Interval training early after heart failure decompensation is safe and improves exercise tolerance and quality of life in selected patients

Abstract

Aims To evaluate safety and efficacy of moderate intensity interval exercise training early after heart failure decompensation on exercise tolerance and health-related quality of life (HRQoL). Methods and results This is a prospective randomized controlled study. We screened 234 consecutive patients admitted with decompensated heart failure; 46 patients (42 men/4 women; 61 ± 12 years of age) were randomized to a moderate intensity aerobic interval training ( n = 24) or to a control group ( n = 22). Patients underwent cardiopulmonary exercise testing, echocardiography and Minnesota Living with Heart Failure questionnaire (MLHFQ) at baseline, after three weeks and after three months. After three weeks, peak-VO increased by 17% in the training group ( p = 0.003) with further increase by 10% after three months ( p < 0.001) but did not change significantly in controls. MLHFQ score improved after three weeks, with better results in the training group (from 64.6 ± 15.6 to 30.8 ± 12.9, p < 0.001). After three months, MLHFQ further improved in the exercise training group, but not in controls. Left ventricular ejection fraction was not significantly different between the two groups at baseline and after three months. No serious adverse events related to exercise testing or training were observed. Conclusions Interval exercise training early after an episode of heart failure decompensation is safe and effective in improving exercise tolerance and health-related quality of life in selected patients after achievement of clinical stability. Positive effects remained sustained after three months. Further studies are needed to define role and indications for interval exercise training early after heart failure decompensation.

Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): A systematic review and meta-analysis

“…7 Following proof-of-concept studies by Coats et al 8 and Hambrecht et al 9 which documented the efficacy and safety, respectively, of exercised-based cardiac rehabilitation (ebCR), multiple studies documented its potential to improve functional capacity, QoL and prognosis in patients with heart failure. [10][11][12][13][14][15][16][17] In these studies, however, the populations under investigation were heterogeneous with respect to LV-EF (<35% up to >50%), New York Heart Association (NYHA) classification, and follow-up period. However, the effect of ebCR on morbidity and mortality on top of evidence-based state-of-the-art pharmaco-and device-therapy in high-risk patients with moderately to severely reduced LV-EF is not yet fully established.…”

“…However, the effect of ebCR on morbidity and mortality on top of evidence-based state-of-the-art pharmaco-and device-therapy in high-risk patients with moderately to severely reduced LV-EF is not yet fully established. [10][11][12][13][14][15][16][17] Although current guidelines recommend ebCR as an effective and safe therapeutic intervention, 1,2,6 HFrEF patients are still clearly underrepresented in CR settings worldwide.…”

Regional differences in exercise training implementation in heart failure: findings from the Exercise Training in Heart Failure (ExTraHF) survey

“…Exercise intolerance, frequently manifested by fatigue or shortness of breath on minimal exertion, is a hallmark of HF 1 : one of the principal goals of treatment is to improve exercise capacity, and interventions designed to change this leading symptom in HF have been shown to improve outcomes . ETP is an important adjunct to non‐pharmacological treatment that has a proven positive effects on mortality, morbidity, exercise capacity and quality of life . Based on the analysis of 801 patients enrolled in nine randomized controlled clinical trials, the ExTraMATCH collaborative group calculated a 35% ( P < 0.05) lower risk for mortality and a 28% ( P < 0.05) lower risk for the composite endpoint of mortality or hospitalization in favour of ETP .…”

“…Post‐hoc sub‐analyses demonstrated that ETP was effective also in special HF populations . Selection of HF patients for ETP is founded on clinical stability and optimal medical therapy, and its continuation is related to maintaining clinical and therapy stability, treatment adherence, exercise capacity responsiveness and control of psychological factors .…”

A flying start? Early interval training in heart failure rehabilitation

“…Similar results from a randomised controlled clinical trial in Moscow are published elsewhere in the European Journal of Preventive Cardiology. Doletsky and colleagues 5 found an increase in VO 2peak from 13.6 ml/kg per minute to 15.9 after a 3-week exercise training programme mostly in male heart failure patients (mean age 61 years, New York Heart Association (NYHA) class II-III), and a further increase to 17.4 at 3 months' follow-up, whereas there was no change in the control group. The improvements were paralleled by better MLHFQ quality of life, reduced left ventricular volume, and higher ejection fraction.…”