(Circulation. 1999;99:1173-1182.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure
Effects on Functional Capacity, Quality of Life, and Clinical Outcome
Presented at the 46th Meeting of the American College of Cardiology, Anaheim, Calif, March 16–19, 1997.
From Servizio di Cardiologia Riabilitativa, Istituto Cardiologico "G.M. Lancisi" (R.B., G.C., A.P.), Ancona, Italy, and Department of Medicine, Columbia University (D.G.), New York, NY.
Correspondence to Romualdo Belardinelli, MD, Via Rismondo, 5, 60100 Ancona, Italy. E-mail R.Bellardinelli{at}fastnet.it
Background—It is still a matter of debate whether exercise training (ET) is a beneficial treatment in chronic heart failure (CHF).
Methods and Results—To determine whether long-term moderate ET
improves functional capacity and quality of life in patients with CHF
and whether these effects translate into a favorable outcome,
110 patients with stable CHF were initially recruited, and 99 (59±14
years of age; 88 men and 11 women) were randomized into 2 groups. One
group (group T, n=50) underwent ET at 60% of peak
O2, initially 3 times a week for 8
weeks, then twice a week for 1 year. Another group (group NT, n=49) did
not exercise. At baseline and at months 2 and 14, all patients
underwent a cardiopulmonary exercise test, while 74 patients
(37 in group T and 37 in group NT) with ischemic heart disease
underwent myocardial scintigraphy. Quality of life was
assessed by questionnaire. Ninety-four patients completed the protocol
(48 in group T and 46 in group NT). Changes were observed only in
patients in group T. Both peak O2 and
thallium activity score improved at 2 months (18% and 24%,
respectively; P<0.001 for both) and did not change
further after 1 year. Quality of life also improved and paralleled
peak O2. Exercise training was
associated both with lower mortality (n=9 versus n=20 for those with
training versus those without; relative risk (RR)=0.37; 95% CI, 0.17
to 0.84; P=0.01) and hospital readmission for heart
failure (5 versus 14; RR=0.29; 95% CI, 0.11 to 0.88;
P=0.02). Independent predictors of events were
ventilatory threshold at baseline (ß-coefficient=0.378) and
posttraining thallium activity score (ß-coefficient -0.165).
Conclusions—Long-term moderate ET determines a sustained improvement in functional capacity and quality of life in patients with CHF. This benefit seems to translate into a favorable outcome.
Key Words: exercise training • heart failure • quality of life • prognosis
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