Effect of Aerobic Exercise training on Insulin Resistance among Non-Diabetic Heart Failure Patients

Insulin resistance (IR) is more particular to exist in patients with heart failure and is strongly in relation to level of physical activity. Aerobic exercises have been shown to ameliorate the insulin signaling through different molecular mechanisms. Aim: Evaluate the effect of aerobic exercise training on insulin resistance among non-diabetic heart failure patients. Design : A quasi-experimental. Setting : The research was performed at Cardio-thoracic Surgery Hospital at New Minia City which affiliated to main Minia University Hospitals. Subjects : A purposive sample of eighty patients with chronic heart failure were recruited and assigned into either study group or control group (40 patients for each group). Tools of data collection: Patient interview questionnaire and Insulin resistance assessment. Results : The mean scores of waist circumference measurements for the study group decreases significantly from 96.9±11.2, at baseline to, 84.2±6.76 post 12 -week of aerobic exercises training when compared to the control group which is relatively constant. Moreover, there were a statistically significant decrease in the results of the laboratory investigations indices for IR post-12-week of aerobic exercises training in study group as compared to control group. Conclusion : Aerobic exercises have a favorable effect on controlling the prognostic determinants of IR which was obvious in the improvement of anthropometric measurements and laboratory investigations.


Introduction:
Heart failure (HF) is the most critical health hazards around the globe as well as is the primary cause of hospitalization, with high morbidity as well as death rates and poor practical ability as well

Research setting
This research was operated in the cardiac inpatient department (located in the second floor) which consisted of 5 rooms (each room contains 6 beds) and out-patient clinic for follow up phase that is contained four rooms for patients' examination and follow-up and present in grounded floor at New Minia City on Cardio-thoracic Surgery Hospital and is affiliated to Minia University hospital in Egypt.

Sample of the research:
Purposive sample of 80 hospitalized chronic HF patients, were recruited and allocated into two groups as followed; study (aerobic exercises) group (forty patients) and control group (forty patients)

Allocation of study and control participants:
Patients who were eligible for recruitment were provided formal consent and assigned as 1:1 to either the study (n=40) or Control (n=40) groups.

Sample size:
The required representative sample size was 14.5% of patients with HF, with a 5% dropout rate.

Inclusion criteria:
Hospitalized patients who recently diagnosed with chronic HF and patient's age from 40 to 70 years week or if the patient performed ordinary activities more than five times per week.

Scoring system:
Each item had a score that ranged from one if the patient wasn't active, two if the patient performed ordinary activities 1-2 times per week, three if the patient performed from three to five times, weekly also more than five times in the week which take score four. Index (LP-IR) and they were evaluated three times during study period (at bassline assessment, after 8 weeks and after 12 weeks).

Scoring system
Content validity: The research tools were evaluated by a five-panel of Medical-Surgical nursing and community nursing professionals with higher than 10 years of experience in this field to evaluate the clarity, feasibility, as well as the applicability of the research tools.

Reliability was evaluated by Alpha
Cronbach's test. Reliability of the 1 st tool was (0.69) and the outcomes of the 2 nd tool was (0.86). The instruments coefficient revealed that this test was enough reliable.

Pilot study:
It was conducted on ten percent of the overall the participants (8 participants) to evaluate the applicability as well as acceptability of the tools, examine the feasibility of work's field; and knowing any potential issues that the researcher could encounter as well as obstruct the gathering of data. No modifications were made. The trial sample was used in the basic sample.

Ethical Consideration
All formal letters were given from the responsible authorities to conduct this study. The research was taken from the Ethics Committee on Faculty of Nursing at Minia University after reviewing the research protocol. There was no dangerous for study participants during the conduction of the research. All sample signed the informed consent and they were told of the study's purpose, method, advantages, nature, and followup. They also had the freedom to leave the study at any moment and without explanation. Through the coding of all data and the protection of the acquired data, the confidentiality and anonymity of each subject were guaranteed and Plagiarism was avoided and intellectual property rights were maintained.

Study fieldwork
Study Field work included three phases' preparatory, implementation, and evaluation Booklet was given to each participant in study group or the patient's caregiver, and after finished the study period the teaching program was given to control group.
-The last three sessions were the demonstration and re-demonstration of performing aerobic exercise that was done especially in the first two weeks during hospitalized period to ensure that the participants and their care-givers can follow this procedure perfectly after discharge from hospital, and during the follow-up period.
-For performing aerobic exercise in hospital, the standard twelve -lead electrocardiogram as well as blood pressure were frequently documented pre, during and post exercise. instructed not to change their usual diet.

Evaluation phase:
The follow-up and evaluation phase for both groups (study and control) was completed by faceto-face interviews using part three of tool I and part two of tool III at baseline, 8-weeks, and 12-weeks after applying the aerobic exercise for the study group to evaluate the effect of aerobic exercise on anthropometric measurement, laboratory investigations, and lowering IR so that the researchers encouraged the participants to attend follow-up appointments.

Statistical analysis
The statistical package for social sciences (SPSS) version 27 was used to arrange, classify, and analyze the collected data. For qualitative data were expressed as frequency and percentage. While quantitative variables were presented as mean and standard deviations. Inferential statistics such as paired t-test, chi-square test, and correlation r-test were used. When the p-value was less than 0.05 statistical significance was assumed.     respectively at baseline to (80%, 90%) respectively post 12-week. There are a highly statistical significance differences among the two groups regarding the clinical manifestation of IR.            Insulin is a strong anabolic hormone that controls glucose, lipid homeostasis, and energy storage. As a result, the liver and skeletal muscles store  Overall, incorporating regular aerobic exercises training into the treatment plan for non-diabetic HF patients has the potential to provide numerous benefits for HF, with subsequently reducing IR.