Persistence pays out exercise benefits in heart failure

By Eleanor McDermid, Senior medwireNews Reporter

Health benefits derived from regular exercise accumulate over the long term, shows a 10-year study in patients with heart failure (HF).

The 63 patients in the study who undertook regular supervised exercise achieved rapid benefits in functional capacity, relative to the 60 patients in the control group, the researchers report in the Journal of the American College of Cardiology. Improvements in ejection fraction appeared after 5 years of regular exercise, and clinical event rates were significantly reduced across the whole 10 years of the study.

Patients who exercised did so to 70% of their maximal oxygen capacity twice weekly, mostly in a "coronary club" under the supervision of a cardiologist and an exercise therapist.

Besides regular access to these healthcare professionals, patients in the coronary club also received help with stopping smoking and managing stress and their diet. This leads editorialist David Whellan (Jefferson Medical College, Philadelphia, Pennsylvania, USA) to question "if this was a study of exercise training or a study evaluating a disease management strategy or model of health care delivery outside the hospital that includes exercise training as a core component."

He says: "Instead of shying away from the reality that training interventions are more than just exercise, investigators need to better define the totality of the intervention being provided."

After 2 years of training, peak oxygen capacity was 3.0 mL/kg per minute better in the exercising than controls group, and this was maintained throughout the study. There was a similar pattern for resting heart rate, and these two factors both independently predicted clinical events (hospitalization and mortality). Clinical events occurred in 12 versus 35 patients from the exercising and control groups, respectively.

After 5 years, the average ejection fraction was significantly larger in the exercising versus control groups, at 41% versus 34%, and there was a 28% difference favoring the exercising group after 10 years, report Romualdo Belardinelli (Lancisi Heart Institute, Ancona, Italy) and team.

Whellan notes that the findings, particularly the clinical endpoints, should be interpreted with caution because of the small size of the study. But he says: "The study provides some valuable lessons regarding adherence, which has been a longstanding issue for exercise training studies enrolling patients with HF."

Overall, 88% of patients in the exercise group were fully adherent, and all were adherent in terms of minutes exercised.

"The group interactions and dynamics created by the coronary club is one strategy that has worked in the past for patients with HF and seems to have played a role in the high compliance rate in the present study," says Whellan.

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