By RONI CARYN RABIN
Published: April 7, 2009
Heart failure patients who started a supervised aerobic exercise program reported better quality of life after three months, though the physical activity only modestly reduced their risk of being hospitalized or dying over two and a half years, researchers have found.
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Health Guide: Heart Failure
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Exercise Training in Patients With Chronic Heart Failure (JAMA)
The results appear to resolve the question of whether it is safe for medically stable patients with heart failure to engage in physical activity, since participants in the exercise group were no more likely to suffer an adverse event than those who were not exercising. Patients with heart failure have traditionally been told to rest, but that recommendation is changing in light of evidence that suggests physical activity is beneficial and may even increase survival rates in some patients.
Two studies, to be published Wednesday in The Journal of the American Medical Association, report data from a multicenter, randomized, controlled clinical trial sponsored by the National Heart, Lung, and Blood Institute. One analysis found that exercise improved overall well-being, while the other found it slightly reduced the risk of hospital admissions and death.
“I think we can say with a high degree of certainty that this is safe,” said Dr. Christopher M. O’Connor, principal investigator of the trial and director of the Duke Heart Center at Duke University School of Medicine in Durham, N.C. “The message for the average heart failure patient is: ‘We believe there are benefits from exercise. Quality of life is important, and physical fitness is important.’ ”
On the other hand, he said, “If you don’t exercise because you don’t want to, or you can’t because of orthopedic issues, you’re not going to harm yourself dramatically.”
Some 5 million Americans have heart failure, in which the heart loses its ability to pump enough blood to supply the body’s needs, and an estimated 500,000 new cases are diagnosed each year. Though medications and other treatments exist, patients often suffer from poor quality of life. Simple activities like climbing stairs leave them fatigued and short of breath, and they are frequently hospitalized and at high risk for premature death.
The trial followed 2,331 stable heart failure patients from the United States, Canada and France. Their median age was 59, and fewer than one-third were women. The patients were randomly assigned to their usual medical care or to standard treatment combined with an aerobic exercise program, then followed for two-and-a-half years on average.
Death and hospitalization rates were only slightly lower in the exercise group. Some 759 patients in the exercise training group, or 65 percent, died or were hospitalized, compared to 796 patients, or 68 percent, of the usual care group. After accounting for several variables, the scientists determined that patients who engaged in exercise cut their risk of death and hospitalization by 11 percent.
According to Dr. Katherine Flynn, an assistant professor of psychiatry and behavioral sciences at Duke University School of Medicine, over half of the patients who exercised experienced palpable improvements in quality of life measures, compared with only 29 percent in the group that received usual care.
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