional strength.
  • Reduce swelling and enhance mobility.

Phase 3: Advance phase (Week 9-12)

  • Resistance band exercises for upper limb and lower limb 10 rep 3 sets.
  • Stair climbing, walking with walker support.
  • Engage in daily physical activity and maintain a heart-healthy lifestyle.
  • Periodic follow up with a physiotherapist and cardiologist.

Above said rehab protocol was followed on after 12 weeks

Outcome Measures & Result

Outcome MeasureBaselineAfter 12 WeeksImprovement
6MWT Distance280 meters390 meters+110 m
Modified Borg Scale0702Improved
Timed Up and Go (TUG)24 sec15 secImproved
Dyspnea ScaleGrade 2Grade 1Improved
GAD-7 (Anxiety Score)8 (mild)4 (minimal)Reduced
  • Improved Exercise Capacity: 6MWT distance increased to 390 meters
  • Reduced Dyspnea: Modified Borg Scale improved to 2/10
  • Enhanced ADL Independence: Improved ability to perform self-care tasks
  • Psychological Well-being: Reduced anxiety and increased motivation for physical activity

Discussion: The findings support the efficacy of home-based physiotherapy in improving functional capacity and symptom management in severe HF patients. Individualized rehabilitation programs incorporating aerobic, strength, and respiratory training contribute to enhanced quality of life and reduced hospitalizations.

Conclusion: Home-based physiotherapy presents a promising approach to managing severe heart failure, promoting ADL independence, and reducing symptom burden. Further research with larger sample sizes is needed to validate its long-term efficacy.

References

  • Piepoli, M. F., Corrà, U., Benzer, W., Bjarnason-Wehrens, B., Dendale, P., Gaita, D., . & Schmid, J. P. (2010). Secondary prevention through cardiac rehabilitation: Physical activity counselling and exercise training. European Journal of Cardiovascular Prevention & Rehabilitation, 17(1), 1–17.
  • Taylor, R. S., Dalal, H., Jolly, K., Moxham, T., & Zawada, A. (2014). Home-based versus centre-based cardiac rehabilitation. Cochrane Database of Systematic Reviews, (6), CD007130.
  • Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Drazner, M. H., … & Wilkoff, B. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology, 62(16), e147–e239.
  • Anderson, L., Sharp, G. A., Norton, R. J., Dalal, H., Dean, S. G., Jolly, K., & Taylor, R. S. (2017). Home-based versus centre-based cardiac rehabilitation. Heart, 103(6), 455–462. https://doi.org/10.1136/heartjnl-2016-309996

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