Effects of exercise training on health status in patients with chronic heart failure HF-ACTION randomized controlled trial

Kathryn E. Flynn, Ileana L. Pina, David J. Whellan, Li Lin, James A. Blumenthal, Stephen J. Ellis, Lawrence J. Fine, Jonathan G. Howlett, Steven J. Keteyian, Dalane W. Kitzman, William E. Kraus, Nancy Houston Miller, Kevin A. Schulman, John A. Spertus, Christopher M. O'Connor, Kevin P. Weinfurt

Research output: Contribution to journalArticle

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Abstract

Findings from previous studies of the effects of exercise training on patientreported health status have been inconsistent. Objective To test the effects of exercise training on health status among patients with heart failure. Design, Setting, and Patients 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. Interventions 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. Main Outcome Measures 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. At3 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.

Original languageEnglish (US)
Pages (from-to)1451-1459
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume301
Issue number14
DOIs
StatePublished - Apr 8 2009
Externally publishedYes

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Health Status
Randomized Controlled Trials
Heart Failure
Exercise
Cardiomyopathies
Confidence Intervals
Random Allocation
Stroke Volume
Linear Models
Outpatients
Outcome Assessment (Health Care)
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effects of exercise training on health status in patients with chronic heart failure HF-ACTION randomized controlled trial. / Flynn, Kathryn E.; Pina, Ileana L.; Whellan, David J.; Lin, Li; Blumenthal, James A.; Ellis, Stephen J.; Fine, Lawrence J.; Howlett, Jonathan G.; Keteyian, Steven J.; Kitzman, Dalane W.; Kraus, William E.; Miller, Nancy Houston; Schulman, Kevin A.; Spertus, John A.; O'Connor, Christopher M.; Weinfurt, Kevin P.

In: JAMA - Journal of the American Medical Association, Vol. 301, No. 14, 08.04.2009, p. 1451-1459.

Research output: Contribution to journalArticle

Flynn, KE, Pina, IL, Whellan, DJ, Lin, L, Blumenthal, JA, Ellis, SJ, Fine, LJ, Howlett, JG, Keteyian, SJ, Kitzman, DW, Kraus, WE, Miller, NH, Schulman, KA, Spertus, JA, O'Connor, CM & Weinfurt, KP 2009, 'Effects of exercise training on health status in patients with chronic heart failure HF-ACTION randomized controlled trial', JAMA - Journal of the American Medical Association, vol. 301, no. 14, pp. 1451-1459. https://doi.org/10.1001/jama.2009.457
Flynn, Kathryn E. ; Pina, Ileana L. ; Whellan, David J. ; Lin, Li ; Blumenthal, James A. ; Ellis, Stephen J. ; Fine, Lawrence J. ; Howlett, Jonathan G. ; Keteyian, Steven J. ; Kitzman, Dalane W. ; Kraus, William E. ; Miller, Nancy Houston ; Schulman, Kevin A. ; Spertus, John A. ; O'Connor, Christopher M. ; Weinfurt, Kevin P. / Effects of exercise training on health status in patients with chronic heart failure HF-ACTION randomized controlled trial. In: JAMA - Journal of the American Medical Association. 2009 ; Vol. 301, No. 14. pp. 1451-1459.
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abstract = "Findings from previous studies of the effects of exercise training on patientreported health status have been inconsistent. Objective To test the effects of exercise training on health status among patients with heart failure. Design, Setting, and Patients 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. Interventions 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. Main Outcome Measures 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. At3 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.",
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AU - Lin, Li

AU - Blumenthal, James A.

AU - Ellis, Stephen J.

AU - Fine, Lawrence J.

AU - Howlett, Jonathan G.

AU - Keteyian, Steven J.

AU - Kitzman, Dalane W.

AU - Kraus, William E.

AU - Miller, Nancy Houston

AU - Schulman, Kevin A.

AU - Spertus, John A.

AU - O'Connor, Christopher M.

AU - Weinfurt, Kevin P.

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N2 - Findings from previous studies of the effects of exercise training on patientreported health status have been inconsistent. Objective To test the effects of exercise training on health status among patients with heart failure. Design, Setting, and Patients 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. Interventions 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. Main Outcome Measures 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. At3 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.

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