Exercise based rehabilitation for heart failure

Abstract

Background The prevalence of chronic heart failure is increasing, and increases with increasing age. Major symptoms include breathlessness and restricted activities of daily living due to reduced functional capacity, which in turn affects quality of life. Exercise training has been shown to be effective in patients with coronary heart disease and has been proposed as an intervention to improve exercise tolerance in patients with heart failure. Objectives To determine the effectiveness of exercise based interventions compared with usual medical care on the mortality, morbidity, exercise capacity and health related quality of life, of patients with heart failure. Search strategy We searched the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2001), MEDLINE (2000 to March 2001), EMBASE (1998 to March 2001), CINAHL (1984 to March 2001) and reference lists of articles. We also sought advice from experts. Selection criteria RCTs of exercise based interventions. The comparison group was usual medical care as defined by the study, or placebo. Adults of all ages with chronic heart failure. Only those studies with criteria for diagnosis of heart failure (based on clinical findings or objective indices) have been included. Data collection and analysis Studies were selected, and data were abstracted, independently by two reviewers. Authors were contacted where possible to obtain missing information. Main results Twenty-nine studies met the inclusion criteria, with 1126 patients randomised. The majority of studies included both patients with primary and secondary heart failure, NYHA class II or III. Only one study specifically examined the effect of exercise training on mortality and morbidity. Exercise training significantly increased VO2 max by (WMD random effects model) 2.16 ml/kg/min (95% CI 2.82 to 1.49), exercise duration increased by 2.38 minutes (95% CI 2.85 to 1.9), work capacity by 15.1 Watts (95% CI 17.7 to 12.6) and distance on the six minute walk by 40.9 metres (95% CI 64.7 to 17.1). Improvements in VO2 max were greater for training programmes of greater intensity and duration. HRQoL improved in the seven of nine trials that measured this outcome. Authors’ conclusions Exercise training improves exercise capacity and quality of life in patients mild to moderate heart failure in the short term. One study found beneficial effects of exercise on cardiac mortality and hospital readmissions over 3 years of follow-up, the remaining included studies did not aim to measure clinical outcomes and were of short duration. The findings of the review are based on small-scale trials in patients who are unrepresentative of the total population of patients with heart failure. Other groups (more severe patients, the elderly, women) may also benefit. Large-scale pragmatic trials of exercise training of longer duration, recruiting a wider spectrum of patients are needed to address these issues.

Impact of a cardiac rehabilitation programme on exercise capacity, parameters of left ventricular function and health-related quality of life in chronic heart failure patients

“…; work capacity: +14 W and 6-MWD: +52 m) is similar to the results of the recent Cochrane review on CR in adults of all ages with CHF [15]. In this analysis of 29 randomised controlled trials of exercise-based interventions with a total of 1126 patients, compared with usual medical care or placebo, peak VO 2 improved by 2.2 ml/kg/min (95% CI 2.8-1.5), work capacity by 15 W (95% CI and distance on the six minute walk test by 41 m (95% CI 65-17).…”

“…Modern management of patients with heart failure implies a multidisciplinary ap-proach with optimisation of medical treatment, risk factor intervention, teaching, exercise advice and training, as well as tailored psychosocial support [11]. This approach is expected to lead to a reduction of rehospitalisation rates [12], costs [13] and even mortality [14], although the latter is still debated [12,15].…”

Effects of a home-based exercise program on clinical outcomes in heart failure

“…[1][2][3][4] However, the effects of exercise training on clinical outcomes are not well identified. Moreover, only 3 studies to date have followed patients beyond 6 months, 3,5,6 leaving the role of exercise in HF unclear.…”

Early Exercise Program for Patients with Heart Failure after Hospital Discharge

“…In this study, the increased 6MWT distance could be observed in both groups, but the 6MWT distance in IG after intervention was significantly higher than in CG after observation. A meta-analysis which was performed by Rees et al [21] revealed that the 6MWT distance increased by 40.9 metres, and a study by Arad et al [20] revealed a 39% improvement of 6MWT distance after exercise training for 18 weeks.…”