Exercise Training Improves Health Status of Heart Failure Patients

Patients with heart failure who participated in aerobic exercise training had modest improvements in self-reported health status compared to those patients who did not have exercise training, according to an article appearing the April 8 issue of JAMA.


Patients with heart failure often experience diminished health status, including reductions in physical and social functioning and other dimensions of health-related quality of life. “Pharmacological and device interventions and disease management programs for heart failure have provided little or modest improvements in health-related quality of life. The extent to which exercise training in addition to optimal evidence-based therapy improves patients’ health status is unknown,” the authors write.


Kathryn E. Flynn, Ph.D., of Duke University School of Medicine, Durham, N.C., and colleagues examined the effects of exercise training on health status among patients with heart failure who were participants of HF-ACTION. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 23-item self-administered disease-specific survey. The KCCQ is scored from 0 to 100, with higher scores representing better health status. HF-ACTION compared scores on the KCCQ overall summary scale and key subscales (i.e., physical limitations, symptoms, quality of life and social limitations) between randomized groups. Median follow-up was 2.5 years.


At 3 months, usual care plus exercise training led to greater improvement in the KCCQ overall summary score compared with usual care alone. Neither group experienced significant changes in KCCQ scores after 3 months, resulting in a sustained, greater improvement overall for the exercise group. At 12 months, 53 percent of patients in the exercise training group had a clinically noticeable improvement from the beginning of the trial compared with 33 percent in the usual care group.


Results for the KCCQ subscales were similar to the results for the overall summary scale. After adjusting for the cause of heart failure, there was a significant overall treatment effect on physical limitations, symptoms, quality of life and social limitations.

“The results demonstrate that participation in an exercise training program provides a modest but statistically significant improvement in patient-reported health status compared with usual care. The clinical meaningfulness of the magnitude of average change requires further study,” the authors conclude.


JAMA. 2009;301[14]:1451-1459.