Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure

Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 05/2009; 301(14):1439-50. DOI: 10.1001/jama.2009.454
Source: PubMed


Guidelines recommend that exercise training be considered for medically stable outpatients with heart failure. Previous studies have not had adequate statistical power to measure the effects of exercise training on clinical outcomes.
To test the efficacy and safety of exercise training among patients with heart failure.
Multicenter, randomized controlled trial of 2331 medically stable outpatients with heart failure and reduced ejection fraction. Participants in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) were randomized from April 2003 through February 2007 at 82 centers within the United States, Canada, and France; median follow-up was 30 months.
Usual care plus aerobic exercise training, consisting of 36 supervised sessions followed by home-based training, or usual care alone.
Composite primary end point of all-cause mortality or hospitalization and prespecified secondary end points of all-cause mortality, cardiovascular mortality or cardiovascular hospitalization, and cardiovascular mortality or heart failure hospitalization.
The median age was 59 years, 28% were women, and 37% had New York Heart Association class III or IV symptoms. Heart failure etiology was ischemic in 51%, and median left ventricular ejection fraction was 25%. Exercise adherence decreased from a median of 95 minutes per week during months 4 through 6 of follow-up to 74 minutes per week during months 10 through 12. A total of 759 patients (65%) in the exercise training group died or were hospitalized compared with 796 patients (68%) in the usual care group (hazard ratio [HR], 0.93 [95% confidence interval {CI}, 0.84-1.02]; P = .13). There were nonsignificant reductions in the exercise training group for mortality (189 patients [16%] in the exercise training group vs 198 patients [17%] in the usual care group; HR, 0.96 [95% CI, 0.79-1.17]; P = .70), cardiovascular mortality or cardiovascular hospitalization (632 [55%] in the exercise training group vs 677 [58%] in the usual care group; HR, 0.92 [95% CI, 0.83-1.03]; P = .14), and cardiovascular mortality or heart failure hospitalization (344 [30%] in the exercise training group vs 393 [34%] in the usual care group; HR, 0.87 [95% CI, 0.75-1.00]; P = .06). In prespecified supplementary analyses adjusting for highly prognostic baseline characteristics, the HRs were 0.89 (95% CI, 0.81-0.99; P = .03) for all-cause mortality or hospitalization, 0.91 (95% CI, 0.82-1.01; P = .09) for cardiovascular mortality or cardiovascular hospitalization, and 0.85 (95% CI, 0.74-0.99; P = .03) for cardiovascular mortality or heart failure hospitalization. Other adverse events were similar between the groups.
In the protocol-specified primary analysis, exercise training resulted in nonsignificant reductions in the primary end point of all-cause mortality or hospitalization and in key secondary clinical end points. After adjustment for highly prognostic predictors of the primary end point, exercise training was associated with modest significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization. Identifier: NCT00047437.

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Available from: William E Kraus, Oct 05, 2015
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    • "The CR program is well-known for its safety and effectiveness to improve the exercise capacity and the quality of life in patients with heart failure [4,5,6]. Holloway et al. [7] performed an 8-week CR program on patients with mild to moderate DCMP. "
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    ABSTRACT: The dilated cardiomyopathy is the common type of cardiomyopathy, and its distinctive characteristic is the systolic dysfunction. Not many reports were issued about the efficacy of cardiac rehabilitation in patients with an advanced dilated cardiomyopathy until yet. A 50-year-old man who was diagnosed with dilated cardiomyopathy with congestive heart failure was admitted to the emergency room after a sudden collapse and a ventricular fibrillation was presented in the actual electrocardiogram. After three months, the patient participated in an 8-week cardiac rehabilitation program with electrocardiogram monitoring for 50 minutes per session at five times per week. The maximal oxygen consumption improved from 13.5 to 19.4 mL/kg/min during this time. At 3.9 metabolic equivalents, the myocardial oxygen demand decreased from 21,710 to 12,669 mmHg.bpm and the Borg's scale of perceived exertion decreased from 15 to 9. The left ventricular ejection fraction improved from 14% to 19%. So in this case report will be presented a patient after a successful cardiac rehabilitation program. Before this the patient suffered from a much more advanced dilated cardiomyopathy and was resuscitated from cardiac arrest.
    Annals of Rehabilitation Medicine 08/2014; 38(4):554-8. DOI:10.5535/arm.2014.38.4.554
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    • "An increase in physical activity level is an important goal in the rehabilitation of patients with chronic heart failure (CHF).1,2 It has been shown that exercise training can improve peak aerobic power "
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    • "Cardiac myocytes also undergo physiological cardiac growth (PCG) as occurred in normal postnatal cardiac growth, physical exercise, or during pregnancy [3], [9], and boosting PCG by exercise is also proposed as a novel means to antagonize PCH and improve impaired cardiac function [10], [11]. Unlike PCH being irreversible, PCG is completely reversible and characterized by enhanced cardiac performance without any obvious cell death and fibrosis [12]. "
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    PLoS ONE 04/2013; 8(4):e62373. DOI:10.1371/journal.pone.0062373 · 3.23 Impact Factor
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