title: Cardiac rehabilitation exercise and self-care for chronic heart failure.
abstract: Chronic heart failure (CHF) is highly prevalent in older individuals and is a major cause of morbidity, mortality, hospitalizations, and disability. Cardiac rehabilitation (CR) exercise training and CHF self-care counseling have each been shown to improve clinical status and clinical outcomes in CHF. Systematic reviews and meta-analyses of CR exercise training alone (without counseling) have demonstrated consistent improvements in CHF symptoms in addition to reductions in cardiac mortality and number of hospitalizations, although individual trials have been less conclusive of the latter 2 findings. The largest single trial, HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), showed a reduction in the adjusted risk for the combined endpoint of all-cause mortality or hospitalization (hazard ratio: 0.89, 95% confidence interval: 0.81 to 0.99; p = 0.03). Quality of life and mental depression also improved. CHF-related counseling, whether provided in isolation or in combination with CR exercise training, improves clinical outcomes and reduces CHF-related hospitalizations. We review current evidence on the benefits and risks of CR and self-care counseling in patients with CHF, provide recommendations for patient selection for third-party payers, and discuss the role of CR in promoting self-care and behavioral changes.
authors.affiliation: Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont. Electronic address: Philip.Ades@vtmednet.org.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Ades
authors.affiliation: Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: Division of Cardiology, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Balady
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Nancy
authors.initials: N
authors.lastname: Houston-Miller
authors.affiliation: Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.affiliation: Division of Cardiology, Columbia University College of Medicine, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
mesh_terms: D002908:Chronic Disease; D003376:Counseling; D017147:Defibrillators, Implantable; D003866:Depressive Disorder / Q000628:therapy; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D010101:Oxygen Consumption / Q000502:physiology; D010349:Patient Compliance; D018579:Patient Selection; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology
keywords: cardiac rehabilitation; chronic heart failure; counseling; exercise training; self-care