DURHAM, N.C. – Heart failure patients who regularly exercise fare better and feel better about their lives than do similar patients who do not work out on a regular basis, say researchers at Duke University Medical Center.
The findings, reported today at the annual meeting of the American Heart Association’s Scientific Sessions 2008, go a long way toward addressing concerns about the value of exercise for the nation’s five million patients with heart failure. They also raise important policy questions for the country’s Medicare program and other insurers.
“Past studies have sent mixed signals about the merit of exercise for patients with heart failure. The HF-ACTION study (A Controlled Trial Investigating Outcomes Exercise TraiNing) shows that exercise is not only safe for patients, but also helps to improve the quality of their lives, overall,” says Kathryn Flynn, PhD, a health services researcher at Duke Clinical Research Institute (DCRI) and lead author of the study.
HF-ACTION is the largest clinical trial to date examining the value of exercise in the treatment of heart failure. Investigators enrolled 2331 patients with moderate to severe heart failure at 82 sites throughout the U.S., Canada and France from 2003 to 2008.
Funded by a $37 million grant from the National Heart, Blood, and Lung Institute, researchers randomized participants to receive either standard care or standard care plus an exercise program.
The exercise regimen consisted of three months of supervised aerobic training on a bicycle or treadmill, followed by instruction for continued home-based training.
Researchers set the exercise goal at five, 40-minute workouts, or 200 minutes of exercise per week. Participants reached about 60 percent of that goal at one year.
Participants had significant heart failure upon entering the study.
Researchers found that a higher percentage of those in the exercise group experienced more robust gains.
“And the best news is that while the gains were modest, they were sustained over time,” says Flynn.
During the study period, the incidence of adverse effects was similar between the two groups. There were 41 heart attacks among patients in the exercise arm and 45 heart attacks among those receiving usual care. Arrythmias occurred in about 14 percent of the patients in each group.
Researchers say the findings are important because they demonstrate that a relatively low-cost and readily available intervention can significantly improve the quality of life for heart failure patients, a finding that may be important for the country’s Medicare program, which currently does not pay for exercise therapy for patients with heart failure.
“We found that a majority of those who exercised ….experienced significant improvement in many aspects of their day-to-day activities, such as working, walking, being able to dress, bathe, and getting out to visit family and friends,” says Ileana Piña, MD, a professor of medicine at Case Western Reserve University and chair of the HF-ACTION Steering Committee.
“This study has important implications for the 5 million Americans who have heart failure,” noted Elizabeth G. Nabel, MD, NHLBI director.
“As the number of people affected by heart failure is expected to rise with the aging U.S. population, it is promising to know that regular aerobic activity can not only help patients extend their lives, but exercise can also positively impact their everyday activities and outlook.”
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