<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03780803</url>
  </required_header>
  <id_info>
    <org_study_id>N/ST/MN/16/002/1153</org_study_id>
    <nct_id>NCT03780803</nct_id>
  </id_info>
  <brief_title>Effect of Home Rehabilitation on State of Patients With PAH, HFREF and IHD</brief_title>
  <official_title>Evaluation of Influence of Home Physical Training Program and Respiratory Rehabilitation on Quality of Life, Body Composition, and Function of Respiratory Muscles in Patients With Primary PAH, HFREF and IHD</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Medical University of Bialystok</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Medical University of Bialystok</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The aim of the study is to evaluate the influence of physical training and respiratory&#xD;
      rehabilitation performed by patients at home on quality of life, symptoms, physical&#xD;
      endurance, force of respiratory and skeletal muscles and body mass composition in patients&#xD;
      with pulmonary arterial hypertension (PAH) or left ventricular heart failure with reduced&#xD;
      ejection fraction - HFREF), or ischemic heart disease and evaluation the number of stem&#xD;
      cells, natural lymphoid cells and distribution of subpopulations of monocytes (including&#xD;
      proangiogenic monocytes) in examined persons and evaluation of theirs eventual influence of&#xD;
      the course of disease.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      The study will be conducted on total group of 100 participants, from which 75 will be the&#xD;
      patients with PAH (pulmonary arterial hypertension), HF-REF (heart failure with reduced&#xD;
      ejection fraction) or IHD (ischemic heart disease).&#xD;
&#xD;
      In all participants medical anamnesis, physical examination, anthropometric measures,&#xD;
      6-minute walking distance (6MWD six minute walking distance) will be performed and initial&#xD;
      functional class according WHO (World Health Organisation)/NYHA (New York Health&#xD;
      Association)/CCS (Canadian Cardiovascular Society) classification will be evaluated. Medical&#xD;
      history will consist of questions regarding coexisting diseases, treatment, lifestyle, family&#xD;
      burden, etc. Quality of life will be assessed with use of The Short Form (36) Health Survey -&#xD;
      SF-36) and Fatigue Severity Scale - FSS. Biochemical measures will be performed including,&#xD;
      among others. brain natriuretic peptide (BNP), blood morphology, P-selectin, concentrations&#xD;
      of cytokines such as : Interleukin 6 (IL-6), soluble Interleukin 6 receptor (sIL-6R), stromal&#xD;
      derived factor-1 (SDF-1, CXCL12) and soluble tumor necrosis factor-like weak inducer of&#xD;
      apoptosis (sTWEAK).&#xD;
&#xD;
      Among lab parameters routinely measured in groups of patients with PAH, HFREF, IHD performed&#xD;
      in Cardiology Department of University Clinical Hospital during hospitalization will be used:&#xD;
      creatinine level, uric acid level, total cholesterol, LDL (low density lipoprotein), HDL&#xD;
      (high density lipoprotein), triglycerides levels, troponin I level, CRP (C reactive protein),&#xD;
      BNP (brain natriuretic peptide), fasting glucose, TSH (thyroid stimulating hormone), blood&#xD;
      morphology and arterial geometry. Fasting venous blood will be collected in 4 tubes each a 10&#xD;
      ml. Two tubes a 10ml (one dedicated to obtain serum (&quot;on clot&quot;), second with heparin) to&#xD;
      perform biochemical analyses, tube a 10ml with EDTA (ethylenediaminetetraacetic acid) will be&#xD;
      used to evaluate PBMC (peripheral blood mononuclear cell) (density gradient centrifugation),&#xD;
      tube a 10ml with citrate will be used to obtain platelet lysate.&#xD;
&#xD;
      Additionally fasting venous blood will be obtained - 2 tubes a 10ml in order to assess number&#xD;
      of stem cells, natural lymphoid cells, and distribution of subpopulations of lymphocytes.&#xD;
&#xD;
      In clinical evaluation measurement of respiratory (inspiratory and expiratory) muscles force&#xD;
      with use of device MicroRPM (respiratory pressure meter), analysis of body mass composition&#xD;
      with special regard to muscular mass with use of bioelectrical impedance analysis method&#xD;
      (BIA) (Maltron) and measurement of hand grip strength with use of hand dynamometer will be&#xD;
      performed.&#xD;
&#xD;
      During first visit also ECG (electrocardiogram) and echocardiography will be done.&#xD;
&#xD;
      The safe protocol of home physical training and respiratory rehabilitation adjusted to the&#xD;
      clinical state of patients will be developed in the form of brochure with photos and precise&#xD;
      description of exercises and the diary of self-control of patient in order to collect data&#xD;
      regarding daily physical activity will be given to participants. Patients willing to take&#xD;
      part in stage of exercises (circa 45 persons) will be trained in Rehabilitation Department&#xD;
      how to perform exercises at homes. Easy to use devices dedicated to respiratory exercises&#xD;
      (Pulmogain Respitrain) enabling respiratory muscles training with various degree of intensity&#xD;
