AHA 2008: HF-ACTION: Early and Sustained Quality-of-Life Improvements With Structured Exercise Program

November 12, 2008

November 12, 2008 (New Orleans, Louisiana) — Heart-failure patients participating in an exercise training program improved their quality of life, with the improvement occurring early and sustained for three years, new research shows. In addition to being safe, investigators say the results are consistent with prior clinical findings and support the use of exercise training in this population.

"The goal of clinicians treating heart-failure patients is help them feel better, to prolong life, but also to improve quality of life," said lead investigator Dr Ileana Piña (Case Western Reserve University, Cleveland, OH) during a morning press conference. "Our results show that participation in a training program produced modest but significant improvement in health status in patients with heart failure compared with usual care. Improvement was associated with exercise training and occurred early during supervised training and was sustained. The results were consistent among subgroups."

The quality-of-life results from the HF-ACTION trial, reported here today at the American Heart Association (AHA) 2008 Scientific Sessions, come on the heels of the overall findings that showed the highly structured exercise program did not reduce all-cause mortality or all-cause hospitalization when compared with patients getting "usual care," in which exercise was simply encouraged, but without specific advice. After adjustment for prespecified major prognostic factors, however, there were significant reductions in mortality and hospitalizations with the structured-exercise program.

HF-ACTION Quality of Life Results

As previously reported by heartwire , HF-ACTION investigators randomized 2331 heart-failure patients (NYHA class 2-4, ejection fraction <35%) to either an exercise program focused on increasing workout intensity and duration or to usual care, in which exercise was simply encouraged based on ACC/AHA recommendations.

The quality of life really needs to be looked at much more carefully by clinicians. This is not just soft science.

The structured-exercise group began with 36 supervised training sessions for 30 minutes of exercise three times per week. Six weeks into the supervised program, patients were given a treadmill or stationary bicycle to use at home along with a heart-rate monitor and were advised to work out five times per week at moderate intensity for 40 minutes. The usual-care group, by contrast, was told at the study outset to exercise at moderate intensity, 30 minutes per day, but were not supervised or encouraged along the way.

In the HF-ACTION substudy, investigators wanted to examine the impact of the exercise program on patients' overall health status. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a test that includes questions on physical limitations, symptoms, quality of life, and social limitations.

In terms of the overall KCCQ score, there was an early improvement, within three months, in the health status of patients in the structured-exercise program. The benefit was sustained to three years, with the overall scores virtually unchanged from three months to 36 months. Moreover, all health-status scales were improved, including physical limitations and symptoms.

"Activities of daily living are increased among patients in the structured program, and there are improvements in patients feeling better about themselves," Piña told heartwire . "Their ability to go out and socialize is also improving. Even their symptoms are better, so they feel better."

Commenting on the results of the study, scheduled discussant Dr Anne Taylor (Columbia University, NY) said the treatment goal of heart failure is the prevention of disease progression, as well as to decrease mortality and morbidity and, important to a chronic-disease population, to improve the quality of life of patients.

She noted that the difference between the two treatment groups was modest but significant, and this is possibly the result of the clinical-trial effect, where even patients in the usual-care arm exercised more than they would have if not enrolled. In addition, further study is needed to confirm the quality-of-life benefit in older patients and those with other comorbidities, as well as to investigate whether the addition of resistance training can add incremental benefit to aerobic training.

Piña said that adherence remains a problem for any exercise-based treatment program, but the substudy data still provide helpful information. "The quality of life really needs to be looked at much more carefully by clinicians. This is not just soft science," she said.

The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.


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