TY - JOUR
T1 - Effects of exercise training on health status in patients with chronic heart failure HF-ACTION randomized controlled trial
AU - Flynn, Kathryn E.
AU - Piña, Ileana L.
AU - Whellan, David J.
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.
PY - 2009/4/8
Y1 - 2009/4/8
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.
AB - 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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U2 - 10.1001/jama.2009.457
DO - 10.1001/jama.2009.457
M3 - Article
C2 - 19351942
AN - SCOPUS:64249151167
SN - 0098-7484
VL - 301
SP - 1451
EP - 1459
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
IS - 14
ER -