      and pedometers to assess daily motor activity will be given to patients.&#xD;
&#xD;
      Stage of exercises during which the next series of tests will be performed will last 6&#xD;
      months. Exercising patients will come to Rehabilitation Department on first and third month&#xD;
      after start of rehabilitation in order to control the correctness of training performance,&#xD;
      filling self-control diary assessment of patients compliance and eventual corrections of&#xD;
      training program. Patients will be also under continuous phone supervision (minimally once a&#xD;
      week) and in the case of doubts and need for consultation. After finishing exercises stage&#xD;
      and performed clinical evaluation, patients will by themselves decide if they are willing to&#xD;
      continue rehabilitation (will have possibility of further use of physiotherapists care), and&#xD;
      follow up assessment will take place after 6 months from finishing exercises stage.&#xD;
&#xD;
      Comparative group will consist of patients with PAH, HF-REF, IHD who agreed to participate in&#xD;
      study but were not qualified to the exercises stage. Control group will consist of patients&#xD;
      of Cardiology Department and Cardiology Outpatient Clinic and Rehabilitation Department&#xD;
      (without cardiovascular diseases). Range of examinations in control group will consists of&#xD;
      medical anamnesis, physical examination, anthropometric measures, individually filled&#xD;
      questionnaires SF-36 and FSS, evaluation of respiratory muscles force, hand grip strength and&#xD;
      analysis of body mass composition BIA.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">February 1, 2016</start_date>
  <completion_date type="Actual">September 30, 2021</completion_date>
  <primary_completion_date type="Actual">September 30, 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Non-Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Other</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Clinical improvement assesment of 6 MWT distance</measure>
    <time_frame>6 months</time_frame>
    <description>6-min walk test (6 MWT) is a exercise test that entails measurement of distance walked over a span of 6 minutes by patient good outcome &gt; 500 m, bad outcome &lt; 200 m</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Evaluation of quality of life</measure>
    <time_frame>6 months</time_frame>
    <description>Quality of life measurement with SF36 (The Short Form (36) Health Survey, which is a 36-item, patient-reported survey of patient health.The Optum™ SF-36v2® Health Survey asks 36 questions to measure functional health and well-being from the patient's point of view. It is a practical, reliable and valid measure of physical and mental health that can be completed in five to ten minutes. The more number of points witness of better quality of life.&#xD;
Scores are calibrated so that 50 is the average score or norm. This norm-based score allows comparison among the three surveys and across the more than 19,000 studies published in the past 20 years. This bibliography includes studies of hundreds of diseases, conditions and populations, and greatly enhances the ability to interpret SF health survey data in new studies.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Force of respiratory muscles</measure>
    <time_frame>6 months</time_frame>
    <description>measurement of maximal inspiratory and expiratory pressure</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Clinical improvement - evaluation of WHO class</measure>
    <time_frame>6 months</time_frame>
    <description>Patients' functional status is assessed with use of World Health Organisation (WHO) for pulmonary arterial hypertension. Best status is class I, worst status is class IV</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluation of NYHA class</measure>
    <time_frame>6 months</time_frame>
    <description>Patients' functional status is assessed with use of New York Heart Association (NYHA) classification for heart failure, best status is class I, worst status is class IV.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Evaluation of CCS class</measure>
    <time_frame>6 months</time_frame>
    <description>Patients' functional status is assessed with use of Canadian Cardiovascular Society (CCS) classification for coronary artery disease. Best status is class I, worst status is class IV</description>
  </secondary_outcome>
  <other_outcome>
    <measure>Body mass composition in patients with PAH</measure>
    <time_frame>6 months</time_frame>
    <description>Bioelectrical impedance analysis of body mass composition- body fat (amount of body fat in kilograms), body fat (amount of body fat percentage), body muscle content (amount of body muscles in kilograms), body muscle content (amount of body muscles percentage), water content (amount of water in kilograms), water content (amount of water percentage), organic substances content (amount of organic substances in kilograms), organic substances content (amount of organic substances percentage).</description>
  </other_outcome>
  <other_outcome>
    <measure>Weight</measure>
    <time_frame>6 months</time_frame>
    <description>measurement of weight in kilograms</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of BNP (brain natriuretic peptide)</measure>
