Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.
BACKGROUND
Findings from previous studies of the effects of exercise training on patient-reported health status have been inconsistent.


OBJECTIVE
To test the effects of exercise training on health status among patients with heart failure.


METHODS
Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure with left ventricular ejection fraction of 35% or less. Patients were randomized from April 2003 through February 2007.


METHODS
Usual care plus aerobic exercise training (n = 1172), consisting of 36 supervised sessions followed by home-based training, vs usual care alone (n = 1159). Randomization was stratified by heart failure etiology, which was a covariate in all models.


METHODS
Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary scale and key subscales at baseline, every 3 months for 12 months, and annually thereafter for up to 4 years. The KCCQ is scored from 0 to 100 with higher scores corresponding to better health status. Treatment group effects were estimated using linear mixed models according to the intention-to-treat principle.


RESULTS
Median follow-up was 2.5 years. At 3 months, usual care plus exercise training led to greater improvement in the KCCQ overall summary score (mean, 5.21; 95% confidence interval, 4.42 to 6.00) compared with usual care alone (3.28; 95% confidence interval, 2.48 to 4.09). The additional 1.93-point increase (95% confidence interval, 0.84 to 3.01) in the exercise training group was statistically significant (P < .001). After 3 months, there were no further significant changes in KCCQ score for either group (P = .85 for the difference between slopes), resulting in a sustained, greater improvement overall for the exercise group (P < .001). Results were similar on the KCCQ subscales, and no subgroup interactions were detected.


CONCLUSIONS
Exercise training conferred modest but statistically significant improvements in self-reported health status compared with usual care without training. Improvements occurred early and persisted over time.


BACKGROUND
clinicaltrials.gov Identifier: NCT00047437.
Flynn
Kathryn E
KE
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA. kathryn.flynn@duke.edu
Piña
Ileana L
IL
Whellan
David J
DJ
Lin
Li
L
Blumenthal
James A
JA
Ellis
Stephen J
SJ
Fine
Lawrence J
LJ
Howlett
Jonathan G
JG
Keteyian
Steven J
SJ
Kitzman
Dalane W
DW
Kraus
William E
WE
Miller
Nancy Houston
NH
Schulman
Kevin A
KA
Spertus
John A
JA
O'Connor
Christopher M
CM
Weinfurt
Kevin P
KP
D000368:Aged; D000553:Ambulatory Care; D002908:Chronic Disease; D015444:Exercise; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012648:Self Care; D018434:Sickness Impact Profile; D016896:Treatment Outcome