Physical Therapy Rehabilitation Approach for Phase II CHF Due to RHD Post-MVR: A Case Study

Fera Syofwatin Ni’mah; Farid Rahman; Kadek Agustini Aryani

doi:10.30787/gaster.v24i1.2342

Authors

Fera Syofwatin Ni’mah Physical Therapy Professional Education Program, Faculty of Health Sciences, Muhammadiyah University of Surakarta, Surakarta
Farid Rahman Physical Therapy Professional Education Program, Faculty of Health Sciences, Muhammadiyah University of Surakarta, Surakarta
Kadek Agustini Aryani Department of Integrated Cardiac Care, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar

DOI:

https://doi.org/10.30787/gaster.v24i1.2342

Keywords:

Congestive Heart Failure, Aerobic Capacity, Rheumatic Heart Disease, Cardiac Rehabilitation, Mitral Valve Replacement

Abstract

Introduction: Congestive Heart Failure (CHF) due to Rheumatic Heart Disease (RHD) often causes cardiac dysfunction after mitral valve replacement (MVR) and tricuspid valve repair (TVR) surgery. Phase II cardiac rehabilitation is important to improve aerobic capacity, cardiorespiratory function, and quality of life in postoperative patients. Objective: To examine the effects of a phase II physical therapy rehabilitation program on improving aerobic capacity in Class II CHF patients with RHD after MVR and TVR. Method: A single case study of a 43-year-old woman with postoperative CHF FC II, who underwent 13 aerobic exercise sessions consisting of walking on a track, treadmill, and stationary bicycle based on the FITT (Frequency, Intensity, Time, Type) principle. Parameters evaluated included blood pressure, heart rate, oxygen saturation, Borg scale, and distance covered in the Six Minute Walking Test (6MWT). Results: Showed an increase in 6MWT distance from 355 meters to 446 meters, METs from 4.18 to 4.9, and Borg score from 6 to 7 with stable vital signs. Conclusion: Gradual aerobic exercise in phase II rehabilitation is safe and effective in improving aerobic capacity, hemodynamic response, and activity tolerance in patients, while preventing deterioration of condition and readmission.

References

Abraham, L. N., Sibilitz, K. L., Berg, S. K., Tang, L. H., Risom, S. S., Lindschou, J., Taylor, R. S., Borregaard, B., & Zwisler, A. D. (2021). Exercise-based cardiac rehabilitation for adults after heart valve surgery. Cochrane Database of Systematic Reviews, 2021(5). https://doi.org/10.1002/14651858.CD010876.pub3

Anak Agung Ketut Yunita Paramita, Made Ratna Saraswati, & Nyoman Wiryawan. (2021). The characteristics of heart failure in patients with diabetes mellitus in Sanglah Hospital Denpasar. Jurnal Penyakit Dalam Udayana, 5(2), 37–45. https://doi.org/10.36216/jpd.v5i2.152

Anderson, L., Oldridge, N., Thompson, D. R., Zwisler, A. D., Rees, K., Martin, N., & Taylor, R. S. (2016). Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. Journal of the American College of Cardiology, 67(1), 1–12. https://doi.org/10.1016/j.jacc.2015.10.044

Basuni, D. T., & Fitria, F. (2023). Six Minute Walking Test as Prognosis Indicator in Stable Chronic CHF Patients in Second Phase Cardiac Rehabilitation. Journal Of The Indonesian Medical Association, 73(2), 97–101. https://doi.org/10.47830/jinma vol.73.2-2023-786

Brown, T. M., Pack, Q. R., Aberegg, E., Brewer, L. C., Ford, Y. R., Forman, D. E., Gathright, E. C., Khadanga, S., Ozemek, C., & Thomas, R. J. (2024). Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation, 150(18), e328–e347. https://doi.org/10.1161/CIR.0000000000001289

Cardiovascular, A. A. of, & Rehabilitation, and P. (2021). Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs (6th ed.). Human Kinetics. do Nascimento, D. M., Machado, K. C., Bock, P. M., Saffi, M. A. L., Goldraich, L. A., Silveira, A. D., Clausell, N., & Schaan, B. D. (2023). Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial. BMC Cardiovascular Disorders, 23(1), 1–10. https://doi.org/10.1186/s12872023-03404-7

Cavero-Redondo, I., Saz-Lara, A., Bizzozero-Peroni, B., Núñez-Martínez, L., Díaz-Goñi, V., Calero-Paniagua, I., Matínez-García, I., & Pascual-Morena, C. (2024). Accuracy of the 6-Minute Walk Test for Assessing Functional Capacity in Patients With Heart Failure With Preserved Ejection Fraction and Other Chronic Cardiac Pathologies: Results of the ExIC-FEp Trial and a Meta-Analysis. Sports Medicine - Open, 10(1). https://doi.org/10.1186/s40798-024-00740-6

Chun, K. H., & Kang, S. M. (2020). Cardiac Rehabilitation in Heart Failure. International journal of heart failure, 3(1), 1–14. https://doi.org/10.36628/ijhf.2020.0021

Cieza, A., Fayed, N., Bickenbach, J., & Prodinger, B. (2016). Refinements of the ICF Linking Rules to strengthen their potential for establishing comparability of health information. Disability and Rehabilitation, 41(5), 574–583. https://doi.org/10.3109/09638288.2016.1145258

Do Nascimento, D. M., Machado, K. C., Bock, P. M., Saffi, M. A. L., Goldraich, L. A., Silveira, A. D., Clausell, N., & Schaan, B. D. (2023). Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial. BMC Cardiovascular Disorders, 23(1), 1 10. https://doi.org/10.1186/s12872 023-03404-7

Dibben, G. O., Faulkner, J., Oldridge, N., Rees, K., Thompson, D. R., Zwisler, A. D., & Taylor, R. S. (2023). Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis. European Heart Journal, 44(6), 452–469. https://doi.org/10.1093/eurheartj/ehac747

Farah Yasmin, Shizra Jawed, Hala Najeeb, Abdul Moeed, Abdul Raafe Atif, Muhammad Umar, Muhammad Sohaib Asghar, M Chadi Alraies, Comparative efficacy and safety of mitral valve repair versus mitral valve replacement in Rheumatic heart disease: A high-value care systematic review and meta-analysis, Current Problems in Cardiology, Volume 49, Issue 6, 2024, 102530, ISSN 0146-2806. https://doi.org/10.1016/j.cpcardiol.2024.102530.

