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

O’Connor, Christopher M.; Whellan, David J.; Lee, Kerry L.; Keteyian, Steven J.; Cooper, Lawton S.; Ellis, Stephen J.; Leifer, Eric; Kraus, William E.; Kitzman, Dalane W.; Blumenthal, James A.; Rendall, David S.; Miller, Nancy Houston; Fleg, Jerome L.; Schulman, Kevin A.; McKelvie, Robert S.; Zannad, Faı̈ez; Piña, Ileana L.

doi:10.1001/jama.2009.454

Cited by 1,772 publications

(1,569 citation statements)

References 32 publications

Supporting

Mentioning

1,442

Contrasting

Unclassified

Order By: Relevance

“…Exercise‐based cardiac rehabilitation is a recommended component of heart failure treatment1 and has a striking impact on symptoms, functional capacity, quality of life, and mortality 2, 3, 4…”

Section: Introductionmentioning

confidence: 99%

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Aslanger

Assous

Bihry

et al. 2015

JAHA

View full text Add to dashboard Cite

BackgroundSuccess of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO 2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular‐arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX‐derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.Methods and ResultsThirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise‐based CR. Noninvasive LV pressure‐volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO 2 was not in a significant correlation with the change in VAC (r=−0.18; P=0.31), mechanical efficiency (r=−0.16, P=0.39), or the change in ejection fraction (r=−0.07; P=0.68).Conclusions CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX‐derived data in predicting clinical outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Aslanger

Assous

Bihry

et al. 2015

JAHA

View full text Add to dashboard Cite

show abstract

“…The findings of the HF‐ACTION study18 support the efficacy and benefit of exercise training in patients with CHF. However, patients underwent aerobic exercise training (treadmill or cycle) at a rather moderate level (60–70% of heart rate reserve), and upper body exercises or strength training was not permitted during the supervised or home‐based training period.…”

Section: Discussionmentioning

confidence: 67%

“…A few studies with long‐term follow‐ups for a year or more have focused mainly on cycling or walking 18, 19. Studies on long‐term follow‐up in a home‐based PMT are lacking.…”

Section: Introductionmentioning

confidence: 99%

Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long‐term effects on walking distance and quality of life; a pilot study

et al. 2017

View full text Add to dashboard Cite

AimsThis study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home‐based programme.Methods and resultsTwenty‐two patients with stable CHF (19 men and 3 women), mean age 63.2 years (SD 8.1), New York Heart Association class II–III were randomized to individual home‐based training (HT group), or home‐based training with a group‐based start‐up in a hospital setting (GT group). A 6 min walk test, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Short Form with 36 items (SF‐36) were administered at baseline and after 3, 6, 9, and 12 months. Exercise training resulted in statistically significant increased walking distance in both groups. The HT group increased on average 107 (80) m from baseline to 12 months, and the GT group by 100 (96) m. Health‐related quality of life, measured with MLHFQ and SF‐36, reached statistically significant improvements in both groups but at different time points. There were no statistically significant differences between groups on any parameters or follow‐ups.ConclusionsLong‐term home‐based peripheral muscle training in patients with CHF, with or without an introductory period in a hospital setting, can be used for initial improvement and retention of walking distance and health‐related quality of life.

show abstract

“…A clear dose dependency of PA on the risk of HF was shown,8, 11 and age‐adjusted recommendations on the amount of PA were defined by the World Health Organization 34. Furthermore, the positive effect of exercise training on the prognosis of HFrEF was shown in the large HF‐ACTION trial 10. In elderly HFpEF patients, regular exercise training was shown to improve self‐rated physical dimensions of QoL, but not other aspects of QoL 17, 18, 19, 29.…”

Section: Discussionmentioning

confidence: 98%

“…In addition, several training interventions have shown significant improvement of exercise capacity and quality of life (QoL) in patients with HF 10, 13…”

Section: Introductionmentioning

confidence: 99%

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

et al. 2017

View full text Add to dashboard Cite

AimsHeart failure with preserved ejection fraction (HFpEF) remains a common condition with no pharmacological treatment. Physical activity (PA) improves symptoms and quality of life (QoL), but no clear recommendations exist on PA in HFpEF patients. We investigated the association of PA (amount/intensity) on clinical phenotype in HFpEF.Methods and resultsThe Aldosterone in Diastolic Heart Failure trial investigated spironolactone vs. placebo in stable HFpEF patients. At baseline, all patients underwent detailed phenotypization including echocardiography, cardiopulmonary exercise testing, 6 minute walking test (6MWT), and QoL assessment (36‐item Short‐Form questionnaire). PA was assessed by a self‐report questionnaire, classified in metabolic equivalents of task (MET) and analysed with regard to exercise capacity, diastolic function, and QoL. Four hundred twenty‐two patients (52% women, age 67 ± 8 years, New York Heart Association II and III) were classified by weekly MET hours into a low (<70), middle (70–140), or high (>140) level of PA. Total PA correlated positively with 6MWT distance (r = 0.17; P = 0.002) and physical function of QoL (r = 0.10; P = 0.05), but not with peak oxygen uptake (peakVO2). In contrast, both 6MWT distance and peakVO2 were significantly higher in patients who performed high‐intensity PA for >8 h/week (P < 0.001, P = 0.02, respectively). Time of high‐intensity PA was related to higher 6MWT distance (r = 0.21, P < 0.001), peakVO2, and better physical function of QoL (both r = 0.13, P = 0.01), whereas low‐intensity PA did not show significant associations. Interestingly, PA was not related to any measure of diastolic function.ConclusionsA higher amount of PA is related to higher submaximal exercise capacity and physical function of QoL. Regarding maximal exercise capacity, only high‐intensity PA showed significant association in HFpEF patients.

show abstract

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

Cited by 1,772 publications

References 32 publications

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long‐term effects on walking distance and quality of life; a pilot study

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

Contact Info

Product

Resources

About