Clinical Research
Heart Failure
10-Year Exercise Training in Chronic Heart Failure: A Randomized Controlled Trial

https://doi.org/10.1016/j.jacc.2012.06.036Get rights and content
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Objectives

This study investigated the effect of a very long-term exercise training program is not known in chronic heart failure (CHF) patients.

Background

We previously showed that long-term moderate exercise training (ET) improves functional capacity and quality of life in New York Heart Association class II and III CHF patients.

Methods

We studied 123 patients with CHF whose condition was stable over the previous 3 months. After randomization, a trained group (T group, n = 63) underwent a supervised ET at 60% of peak oxygen consumption (Vo2), 2 times weekly for 10 years, whereas a nontrained group (NT group, n = 60) did not exercise formally. The ET program was supervised and performed mostly at a coronary club with periodic control sessions twice yearly at the hospital’s gym.

Results

In the T group, peak Vo2 was more than 60% of age- and gender-predicted maximum Vo2 each year during the 10-year study (p < 0.05 vs. the NT group). In NT patients, peak Vo2 decreased progressively with an average of 52 ± 8% of maximum Vo2 predicted. Ventilation relative to carbon dioxide output (VE/Vco2) slope was significantly lower (35 ± 9) in T patients versus NT patients (42 ± 11, p < 0.01). Quality-of-life score was significantly better in the T group versus the NT group (43 ± 12 vs. 58 ± 14, p < 0.05). During the 10-year study, T patients had a significant lower rate of hospital readmission (hazard ratio: 0.64, p < 0.001) and cardiac mortality (hazard ratio: 0.68, p < 0.001) than controls. Multivariate analysis selected peak Vo2 and resting heart rate as independent predictors of events.

Conclusions

Moderate supervised ET performed twice weekly for 10 years maintains functional capacity of more than 60% of maximum Vo2 and confers a sustained improvement in quality of life compared with NT patients. These sustained improvements are associated with reduction in major cardiovascular events, including hospitalizations for CHF and cardiac mortality.

Key Words

cardiopulmonary exercise test
chronic heart failure
functional capacity
long-term exercise training
quality of life
supervision
survival

Abbreviations and Acronyms

CHF
chronic heart failure
CI
confidence interval
CPET
cardiopulmonary exercise test
EF
ejection fraction
ET
exercise training
HR
hazard ratio
LVEF
left ventricular ejection fraction
NT group
nontrained group
NYHA
New York Heart Association
QOL
quality of life
T group
trained group
Vco2
carbon dioxide output
VE/Vco2
ventilation relative to carbon dioxide output
Vo2
oxygen consumption

Cited by (0)

The study was sponsored by the Lancisi Heart Institute. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.