Heidenreich, Paul A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., & Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(17), e263-e421. https://doi.org/10.1161/CIR.0000000000001063

Hua, C., Huang, W., Chen, Z. et al. (2024). Effects of exercise-based cardiac rehabilitation delivery modes on chronic heart failure: a systematic review and network meta-analysis. https://doi.org/10.1038/s41598-024-82608-z

H., Attar, A., & Koushkie Jahromi, M. (2024). Efficacy of exercise training-based cardiac rehabilitation programs after transcatheter aortic valve implantation: A systematic review and meta-analysis. International Journal of Cardiology: Cardiovascular Risk and Prevention, 20(October 2023), 200238. https://doi.org/10.1016/j.ijcrp.2024.200238

Kong, X., Zhu, J., Chang, J., & Meng, X. (2024). Effects of Cardiac Rehabilitation on Patients Undergoing Heart Valve Surgery: A Systematic Review and Meta-Analysis. Heart Surgery Forum, 27(10), E1228–E1236. https://doi.org/10.59958/hsf.7485

Petros Roditis, Stavros Dimopoulos, Dimitrios Sakellariou, Serafim Sarafoglou, Elissavet Kaldara, John Venetsanakos, John Vogiatzis, Maria Anastasiou-Nana, Charis Roussos, Serafim Nanas, The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure, European journal of cardiovascular prevention and rehabilitation, Volume 14, Issue 2, 1 April 2007, Pages 304–311. https://doi.org/10.1097/01.hjr.0b013e32808621a3

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. (2019). Panduan Rehabilitasi Kardiovaskular. Edisi 1. Diakses pada 3 Oktober 2025 dari https://inaheart.org/guidelines/panduan-rehabilitasi-kardiovaskular.

Perone, F., Loguercio, M., Sabato, F., Pasquini, A., Ostojic, M., Avagimyan, A., Sileikiene, V., Popiolek-Kalisz, J., Aleksova, A., & Ambrosetti, M. (2025). Cardiac Rehabilitation After Mitral Valve Intervention: Tailored Assessment, Management, and Exercise Training. Journal of Cardiovascular Development and Disease, 12(7), 1–19. https://doi.org/10.3390/jcdd12070265

Prodinger, B., & Stucki, G. (2021). ICF-based conceptualization of rehabilitation needs in persons with chronic heart failure. European Journal of Cardiopulmonary Rehabilitation, 31(3), 422–430.

Prokopidis, K., Irlik, K., Ispoglou, T., Ferentinos, P., Mitropoulos, A., Schlögl, M., Isanejad, M., Kegler, K., Nabrdalik, K., & Lip, G. Y. H. (2025). Exercise capacity in heart failure: A systematic review and meta-analysis of HFrEF and HFpEF disparities in VO2peak and 6-minute walking distance. European Heart Journal Open, 5(3), 1–10. https://doi.org/10.1093/ehjopen/oeaf0 55

Radi, B., Tiksnadi, B. B., Dwiputra, B., Sarvasti, D., & Ambari, A. M. (2019). Panduan Kardiovaskular. Diakses pada tanggal 10 Oktober 2025 dari https://inaheart.org/storage/guideline/5008a0d985307ff6cc2a51f1d1a62891.pdf

Rahman, F., & Anugerah, R. W. D. (2022). Hubungan Kepatuhan Aktivitas Fisik Dengan Kapasitas Aerobik Pada Pasien Osteoartritis Lutut Di RSUD Dr. Moewardi. FISIO MU: Physiotherapy Evidences, 3(2), 130–135. https://doi.org/10.23917/fisiomu.v3i2.18062

Sari, E. A., Wahyuni, W., & Aryani, K. A. (2025). Rehabilitasi Fisioterapi Fase II pada Pasien Gagal Jantung Kongestif: Studi Kasus. Jurnal Fisioterapi Dan Rehabilitasi, 09(02), 280–288. https://doi.org/10.33660/jfrwhs.v9i2.553

Stucki, G., Bickenbach, J., Gutenbrunner, C., & Melvin, J. (2018). Rehabilitation: The health strategy of the 21st century. Journal of Rehabilitation Medicine, 50(4), 309–316. https://doi.org/10.2340/16501977-2200

Sibilitz, K. L., Tang, L. H., Berg, S. K., Thygesen, L. C., Risom, S. S., Rasmussen, T. B., Schmid, J. P., Borregaard, B., Hassager, C., Køber, L., Taylor, R. S., & Zwisler, A. D. (2022). Long-term effects of cardiac rehabilitation after heart valve surgery - results from the randomized CopenHeartVR trial. Scandinavian Cardiovascular Journal, 56(1), 247–255. https://doi.org/10.1080/14017431.2022.2095432

Taylor, J. L., Myers, J., & Bonikowske, A. R. (2023). Practical guidelines for exercise prescription in patients with chronic heart failure. Heart Failure Reviews, 28(6), 1285–1296. https://doi.org/10.1007/s10741-023-10310-9