Balance as a functional marker of health status in patients with LVEF <40% in a home-based cardiac rehabilitation programme
C Rebelo, V Afreixo, J Bastos, A AbreuAbstract
Background
Patients hospitalised with reduced left ventricular ejection fraction (LVEF) frequently experience considerable limitations in daily activities, dependence on assistance, and reduced mobility. Impaired balance and walking capacity hinder recovery, promote frailty, and increase susceptibility to further complications. Physical inactivity, a recognised cardiovascular risk factor, exacerbates functional decline, weakens resilience, and accelerates disease progression.
Aim
To evaluate the physical fitness of patients with reduced LVEF participating in a home-based cardiac rehabilitation (CR) programme designed to improve cardiovascular health and functional capacity.
Methods
A longitudinal, prospective experimental study was conducted among hospitalised patients diagnosed with coronary artery disease. Physical fitness was assessed using the Fullerton Functional Fitness Test Battery (dynamic balance, mobility, flexibility, and muscular strength), handgrip strength test (upper limb force), and the 6-minute walk test (6MWT) to assess cardiorespiratory endurance. Participants also completed the Morisky Medication Adherence Scale, STOP-Bang questionnaire, International Physical Activity Questionnaire (IPAQ), Hospital Anxiety and Depression Scale (HADS), and EQ-5D quality-of-life scale. Functional outcomes were compared between baseline (T1) and follow-up (T2) assessments.
Results
Sixty-four patients completed the evaluation. Statistically significant improvements (p < 0.001) were observed across all components of the Fullerton test battery between T1 and T2, including upper and lower limb strength, flexibility, motor agility, dynamic balance and aerobic endurance (6MWT). Handgrip strength also significantly increased at T2, indicating improved upper body function. Furthermore, notable progress was recorded in IPAQ, HADS, and EQ-5D scores, reflecting improved physical activity levels, psychological well-being, and overall quality of life.
Conclusions
Several factors may contribute to LVEF improvement, including enhanced control of cardiovascular risk factors, muscular recovery, and improved functional capacity. Although patients with LVEF ≤40% remain at heightened risk of cardiovascular complications; however, significant improvements in balance, fitness, and quality of life following CR highlight its clinical relevance. Balance assessment is a practical and sensitive indicator of CR success, emphasising its importance in monitoring progress and guiding interventions that reduce frailty and disability in this high-risk group.Group ComparisonFor image description, please refer to the figure legend and surrounding text.