    <time_frame>6 months</time_frame>
    <description>Biochemical analyses - serum concentrations of brain natriuretic peptide (BNP) pg/ml</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of creatinine</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of creatinine mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of uric acid</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of uric acid mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of total cholesterol</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of total cholesterol mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of LDL</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of LDL (low density lipoprotein) mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of HDL</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of HDL (high density lipoprotein) mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of triglycerides</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of triglycerides mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of CRP</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of CRP (C-reactive protein) mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of fasting glucose</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of fasting glucose mg/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Activity of TSH</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum activity of TSH mU/l,</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of Troponin I</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of troponin I µg/l,</description>
  </other_outcome>
  <other_outcome>
    <measure>Number of WBC</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of number of WBC (white blood cells) K/µl,</description>
  </other_outcome>
  <other_outcome>
    <measure>Number of RBC</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of number of RBC (red blood cells ) M/µl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of Hemoglobin</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of Hgb (hemoglobin) g/dl</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of P selectin</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of P selectin, ng/ml</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of Il-6</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of interleukin 6 (IL-6) pg/ml</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of sIl-6 R</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of soluble Interleukin 6 receptor (sIL-6R),ng/ml</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of SDF-1</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of stromal derived factor-1 (SDF-1, CXCL12), ng/ml</description>
  </other_outcome>
  <other_outcome>
    <measure>Concentration of sTWEAK</measure>
    <time_frame>6 months</time_frame>
    <description>Measurement of serum concentrations of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK). pg/ml</description>
  </other_outcome>
  <other_outcome>
    <measure>Percentage of stem cells</measure>
    <time_frame>6 months</time_frame>
    <description>assesment of amount of stem cells (percentage of undifferentiated cells)</description>
  </other_outcome>
  <other_outcome>
    <measure>percentage of subpopulations of monocytes</measure>
    <time_frame>6 months</time_frame>
    <description>profile of subpopulations of monocytes (percentage)</description>
  </other_outcome>
  <number_of_arms>4</number_of_arms>
  <enrollment type="Actual">93</enrollment>
  <condition>Pulmonary Hypertension</condition>
  <condition>Heart Failure With Reduced Ejection Fraction</condition>
  <condition>Ischemic Heart Disease</condition>
  <arm_group>
    <arm_group_label>Patients with PAH</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>home cardiac rehabilitation and respiratory rehabilitation</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Patients with HFREF</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>home cardiac rehabilitation and respiratory rehabilitation</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Patients with IHD</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>home cardiac rehabilitation and respiratory rehabilitation</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Control group</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>No rehabilitation</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>home cardiac rehabilitation and respiratory rehabilitation</intervention_name>
    <arm_group_label>Patients with HFREF</arm_group_label>
    <arm_group_label>Patients with IHD</arm_group_label>
    <arm_group_label>Patients with PAH</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  age &gt;18 years&#xD;
&#xD;
          -  informed consent signed by patient to conduct the study&#xD;
&#xD;
          -  no diseases excluding rehabilitation&#xD;
&#xD;
          -  pts with idiopathic, inherited PAH (pulmonary arterial hypertension), or in the course&#xD;
             of connective tissue diseases, portal hypertension, congenital heart diseases.&#xD;
&#xD;
          -  PAH confirmed in catheterisation of right side of heart mPAP (mean pulmonary arterial&#xD;
             pressure) ≥25 mmHg, PCWP (pulmonary capillary wedge pressure) ≤15mmHg.&#xD;
&#xD;
