Exercise Training in Chronic Heart Failure - Exercise Training in CHF

Description:

The goal of the trial was to evaluate a supervised long-term exercise training program compared with no formal exercise training program among patients with chronic stable heart failure.

Hypothesis:

Long-term exercise training will improve functional capacity and quality of life.

Study Design

  • Parallel
  • Randomized

Patient Populations:

  • Patients with heart failure who were stable for >3 months
  • LVEF <40%
  • Ability to exercise

    Number of enrollees: 123
    Duration of follow-up: 10 years
    Mean patient age: 59 years
    Percentage female: 22%
    Ejection fraction: 37%
    New York Heart Association class: II (59%), III (41%)

Exclusions:

  • Significant valve disease
  • Uncontrolled diabetes or hypertension
  • Orthopedic or neurological problems
  • Renal insufficiency

Primary Endpoints:

  • Peak oxygen consumption

Secondary Endpoints:

  • Quality of life
  • LVEF
  • Adverse cardiac events

Drug/Procedures Used:

Patients with chronic stable heart failure were randomized to an exercise training program (n = 63) versus control (n = 60).

Exercise training was performed under the supervision of a cardiologist and an exercise therapist. Initially, patients exercised 3 times per week in the hospital setting for 2 months, then two supervised sessions for the remainder of the year at an exercise club. Long-term, patients returned to the hospital to exercise every 6 months, then back to the exercise club where they exercised at 70% of peak oxygen consumption.

Patients in the control group were advised not to exercise in a supervised environment; however, they could engage in their own aerobic activities no more than 30 minutes in duration.

Concomitant Medications:

  • Angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers: 100% of patients
  • Aspirin: 75%
  • Beta-blockers: 46%
  • Diuretics: 52%
  • Statins: 60%

Principal Findings:

Overall, 123 patients were randomized. The mean age was 59 years, 22% were women, mean left ventricular ejection fraction (LVEF) was 37%, and cause of cardiomyopathy was ischemic in 80%. Adherence to the exercise program was 88%.

At 12 months, peak oxygen consumption improved 14.7% in the exercise training group versus decreased 2.5% in the control group (p < 0.01). Peak oxygen consumption remained higher at each subsequent follow-up for exercise versus control. At 10 years, the absolute difference in peak oxygen consumption was 3.6 ml/kg/min higher in the exercise versus control group (p < 0.01).

LVEF improved between the two groups at 5 years: 41% with exercise versus 34% with control (p < 0.01).

Quality of life improved between the two groups: 43 with exercise versus 58 with control (p < 0.05).

- Cardiac events (n): 12 versus 35 (p < 0.0001), respectively, for exercise versus control
- Hospital readmission for heart failure (n): 8 versus 25 (p < 0.001), respectively
- Cardiac deaths (n): 4 versus 10 (p < 0.001), respectively

Interpretation:

Among patients with chronic stable heart failure, a long-term moderate intensity supervised exercise program improved functional capacity and quality of life. Long-term exercise was also associated with an improvement in LVEF and a reduction in cardiac events; however, the benefit on clinical outcomes warrants confirmation.

These results apply to a relatively young cohort of patients with mild heart failure symptoms. It is unknown if the results would have been attenuated had more patients been treated with beta-blockers. This study contrasts with the HF-ACTION trial, which found no improvement in survival with nonsupervised exercise at 2.5 years of follow-up. Although long-term supervised exercise was beneficial, the strategy of this trial would be relatively difficult to implement in practice.

References:

Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-Year Exercise Training in Chronic Heart Failure: A Randomized Controlled Trial. J Am Coll Cardiol 2012;60:1521-1528.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Follow-Up Studies, Oxygen Consumption, Patient Readmission, Quality of Life, Cardiomyopathies, Exercise Therapy, Heart Failure, Stroke Volume


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