Exercise capacity,physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure

Abstract

Objective: To determine the short- and long-term effects of an intensive, concentrated rehabilitation programme in patients with chronic heart failure.

Design: Randomized controlled trial, with one-month and six-year evaluations. Setting: Residential rehabilitation centre in Switzerland.

Subjects: Fifty patients with chronic heart failure, randomized to exercise or control groups.

Interventions: A rehabilitation programme lasting one month, including educational sessions, a low-fat diet, and 2 hours of individually prescribed exercise daily.

Main measures: Exercise test responses, health outcomes and physical activity patterns.

Results: Peak Vo₂ increased 21.4% in the exercise group during the rehabilitation programme (P<0.05), whereas peak Vo₂ did not change among controls. After the six-year follow-up period, peak Vo₂ was only slightly higher than that at baseline in the trained group (7%, NS), while peak Vo₂ among controls was unchanged. During long-term follow-up, 9 and 12 patients died in the exercise and control groups, respectively (P = 0.63). At six years, physical activity patterns tended to be higher in the exercise group; the mean energy expenditure values over the last year were 2704 ± 1970 and 2085 ± 1522 kcal/week during recreational activities for the exercise and control groups, respectively. However, both groups were more active compared to energy expenditure prior to their cardiac event (P<0.001).

Conclusions: Six years after participation in a residential rehabilitation programme, patients with chronic heart failure had slightly better outcomes than control subjects, maintained exercise capacity and engaged in activities that exceed the minimal amount recommended by guidelines for cardiovascular health.

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References

Pina IL , Apstein CS , Balady GJ et al. Exercise and heart failure: a statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation 2003; 107: 1210—25.

Meyer T. , Kindermann M. , Kindermann W. Exercise programmes for patients with chronic heart failure. Sports Med 2004; 34: 939—54.

ExTraMATCH Collaborative. Exercise training meta-analysis of trials in patients with chronic heart failure . BMJ 2004; 328: 189—96.

Smart N. , Marwick TH Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med 2004; 116: 693—706.

Boesch C. , Myers J. , Habersaat A. , Ilarraza H. , Kottman W. , Dubach P. Maintenance of exercise capacity and physical activity patterns 2 years after cardiac rehabilitation. J Cardiopulm Rehabil 2005; 25: 14—23.

Dubach P. , Myers J. , Dziekan G. et al. Effects of exercise training on myocardial remodeling in patients with reduced left ventricular function after myocardial infarction. Circulation 1997; 95: 2060—67.

Borg Gav. Borg's perceived exertion and pain scales. Human Kinetics , 1998.

Myers J. , Buchanan N. , Walsh D. et al. Comparison of the ramp versus standard exercise protocols. J Am Coll Cardiol 1991; 17: 1334—42.

Paffenbarger RS , Hyde RT , Wing AL , Hsieh CC Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986; 314: 605—13.

10.

Ainsworth BE , Haskell WL , Leon AS et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71—80.

11.

Basset DR , Vachon JA , Kirkland AO , Howley ET , Johnson KR Energy cost of stair climbing and descending on the college alumnus questionnaire . Med Sci Sports Exerc 1997; 29: 1250—54.

12.

Myers J. , Wagner D. , Schertler T. et al. Effects of exercise training on left ventricular volumes and function in patients with nonischemic cardiomyopathy: application of magnetic resonance myocardial tagging. Am Heart J 2002 ; 144: 719—25.

13.

Stolen KQ , Kemppainen J. , Ukkonen H. et al. Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy. J Am Coll Cardiol 2003; 41: 460—67.

14.

Webb-Peploe KM , Chua TP , Harringtron D. et al. Different response of patients with idiopathic and ischaemic dilated cardiomyopathy to exercise training. Int J Cardiol 2000; 74: 215—24.

15.

Fleg JL , Morel CH , Bos AG et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 2005; 112: 674—82.

16.

Pate RR , Pratt MP , Blair SN et al. Physical activity and public health: a recommendation from the Centers for disease control and prevention and the American college of sports medicine. JAMA 1995; 273: 402—407.

17.

U.S. Public Health Service, Office of the Surgeon General : Physical activity and health: a report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

18.

American College of Sports Medicine. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults . Med Sci Sports Exerc 1999; 31: 916—20.

19.

Belardinelli R. , Georgiou D. , Cianci G. , Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. ACP J Club 1999; 132: 42.