          -  Chronic heart failure - left ventricle ejection fraction &lt;40% in echocardiography,&#xD;
             NYHA *New York Health Association) class II-III&#xD;
&#xD;
          -  stable ischaemic heart disease in CCS (Canadian Cardiovascular Society) class II-III&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Other types of pulmonary hypertension&#xD;
&#xD;
          -  COPD (chronic obstructive pulmonary disease), asthma&#xD;
&#xD;
          -  malignancies&#xD;
&#xD;
          -  Acute inflammatory state up to 4 weeks before inclusion to the study&#xD;
&#xD;
          -  Acute coronary syndrome up to 3 months before inclusion to the study&#xD;
&#xD;
          -  Heart failure in NYHA IV class&#xD;
&#xD;
          -  severe anaemia (Hgb &lt;11g/dl for men &lt;10g/dl for women)&#xD;
&#xD;
          -  electrolyte and hormonal disturbances in period of 1 month before inclusion to the&#xD;
             study&#xD;
&#xD;
          -  substantial modification of treatment of main disease within last 3 months&#xD;
&#xD;
          -  ischaemic heart disease in CCS class IV&#xD;
&#xD;
          -  Other clinical situations excluding to perform controlled program of rehabilitation&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Karol Kamiński, Professor</last_name>
    <role>Study Chair</role>
    <affiliation>Medical University of Bialystok</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Medical University of Bialystok, Department of Rehabilitation</name>
      <address>
        <city>Białystok</city>
        <state>Podlaskie</state>
        <zip>15-089</zip>
        <country>Poland</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Poland</country>
  </location_countries>
  <link>
    <url>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316895/</url>
    <description>Effectiveness and safety of a simple home-based rehabilitation program in pulmonary arterial hypertension: an interventional pilot study</description>
  </link>
  <reference>
    <citation>Morris NR, Kermeen FD, Holland AE. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev. 2017 Jan 19;1(1):CD011285. doi: 10.1002/14651858.CD011285.pub2.</citation>
    <PMID>28099988</PMID>
  </reference>
  <reference>
    <citation>Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006 Oct 3;114(14):1482-9. doi: 10.1161/CIRCULATIONAHA.106.618397. Epub 2006 Sep 18.</citation>
    <PMID>16982941</PMID>
  </reference>
  <reference>
    <citation>Zafrir B. Exercise training and rehabilitation in pulmonary arterial hypertension: rationale and current data evaluation. J Cardiopulm Rehabil Prev. 2013 Sep-Oct;33(5):263-73. doi: 10.1097/HCR.0b013e3182a0299a.</citation>
    <PMID>23962982</PMID>
  </reference>
  <reference>
    <citation>Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, Singh S. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014 Apr 27;2014(4):CD003331. doi: 10.1002/14651858.CD003331.pub4.</citation>
    <PMID>24771460</PMID>
  </reference>
  <reference>
    <citation>Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F, Rees K, Singh S, Taylor RS. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart. 2015 Jan 28;2(1):e000163. doi: 10.1136/openhrt-2014-000163. eCollection 2015.</citation>
    <PMID>25685361</PMID>
  </reference>
  <reference>
    <citation>Oldridge N. Exercise-based cardiac rehabilitation in patients with coronary heart disease: meta-analysis outcomes revisited. Future Cardiol. 2012 Sep;8(5):729-51. doi: 10.2217/fca.12.34.</citation>
    <PMID>23013125</PMID>
  </reference>
  <reference>
    <citation>Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001800. doi: 10.1002/14651858.CD001800.pub2.</citation>
    <PMID>21735386</PMID>
  </reference>
  <verification_date>February 2021</verification_date>
  <study_first_submitted>September 13, 2018</study_first_submitted>
  <study_first_submitted_qc>December 17, 2018</study_first_submitted_qc>
  <study_first_posted type="Actual">December 19, 2018</study_first_posted>
  <last_update_submitted>October 23, 2021</last_update_submitted>
  <last_update_submitted_qc>October 23, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">November 1, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>cardiac rehabilitation</keyword>
  <keyword>pulmonary rehabilitation</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Hypertension, Pulmonary</mesh_term>
    <mesh_term>Heart Diseases</mesh_term>
    <mesh_term>Myocardial Ischemia</mesh_term>
    <mesh_term>Coronary Artery Disease</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03780803
org study id: N/ST/MN/16/002/1153
nct id: NCT03780803
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
The aim of the study is to evaluate the influence of physical training and respiratory
      rehabilitation performed by patients at home on quality of life, symptoms, physical
      endurance, force of respiratory and skeletal muscles and body mass composition in patients
      with pulmonary arterial hypertension (PAH) or left ventricular heart failure with reduced
      ejection fraction - HFREF), or ischemic heart disease and evaluation the number of stem
      cells, natural lymphoid cells and distribution of subpopulations of monocytes (including
      proangiogenic monocytes) in examined persons and evaluation of theirs eventual influence of
      the course of disease.
