Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.
Journal Article (Journal Article;Multicenter Study)
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.
Full Text
Duke Authors
- Blumenthal, James Alan
- Flynn, Kathryn Eve
- Kraus, William Erle
- O'Connor, Christopher Michael
- Weinfurt, Kevin Phillip
Cited Authors
- 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,
Published Date
- April 8, 2009
Published In
Volume / Issue
- 301 / 14
Start / End Page
- 1451 - 1459
PubMed ID
- 19351942
Pubmed Central ID
- PMC2690699
Electronic International Standard Serial Number (EISSN)
- 1538-3598
Digital Object Identifier (DOI)
- 10.1001/jama.2009.457
Language
- eng
Conference Location
- United States