Response to Exercise Training and Outcomes in Patients With Heart Failure and Diabetes Mellitus: Insights From the HF-ACTION Trial

Adam Z. Banks, Robert J. Mentz, Amanda Stebbins, Catherine R. Mikus, Phillip J. Schulte, Jerome L. Fleg, Lawton S. Cooper, Eric S. Leifer, Dalynn T. Badenhop, Steven J. Keteyian, Ileana L. Pina, Dalane W. Kitzman, Mona Fiuzat, David J. Whellan, William E. Kraus, Christopher M. O'Connor

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: In HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), exercise training improved functional capacity in heart failure with reduced ejection fraction (HFrEF). Previous studies have suggested that diabetes mellitus (DM) may be associated with an attenuated response to exercise. We explored whether DM attenuated the improvement in functional capacity with exercise. Methods and Results: HF-ACTION randomized 2331 patients with HFrEF to medical therapy with or without exercise training over a median follow-up of 2.5 years. We examined the interaction between DM and exercise response measured by change in 6-minute walk distance (6MWD) and peak VO2. We also examined outcomes by DM status. In HF-ACTION, 748 (32%) patients had DM. DM patients had lower functional capacity at baseline and had lower exercise volumes at 3 months. There was a significant interaction between DM status and exercise training for change in peak VO2 (interaction P = .02), but not 6MWD. In the exercise arm, DM patients had a smaller mean increase in peak VO2 than non-DM patients (P = .03). There was no interaction between DM and exercise on clinical outcomes. After risk adjustment, DM was associated with increased all-cause mortality/hospitalization (P = .03). Conclusions: In HF-ACTION, DM was associated with lower baseline functional capacity, an attenuated improvement in peak VO2, and increased hospitalizations.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - May 19 2015

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Diabetes Mellitus
Heart Failure
Exercise
Hospitalization
Risk Adjustment
Mortality

Keywords

  • Chronic heart failure
  • Diabetes mellitus
  • Functional capacity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Response to Exercise Training and Outcomes in Patients With Heart Failure and Diabetes Mellitus : Insights From the HF-ACTION Trial. / Banks, Adam Z.; Mentz, Robert J.; Stebbins, Amanda; Mikus, Catherine R.; Schulte, Phillip J.; Fleg, Jerome L.; Cooper, Lawton S.; Leifer, Eric S.; Badenhop, Dalynn T.; Keteyian, Steven J.; Pina, Ileana L.; Kitzman, Dalane W.; Fiuzat, Mona; Whellan, David J.; Kraus, William E.; O'Connor, Christopher M.

In: Journal of Cardiac Failure, 19.05.2015.

Research output: Contribution to journalArticle

Banks, AZ, Mentz, RJ, Stebbins, A, Mikus, CR, Schulte, PJ, Fleg, JL, Cooper, LS, Leifer, ES, Badenhop, DT, Keteyian, SJ, Pina, IL, Kitzman, DW, Fiuzat, M, Whellan, DJ, Kraus, WE & O'Connor, CM 2015, 'Response to Exercise Training and Outcomes in Patients With Heart Failure and Diabetes Mellitus: Insights From the HF-ACTION Trial', Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2015.12.007
Banks, Adam Z. ; Mentz, Robert J. ; Stebbins, Amanda ; Mikus, Catherine R. ; Schulte, Phillip J. ; Fleg, Jerome L. ; Cooper, Lawton S. ; Leifer, Eric S. ; Badenhop, Dalynn T. ; Keteyian, Steven J. ; Pina, Ileana L. ; Kitzman, Dalane W. ; Fiuzat, Mona ; Whellan, David J. ; Kraus, William E. ; O'Connor, Christopher M. / Response to Exercise Training and Outcomes in Patients With Heart Failure and Diabetes Mellitus : Insights From the HF-ACTION Trial. In: Journal of Cardiac Failure. 2015.
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abstract = "Background: In HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), exercise training improved functional capacity in heart failure with reduced ejection fraction (HFrEF). Previous studies have suggested that diabetes mellitus (DM) may be associated with an attenuated response to exercise. We explored whether DM attenuated the improvement in functional capacity with exercise. Methods and Results: HF-ACTION randomized 2331 patients with HFrEF to medical therapy with or without exercise training over a median follow-up of 2.5 years. We examined the interaction between DM and exercise response measured by change in 6-minute walk distance (6MWD) and peak VO2. We also examined outcomes by DM status. In HF-ACTION, 748 (32{\%}) patients had DM. DM patients had lower functional capacity at baseline and had lower exercise volumes at 3 months. There was a significant interaction between DM status and exercise training for change in peak VO2 (interaction P = .02), but not 6MWD. In the exercise arm, DM patients had a smaller mean increase in peak VO2 than non-DM patients (P = .03). There was no interaction between DM and exercise on clinical outcomes. After risk adjustment, DM was associated with increased all-cause mortality/hospitalization (P = .03). Conclusions: In HF-ACTION, DM was associated with lower baseline functional capacity, an attenuated improvement in peak VO2, and increased hospitalizations.",
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AU - Banks, Adam Z.