The study will be conducted on total group of 100 participants, from which 75 will be the
      patients with PAH (pulmonary arterial hypertension), HF-REF (heart failure with reduced
      ejection fraction) or IHD (ischemic heart disease).

      In all participants medical anamnesis, physical examination, anthropometric measures,
      6-minute walking distance (6MWD six minute walking distance) will be performed and initial
      functional class according WHO (World Health Organisation)/NYHA (New York Health
      Association)/CCS (Canadian Cardiovascular Society) classification will be evaluated. Medical
      history will consist of questions regarding coexisting diseases, treatment, lifestyle, family
      burden, etc. Quality of life will be assessed with use of The Short Form (36) Health Survey -
      SF-36) and Fatigue Severity Scale - FSS. Biochemical measures will be performed including,
      among others. brain natriuretic peptide (BNP), blood morphology, P-selectin, concentrations
      of cytokines such as : Interleukin 6 (IL-6), soluble Interleukin 6 receptor (sIL-6R), stromal
      derived factor-1 (SDF-1, CXCL12) and soluble tumor necrosis factor-like weak inducer of
      apoptosis (sTWEAK).

      Among lab parameters routinely measured in groups of patients with PAH, HFREF, IHD performed
      in Cardiology Department of University Clinical Hospital during hospitalization will be used:
      creatinine level, uric acid level, total cholesterol, LDL (low density lipoprotein), HDL
      (high density lipoprotein), triglycerides levels, troponin I level, CRP (C reactive protein),
      BNP (brain natriuretic peptide), fasting glucose, TSH (thyroid stimulating hormone), blood
      morphology and arterial geometry. Fasting venous blood will be collected in 4 tubes each a 10
      ml. Two tubes a 10ml (one dedicated to obtain serum ("on clot"), second with heparin) to
      perform biochemical analyses, tube a 10ml with EDTA (ethylenediaminetetraacetic acid) will be
      used to evaluate PBMC (peripheral blood mononuclear cell) (density gradient centrifugation),
      tube a 10ml with citrate will be used to obtain platelet lysate.

      Additionally fasting venous blood will be obtained - 2 tubes a 10ml in order to assess number
      of stem cells, natural lymphoid cells, and distribution of subpopulations of lymphocytes.

      In clinical evaluation measurement of respiratory (inspiratory and expiratory) muscles force
      with use of device MicroRPM (respiratory pressure meter), analysis of body mass composition
      with special regard to muscular mass with use of bioelectrical impedance analysis method
      (BIA) (Maltron) and measurement of hand grip strength with use of hand dynamometer will be
      performed.

      During first visit also ECG (electrocardiogram) and echocardiography will be done.

      The safe protocol of home physical training and respiratory rehabilitation adjusted to the
      clinical state of patients will be developed in the form of brochure with photos and precise
      description of exercises and the diary of self-control of patient in order to collect data
      regarding daily physical activity will be given to participants. Patients willing to take
      part in stage of exercises (circa 45 persons) will be trained in Rehabilitation Department
      how to perform exercises at homes. Easy to use devices dedicated to respiratory exercises
      (Pulmogain Respitrain) enabling respiratory muscles training with various degree of intensity
      and pedometers to assess daily motor activity will be given to patients.

