Determinants of walking fitness in patients with heart failure attending cardiac rehabilitation

Abstract

IntroductionPatients with heart failure (HF) attending cardiac rehabilitation (CR) benefit in terms of improved quality of life, physical fitness and reduced hospital admissions. Too few patients with HF attend CR and little data exist on the characteristics of those who do especially in respect of physical fitness. This study evaluates the extent by which clinical and demographic factors determine walking fitness in patients with a primary diagnosis of HF.MethodsClinical data from the British Heart Foundation National Audit of Cardiac Rehabilitation identified 1519 patients with HF who completed an incremental shuttle walk test (ISWT). Stepwise regression accounting for age, gender and multiple potential confounders assessed their contribution to total walking distance.ResultsMean age was 64.5 (SD 12.70) years with a range of ISWT distances across gender and associated comorbidities from 215 to 282 m. Walking distance reduced by 4.9 m for each year increase in age above mean age (p<0.001). After accounting for confounders, females walked 42.1 m less than males (p≤ 0.001). Pulmonary disease and the existence of depression was associated with a 39.3 and 52.2 m reduction in walking distance, respectively. Body mass index >30 was associated with 28.5 m reduction in walking distance (p<0.001). HF severity failed to improve the regression model fit or achieve significance in the analysisConclusionsAge, gender and the presence of pulmonary disease or depression were highly significant factors in predicting walking fitness in patients with HF. The study also produced a set of reference values based on these four factors to aid the interpretation of walking fitness in patients with HF.

Exercise training and testing in patients with heart failure

“…It should however be borne in mind that HF has a progressive development (25) and that with age, the predicted walking distance and work capacity "normally" decreases (75,99). In line with study II, earlier studies have shown none or poor improvement by an exercise programme in HF patients (100,101).…”

The relationship between six-minute walked distance and health-related quality of life in patients with chronic heart failure

“…On the other hand, this would make it possible to analyze the training effect with less confounders. Doherty et al [30] showed that patients with HF and comorbidities, walked 42 m shorter than patients with less comorbidity. Among the inclusion criteria were being in NYHA class II or III.…”

Exercise rehabilitation in COPD and heart failure: comparison of two national audits

“…23 However, there is limited research examining clinical outcomes in adults with cardiorespiratory disease using national CR and PR audit data. 24 Furthermore, PR and CR programmes may view the presence of comorbidity differently, which may result in an enrolment and completion bias between those with cardiorespiratory disease or single cardiac/ pulmonary disease. Understanding this further may provide insight into how these patients travel through the UK healthcare system and the approach of PR and CR services, including the collection of appropriate outcome measures.…”

“…The UK's National Health Service (NHS) supports the delivery of one exercise rehabilitation programme for adults presenting with breathlessness [ 22 ], and there is support for individualised multi-morbid exercise rehabilitation [ 23 ]. However, there is limited research examining clinical outcomes in adults with cardiorespiratory disease using national CR and PR audit data [ 24 ]. Furthermore, PR and CR programmes may view the presence of comorbidity differently, which may result in an enrolment and completion bias between those with cardiorespiratory disease or single cardiac/ pulmonary disease.…”