AU - Mentz, Robert J.

AU - Stebbins, Amanda

AU - Mikus, Catherine R.

AU - Schulte, Phillip J.

AU - Fleg, Jerome L.

AU - Cooper, Lawton S.

AU - Leifer, Eric S.

AU - Badenhop, Dalynn T.

AU - Keteyian, Steven J.

AU - Pina, Ileana L.

AU - Kitzman, Dalane W.

AU - Fiuzat, Mona

AU - Whellan, David J.

AU - Kraus, William E.

AU - O'Connor, Christopher M.

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N2 - Background: In HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), exercise training improved functional capacity in heart failure with reduced ejection fraction (HFrEF). Previous studies have suggested that diabetes mellitus (DM) may be associated with an attenuated response to exercise. We explored whether DM attenuated the improvement in functional capacity with exercise. Methods and Results: HF-ACTION randomized 2331 patients with HFrEF to medical therapy with or without exercise training over a median follow-up of 2.5 years. We examined the interaction between DM and exercise response measured by change in 6-minute walk distance (6MWD) and peak VO2. We also examined outcomes by DM status. In HF-ACTION, 748 (32%) patients had DM. DM patients had lower functional capacity at baseline and had lower exercise volumes at 3 months. There was a significant interaction between DM status and exercise training for change in peak VO2 (interaction P = .02), but not 6MWD. In the exercise arm, DM patients had a smaller mean increase in peak VO2 than non-DM patients (P = .03). There was no interaction between DM and exercise on clinical outcomes. After risk adjustment, DM was associated with increased all-cause mortality/hospitalization (P = .03). Conclusions: In HF-ACTION, DM was associated with lower baseline functional capacity, an attenuated improvement in peak VO2, and increased hospitalizations.

AB - Background: In HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), exercise training improved functional capacity in heart failure with reduced ejection fraction (HFrEF). Previous studies have suggested that diabetes mellitus (DM) may be associated with an attenuated response to exercise. We explored whether DM attenuated the improvement in functional capacity with exercise. Methods and Results: HF-ACTION randomized 2331 patients with HFrEF to medical therapy with or without exercise training over a median follow-up of 2.5 years. We examined the interaction between DM and exercise response measured by change in 6-minute walk distance (6MWD) and peak VO2. We also examined outcomes by DM status. In HF-ACTION, 748 (32%) patients had DM. DM patients had lower functional capacity at baseline and had lower exercise volumes at 3 months. There was a significant interaction between DM status and exercise training for change in peak VO2 (interaction P = .02), but not 6MWD. In the exercise arm, DM patients had a smaller mean increase in peak VO2 than non-DM patients (P = .03). There was no interaction between DM and exercise on clinical outcomes. After risk adjustment, DM was associated with increased all-cause mortality/hospitalization (P = .03). Conclusions: In HF-ACTION, DM was associated with lower baseline functional capacity, an attenuated improvement in peak VO2, and increased hospitalizations.

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