      Stage of exercises during which the next series of tests will be performed will last 6
      months. Exercising patients will come to Rehabilitation Department on first and third month
      after start of rehabilitation in order to control the correctness of training performance,
      filling self-control diary assessment of patients compliance and eventual corrections of
      training program. Patients will be also under continuous phone supervision (minimally once a
      week) and in the case of doubts and need for consultation. After finishing exercises stage
      and performed clinical evaluation, patients will by themselves decide if they are willing to
      continue rehabilitation (will have possibility of further use of physiotherapists care), and
      follow up assessment will take place after 6 months from finishing exercises stage.

      Comparative group will consist of patients with PAH, HF-REF, IHD who agreed to participate in
      study but were not qualified to the exercises stage. Control group will consist of patients
      of Cardiology Department and Cardiology Outpatient Clinic and Rehabilitation Department
      (without cardiovascular diseases). Range of examinations in control group will consists of
      medical anamnesis, physical examination, anthropometric measures, individually filled
      questionnaires SF-36 and FSS, evaluation of respiratory muscles force, hand grip strength and
      analysis of body mass composition BIA.
allocation: Non-Randomized
intervention model: Parallel Assignment
primary purpose: Other
masking: None (Open Label)
measure: Clinical improvement assesment of 6 MWT distance
time frame: 6 months
description: 6-min walk test (6 MWT) is a exercise test that entails measurement of distance walked over a span of 6 minutes by patient good outcome > 500 m, bad outcome < 200 m
measure: Evaluation of quality of life
time frame: 6 months
description: Quality of life measurement with SF36 (The Short Form (36) Health Survey, which is a 36-item, patient-reported survey of patient health.The Optum™ SF-36v2® Health Survey asks 36 questions to measure functional health and well-being from the patient's point of view. It is a practical, reliable and valid measure of physical and mental health that can be completed in five to ten minutes. The more number of points witness of better quality of life.
Scores are calibrated so that 50 is the average score or norm. This norm-based score allows comparison among the three surveys and across the more than 19,000 studies published in the past 20 years. This bibliography includes studies of hundreds of diseases, conditions and populations, and greatly enhances the ability to interpret SF health survey data in new studies.
measure: Force of respiratory muscles
time frame: 6 months
description: measurement of maximal inspiratory and expiratory pressure
measure: Clinical improvement - evaluation of WHO class
time frame: 6 months
description: Patients' functional status is assessed with use of World Health Organisation (WHO) for pulmonary arterial hypertension. Best status is class I, worst status is class IV
measure: Evaluation of NYHA class
time frame: 6 months
description: Patients' functional status is assessed with use of New York Heart Association (NYHA) classification for heart failure, best status is class I, worst status is class IV.
measure: Evaluation of CCS class
time frame: 6 months
description: Patients' functional status is assessed with use of Canadian Cardiovascular Society (CCS) classification for coronary artery disease. Best status is class I, worst status is class IV
measure: Body mass composition in patients with PAH
time frame: 6 months
description: Bioelectrical impedance analysis of body mass composition- body fat (amount of body fat in kilograms), body fat (amount of body fat percentage), body muscle content (amount of body muscles in kilograms), body muscle content (amount of body muscles percentage), water content (amount of water in kilograms), water content (amount of water percentage), organic substances content (amount of organic substances in kilograms), organic substances content (amount of organic substances percentage).
