Aerobics benefits chronic heart failure patients
Regular exercise is safe for heart failure patients and may slightly lower their risk of death or hospitalisation, according to results from the largest and most comprehensive clinical trial to examine the effects of exercise in chronic heart failure patients.
Supported by the National Heart, Lung, and Blood Institute (NHLBI) in the United States, the study also found that heart failure patients who add regular, moderate physical activity to standard medical therapy report a higher quality of life compared with similar patients who receive medical therapy only.
Researchers working with HF-ACTION (Heart Failure – A Controlled Trial Investigating Outcomes of Exercise TraiNing) reported their findings in two papers published in the Journal of the American Medical Association. The study was conducted at 82 centres in the United States, Canada, and France.
“Many patients and health care providers have continued to be concerned about the safety of aerobic exercise for heart failure,” said NHLBI director, Dr Elizabeth Nabel.
“With the results of this robust clinical trial, we can now reassure heart failure patients that, with appropriate medical supervision, regular aerobic exercise is not only safe but it can also improve their lives in really meaningful ways”.
Earlier, smaller clinical trials have suggested that exercise is beneficial for heart failure patients, and clinical guidelines were developed to recommend moderate exercise for this condition. Nonetheless, safety concerns have persisted.
HF-ACTION followed 2,331 patients with moderate-to-severe systolic heart failure for up to four years. Compared with a usual-care group, an exercise-training group had slightly fewer deaths or hospitalisations from any cause. When researchers adjusted the findings (as specified in the study design) for the strongest predictors of death or hospitalisation – initial exercise capacity, history of atrial fibrillation, depression, cardiac pumping function, and cause of heart failure – exercise training was linked to an 11% lower risk of all-cause death or hospitalisation and a 15% lower risk of cardiovascular-related death or heart failure hospitalisation.
In addition, there was no significant difference in serious adverse events between the two groups, such as an abnormal heart rhythm, hip fracture, or hospitalisation related to exercise, suggesting that exercise training was well-tolerated and safe.
The researchers note that the benefit of exercise may be underestimated by the observed study results because many of the usual-care participants also exercised. In addition, adherence to prescribed exercise in the exercise-training group was below goal in the majority of participants.
Overall, the exercise training was well-tolerated. There was no significant difference between the two study arms in serious adverse events, including an abnormal heart rhythm, hip fracture, or hospitalisation related to exercise.
Furthermore, after training, participants in the exercise group scored significantly higher than those in the usual-care group on a standard, self-administered quality-of-life questionnaire. Participants reported fewer physical and social limitations and symptoms, and improved quality of life after three months. The improvements persisted throughout the follow-up period and were consistent regardless of sex, race, or age.
