Exercise: a “new drug” for elderly patients with chronic heart failure

Abstract

Patients with chronic heart failure (CHF) experience progressive deterioration of functional capacity and quality of life (QoL). This prospective, randomized, controlled trial assesses the effect of exercise training (ET) protocol on functional capacity, rehospitalization, and QoL in CHF patients older than 70 years compared with a control group. A total of 343 elderly patients with stable CHF (age, 76.90±5.67, men, 195, 56.9%) were randomized to ET (TCG, n=170) or usual care (UCG, n=173). The ET protocol involved supervised training sessions for 3 months in the hospital followed by home-telemonitored sessions for 3 months. Assessments, performed at baseline and at 3 and 6 months, included: ECG, resting echocardiography, NT-proBNP, 6-minute walk test (6MWT), Minnesota Living with Heart Failure Questionnaire, and comprehensive geriatric assessment with the InterRAI-HC instrument. As compared to UCG, ET patients at 6 months showed: i) significantly increased 6MWT distance (450±83 vs. 290±97 m, p<0.001); ii) increased ADL scores (5.00±2.49 vs. 6.94±5.66, p=0.037); iii) 40% reduced risk of rehospitalisation (hazard ratio=0.558, 95%CI, 0.326-0.954, p=0.033); and iv) significantly improved perceived QoL (28.6±12.3 vs. 44.5±12.3, p<0.001). In hospital and home-based telemonitored exercise confer significant benefits on the oldest CHF patients, improving functional capacity and subjective QoL and reducing risk of rehospitalisation.

Physical activity and progenitor cell-mediated endothelial repair in chronic heart failure: Is there a role for epigenetics?

“…Overall, these findings contribute to explain the molecular mechanisms underlying the benefits induced by PA and support the prescription of personalized ET to elderly CHF patients as an effective and safe "drug" (Antonicelli et al, 2016).…”

Reappraisal on pharmacological and mechanical treatments of heart failure

“…Exercise is seen as a diagnostic and prognostic tool as well as a therapeutic intervention in CHF [195]. Several trials have shown that exercise is beneficial for CHF [196][197][198][199][200], not only improving functional capacity and the QoL but also reducing the risk of rehospitalization, even showing a tendency towards better survival rates. Moreover, both poor and intermediate self-reported physical activity were associated with a higher risk of HHF and mortality [201].…”

The Experimental Pathology at Ancona: 50 Years of Exciting and Pioneering Research on Human Pathology

“…Since epigenetic modifications are reversible, affecting gene expression without altering the DNA sequence, recently we activated a line of research aimed to assess the impact of lifestyles, such as exercise and diet, on aging processes [2,3,34,63]. Although in vivo detection and targeting of senescent cells are still being investigated, it is likely that therapeutic strategies based on antioxidant and anti-inflammatory compounds would involve generalized anti-aging effects [59].…”