Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure. Effects on Functional Capacity, Quality of Life, and Clinical Outcome.

Abstract

Background-It is still a matter of debate whether exercise training (ET) is a beneficial treatment in chronic heart failure (CHF). Methods and Results-To determine whether long-term moderate ET improves functional capacity and quality of life in patients with CHF and whether these effects translate into a favorable outcome, 110 patients with stable CHF were initially recruited, and 99 (59±14 years of age; 88 men and 11 women) were randomized into 2 groups. One group (group T, n=50) underwent ET at 60% of peak VO 2 , initially 3 times a week for 8 weeks, then twice a week for I year. Another group (group NT, n=49) did not exercise. At baseline and at months 2 and 14, all patients underwent a cardiopulmonary exercise test, while 74 patients (37 in group T and 37 in group NT) with ischemic heart disease underwent myocardial scintigraphy. Quality of life was assessed by questionnaire. Ninety-four patients completed the protocol (48 in group T and 46 in group NT). Changes were observed only in patients in group T. Both peak VO 2 and thallium activity score improved at 2 months (18% and 24%, respectively; P<0.001 for both) and did not change further after 1 year. Quality of life also improved and paralleled peak VO 2 , Exercise training was associated both with lower mortality (n =9 versus n=20 for those with training versus those without; relative risk (RR)=0.37; 95% CI, 0.17 to 0.84; P=0.01) and hospital readmission for heart failure (5 versus 14; RR=0.29; 95% CI, 0.11 to 0.88; P=0.02). Independent predictors of events were ventilatory threshold at baseline (β-coefficient=0.378) and posttraining thallium activity score (β-coefficient -0.165). Conclusions-Long-term moderate ET determines a sustained improvement in functional capacity and quality of life in patients with CHF. This benefit seems to translate into a favorable outcome.