Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.

Authors

• Kathryn E Flynn
• Ileana L Piña
• David J Whellan
• Li Lin
• James A Blumenthal
• Stephen J Ellis
• Lawrence J Fine
• Jonathan G Howlett
• Steven J Keteyian
• Dalane W Kitzman
• William E Kraus
• Nancy Houston Miller
• Kevin A Schulman
• John A Spertus
• Christopher M O'Connor
• Kevin P Weinfurt

Publication/Presentation Date

4-8-2009

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.

Volume

301

Issue

14

First Page

1451

Last Page

1459

ISSN

1538-3598

Published In/Presented At

Flynn, K. E., Piña, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., Fine, L. J., Howlett, J. G., Keteyian, S. J., Kitzman, D. W., Kraus, W. E., Miller, N. H., Schulman, K. A., Spertus, J. A., O'Connor, C. M., Weinfurt, K. P., & HF-ACTION Investigators (2009). Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 301(14), 1451–1459. https://doi.org/10.1001/jama.2009.457

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

19351942

Department(s)

Administration and Leadership

Document Type

Article