Abstract
BackgroundExercise training in heart failure (HF) is recommended but not routinely offered, because of logistic and safety-related reasons. In 2020, the German Society for Prevention&Rehabilitation and the German Society for Cardiology requested establishing dedicated “HF training groups.” Here, we aimed to implement and evaluate the feasibility and safety of one of the first HF training groups in Germany.MethodsTwelve patients (three women) with symptomatic HF (NYHA class II/III) and an ejection fraction ≤ 45% participated and were offered weekly, physician-supervised exercise training for 1 year. Patients received a wrist-worn pedometer (M430 Polar) and underwent the following assessments at baseline and after 4, 8 and 12 months: cardiopulmonary exercise test, 6-min walk test, echocardiography (blinded reading), and quality of life assessment (Kansas City Cardiomyopathy Questionnaire, KCCQ).ResultsAll patients (median age [quartiles] 64 [49; 64] years) completed the study and participated in 76% of the offered 36 training sessions. The pedometer was worn ≥ 1000 min per day over 86% of the time. No cardiovascular events occurred during training. Across 12 months, NT-proBNP dropped from 986 pg/ml [455; 1937] to 483 pg/ml [247; 2322], and LVEF increased from 36% [29;41] to 41% [32;46]%, (p for trend = 0.01). We observed no changes in exercise capacity except for a subtle increase in peak VO2% predicted, from 66.5 [49; 77] to 67 [52; 78]; p for trend = 0.03. The physical function and social limitation domains of the KCCQ improved from 60 [54; 82] to 71 [58; 95, and from 63 [39; 83] to 78 [64; 92]; p for trend = 0.04 and = 0.01, respectively. Positive trends were further seen for the clinical and overall summary scores.ConclusionThis pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF.
Highlights
In Germany, the concept of ambulatory “cardiac training groups” (HSGs, Herzsportgruppen) supervised by a physician with emergency equipment and an experienced exercise physiologist was initiated and implemented as early as 1965
Adult patients were eligible if they had symptomatic heart failure (New York Heart Association functional class II or III) with a reduced left ventricular ejection fraction (LVEF) below 45%, and were physically and mentally capable of and willing to participate in a weekly training program
The median age of the participants was 64 years (49; 73), 25% were female, 33% had ischemic cardiomyopathy, 59% were in NYHA functional class III, and 75% exhibited heart failure with reduced ejection fraction
Summary
In Germany, the concept of ambulatory “cardiac training groups” (HSGs, Herzsportgruppen) supervised by a physician with emergency equipment and an experienced exercise physiologist was initiated and implemented as early as 1965. Despite well-established evidence and guidelines recommending physical activity to improve health-related quality of life and to reduce hospitalization rates in patients with heart failure, their participation in the above-mentioned HSGs is heavily underrepresented, most likely because of their perceived higher risk for cardiovascular events during training sessions [3,4,5]. Conclusion This pilot study showed that the implementation of a supervised HF-exercise program is feasible, safe, and has the potential to improve both quality of life and surrogate markers of HF severity. This first exercise experiment should facilitate the design of risk-adopted training programs for patients with HF
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