Regular exercise is safe for heart failure patients and may slightly lower their risk of death or hospitalization, as per results from the largest and most comprehensive clinical trial to examine the effects of exercise in chronic heart failure patients. Supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, the study also observed that heart failure patients who add regular, moderate physical activity to standard medical treatment report a higher quality of life in comparison to similar patients who receive medical treatment only.

Scientists with HF-ACTION (Heart Failure A Controlled Trial Investigating Outcomes of exercise TraiNing) have published two papers in the April 8, 2009, issue of the Journal of the American Medical Association The study was conducted at 82 centers in the United States, Canada, and France.

"A number of patients and health care providers have continued to be concerned about the safety of aerobic exercise for heart failure," said NHLBI Director Elizabeth G. Nabel, M.D. "With the results of this robust clinical trial, we can now reassure heart failure patients that, with appropriate medical supervision, regular aerobic exercise is not only safe but it can also improve their lives in really meaningful ways."

About 5 million people in the United States have heart failure, a potentially life-threatening condition in which the heart has a reduced ability to pump blood through the body. The number of people with heart failure is growing, and each year, another 550,000 people are diagnosed for the first time. The leading cause of hospitalization among Americans age 65 and older, heart failure commonly develops over several years and usually results from coronary artery disease, high blood pressure, or diabetes. Treatment typically includes changes in lifestyle, medicines, and regular outpatient follow-up with a health care provider. Some patients also need medical devices to help the heart pump better, or surgeries, such as a coronary artery bypass operation or heart transplant.

Earlier, smaller clinical trials have suggested that exercise is beneficial for heart failure patients, and.

clinical guidelines recommend moderate exercise for this condition. Nonetheless, safety concerns have persisted.

HF ACTION followed 2,331 patients with moderate-to-severe systolic heart failure (average age 59) for up to four years (average of 2.5 years). About one-half of the participants were randomly assigned to receive usual care alone, which included medical and device treatment as prescribed by their physicians and educational materials on disease management. They were also asked to engage in 30 minutes of moderate physical activity on most days of the week.

The other half of the participants were in the exercise training group, and they received usual care plus 36 sessions of group-based, supervised aerobic exercise training (walking or stationary cycling) of up to 35 minutes three times per week. These participants were asked to transition to home-based training at the same intensity five times per week for the remainder of the study and received a treadmill or stationary bike for home use and a heart rate monitor.

In comparison to the usual care group, the exercise training group had slightly fewer (statistically non-significant) deaths or hospitalizations from any cause. When scientists adjusted the findings (as specified in the study design) for the strongest predictors of death or hospitalization initial exercise capacity, history of atrial fibrillation, depression, cardiac pumping function, and cause of heart failure -- exercise training was associated with an 11 percent lower risk of all-cause death or hospitalization and a 15 percent lower risk of cardiovascular-related death or heart failure hospitalization. In addition, there was no significant difference in serious adverse events between the two groups, such as an abnormal heart rhythm, hip fracture, or hospitalization correlation to exercise, suggesting that exercise training was well tolerated and safe.

The scientists note that the benefits of exercise appears to be underestimated by the observed study results because a number of of the usual care participants also exercised. In addition, adherence to prescribed exercise in the exercise training group was below goal in the majority of participants.

Furthermore, after training, participants in the exercise group scored significantly higher than those in the usual care group on a standard, self-administered quality-of-life questionnaire. Participants reported fewer physical and social limitations and symptoms, and improved quality of life after three months. The improvements persisted throughout the follow-up period and were consistent regardless of sex, race, or age.


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