measure: Weight
time frame: 6 months
description: measurement of weight in kilograms
measure: Concentration of BNP (brain natriuretic peptide)
time frame: 6 months
description: Biochemical analyses - serum concentrations of brain natriuretic peptide (BNP) pg/ml
measure: Concentration of creatinine
time frame: 6 months
description: Measurement of serum concentrations of creatinine mg/dl
measure: Concentration of uric acid
time frame: 6 months
description: Measurement of serum concentrations of uric acid mg/dl
measure: Concentration of total cholesterol
time frame: 6 months
description: Measurement of serum concentrations of total cholesterol mg/dl
measure: Concentration of LDL
time frame: 6 months
description: Measurement of serum concentrations of LDL (low density lipoprotein) mg/dl
measure: Concentration of HDL
time frame: 6 months
description: Measurement of serum concentrations of HDL (high density lipoprotein) mg/dl
measure: Concentration of triglycerides
time frame: 6 months
description: Measurement of serum concentrations of triglycerides mg/dl
measure: Concentration of CRP
time frame: 6 months
description: Measurement of serum concentrations of CRP (C-reactive protein) mg/dl
measure: Concentration of fasting glucose
time frame: 6 months
description: Measurement of serum concentrations of fasting glucose mg/dl
measure: Activity of TSH
time frame: 6 months
description: Measurement of serum activity of TSH mU/l,
measure: Concentration of Troponin I
time frame: 6 months
description: Measurement of serum concentrations of troponin I µg/l,
measure: Number of WBC
time frame: 6 months
description: Measurement of number of WBC (white blood cells) K/µl,
measure: Number of RBC
time frame: 6 months
description: Measurement of number of RBC (red blood cells ) M/µl
measure: Concentration of Hemoglobin
time frame: 6 months
description: Measurement of serum concentrations of Hgb (hemoglobin) g/dl
measure: Concentration of P selectin
time frame: 6 months
description: Measurement of serum concentrations of P selectin, ng/ml
measure: Concentration of Il-6
time frame: 6 months
description: Measurement of serum concentrations of interleukin 6 (IL-6) pg/ml
measure: Concentration of sIl-6 R
time frame: 6 months
description: Measurement of serum concentrations of soluble Interleukin 6 receptor (sIL-6R),ng/ml
measure: Concentration of SDF-1
time frame: 6 months
description: Measurement of serum concentrations of stromal derived factor-1 (SDF-1, CXCL12), ng/ml
measure: Concentration of sTWEAK
time frame: 6 months
description: Measurement of serum concentrations of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK). pg/ml
measure: Percentage of stem cells
time frame: 6 months
description: assesment of amount of stem cells (percentage of undifferentiated cells)
measure: percentage of subpopulations of monocytes
time frame: 6 months
description: profile of subpopulations of monocytes (percentage)
arm group label: Patients with PAH
arm group type: Experimental
description: home cardiac rehabilitation and respiratory rehabilitation
arm group label: Patients with HFREF
arm group type: Experimental
description: home cardiac rehabilitation and respiratory rehabilitation
arm group label: Patients with IHD
arm group type: Experimental
description: home cardiac rehabilitation and respiratory rehabilitation
arm group label: Control group
arm group type: No Intervention
description: No rehabilitation
intervention type: Other
intervention name: home cardiac rehabilitation and respiratory rehabilitation
arm group label: Patients with HFREF
arm group label: Patients with IHD
arm group label: Patients with PAH
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
last name: Karol Kamiński, Professor
role: Study Chair
affiliation: Medical University of Bialystok
facility: 
country: Poland
url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316895/
description: Effectiveness and safety of a simple home-based rehabilitation program in pulmonary arterial hypertension: an interventional pilot study
citation: Morris NR, Kermeen FD, Holland AE. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev. 2017 Jan 19;1(1):CD011285. doi: 10.1002/14651858.CD011285.pub2.
PMID: 28099988
citation: Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006 Oct 3;114(14):1482-9. doi: 10.1161/CIRCULATIONAHA.106.618397. Epub 2006 Sep 18.
PMID: 16982941
citation: Zafrir B. Exercise training and rehabilitation in pulmonary arterial hypertension: rationale and current data evaluation. J Cardiopulm Rehabil Prev. 2013 Sep-Oct;33(5):263-73. doi: 10.1097/HCR.0b013e3182a0299a.
PMID: 23962982
citation: Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, Singh S. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014 Apr 27;2014(4):CD003331. doi: 10.1002/14651858.CD003331.pub4.
PMID: 24771460
citation: Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F, Rees K, Singh S, Taylor RS. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart. 2015 Jan 28;2(1):e000163. doi: 10.1136/openhrt-2014-000163. eCollection 2015.
PMID: 25685361
citation: Oldridge N. Exercise-based cardiac rehabilitation in patients with coronary heart disease: meta-analysis outcomes revisited. Future Cardiol. 2012 Sep;8(5):729-51. doi: 10.2217/fca.12.34.
PMID: 23013125
citation: Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001800. doi: 10.1002/14651858.CD001800.pub2.
PMID: 21735386
responsible party type: Sponsor
mesh term: Hypertension, Pulmonary
mesh term: Heart Diseases
mesh term: Myocardial Ischemia
mesh term: Coronary Artery Disease
sharing ipd: No