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Exercise Training in Heart Failure

List of key references prepared and regularly updated by the Heart Failure Association (HFA)



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

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Flynn KE, Piña 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.

JAMA. 2009 Apr 8;301(14):1451-9.

Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial

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O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, FESC, Piña IL; HF-ACTION Investigators.

JAMA. 2009 Apr 8;301(14):1439-50.

Synopsis

These 2 papers report the study that was the first randomized study to reach adequate statistical power to evaluate efficacy and safety of aerobic exercise training in patients with chronic heart failure (CHF).  It comprised 2331 outpatients with stable CHF (median LVEF: 25%, NYHA class III-IV: 37%) and demonstrated that aerobic exercise training consisting of 36 supervised sessions followed by home-based training combined with standard treatment, compared to standard treatment alone, was safe and associated with the significant improvement in quality of life among trained patients.  Although there was no statistical difference in the incidence of primary end-points between trained and non-trained group, after adjustment for other clinical prognosticators, exercise training resulted in a reduction in the composite secondary end point (all-cause mortality or hospitalization, and cardiovascular mortality or heart failure hospitalization) over a median follow-up of 30 months.

Commentary

Regular aerobic exercise training is associated with pulmonary, cardiovascular, immune, autonomic and skeletal muscle metabolic adaptations that increase oxygen delivery and optimize energy utilization, as demonstrated in several small observational studies in patients with systolic chronic heart failure.  This is the first randomized study planned to evaluate efficacy and safety of aerobic exercise training in patients with chronic heart failure.  It has demonstrated an increase in quality of life in trained patients.  Although in primary analyses there was no effect on prognosis, but the secondary analyses are quite promising regarding the favourable modification of outcome.