Faculty Collaboration Database

Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009 Apr 08;301(14):1451-9

Date

04/09/2009

Pubmed ID

19351942

Pubmed Central ID

PMC2690699

DOI

10.1001/jama.2009.457

Scopus ID

2-s2.0-64249151167 (requires institutional sign-in at Scopus site)   615 Citations

Abstract

CONTEXT: Findings from previous studies of the effects of exercise training on patient-reported health status have been inconsistent.

OBJECTIVE: To test the effects of exercise training on health status among patients with heart failure.

DESIGN, SETTING, AND PATIENTS: Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure with left ventricular ejection fraction of 35% or less. Patients were randomized from April 2003 through February 2007.

INTERVENTIONS: Usual care plus aerobic exercise training (n = 1172), consisting of 36 supervised sessions followed by home-based training, vs usual care alone (n = 1159). Randomization was stratified by heart failure etiology, which was a covariate in all models.

MAIN OUTCOME MEASURES: Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary scale and key subscales at baseline, every 3 months for 12 months, and annually thereafter for up to 4 years. The KCCQ is scored from 0 to 100 with higher scores corresponding to better health status. Treatment group effects were estimated using linear mixed models according to the intention-to-treat principle.

RESULTS: Median follow-up was 2.5 years. At 3 months, usual care plus exercise training led to greater improvement in the KCCQ overall summary score (mean, 5.21; 95% confidence interval, 4.42 to 6.00) compared with usual care alone (3.28; 95% confidence interval, 2.48 to 4.09). The additional 1.93-point increase (95% confidence interval, 0.84 to 3.01) in the exercise training group was statistically significant (P < .001). After 3 months, there were no further significant changes in KCCQ score for either group (P = .85 for the difference between slopes), resulting in a sustained, greater improvement overall for the exercise group (P < .001). Results were similar on the KCCQ subscales, and no subgroup interactions were detected.

CONCLUSIONS: Exercise training conferred modest but statistically significant improvements in self-reported health status compared with usual care without training. Improvements occurred early and persisted over time.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00047437.

Author List

Flynn KE, Piña IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O'Connor CM, Weinfurt KP, HF-ACTION Investigators

Author

Kathryn Eve Flynn PhD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Ambulatory Care
Chronic Disease
Exercise
Exercise Test
Exercise Therapy
Female
Health Status
Heart Failure
Humans
Male
Middle Aged
Quality of Life
Self Care
Sickness Impact Profile
Treatment Outcome