Whellan, who is also director of clinical research at the Jefferson Heart Center, says previous studies sent mixed signals, due, in part, to their small size. Some found exercise beneficial, but others did not, and there was limited safety data. "It took a study of this size and duration to determine that exercise is not only safe, but also effective in lowering risk of hospitalization or death for patients with heart failure."
Clinical guidelines say exercise should be considered for stable patients with heart failure, but the lack of definitive data about its long-term benefits has limited Medicare and other insurers from considering an intervention that should be covered.
Participants in HF-ACTION had a significant degree of heart failure, determined by left ventricular ejection rate (LVEF), a measure of how vigorously the heart pumps blood throughout the body. The patients' mean LVEF was 25; a value less than 35 is considered problematic. And they were already receiving optimal care. Ninety-five percent were taking medications for heart failure, such as ACE-inhibitors or beta-blockers, and 45 percent were using mechanical devices to boost their hearts' ability to pump or to treat arrthymias. The average age of the patients was 59 and almost one-third of them were women.
"These patients were quite sick and were receiving exceptionally good care. That makes the gains they made in the exercise program all the more remarkable," said Whellan.
Patients in the exercise arm started out slowly, with a goal of three, 30-minute workout sessions three times per week. After 18 sessions, they transitioned to workouts at home, with a goal of 40 minutes five days per week on a stationary bicycle or treadmill. Patients kept logs of their exercise times and heart rates.
In contrast, patients in the usual care arm continued their usu
|Contact: Michelle Gailiun|
Duke University Medical Center