Exercise training in heart failure: inpatient and outpatient considerations

Association of physical activity and prognostic parameters in elderly patients with heart failure

OBJECTIVE

Assessment of habitual physical activity (PA) in patients with heart failure.

METHODS

This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO(2peak), percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.

RESULTS

Accelerometry showed a stronger correlation with VO(2peak) and NYHA class (R = .73 and R = -.68; p < .001) than AQ (R = .58 and R = -.65; p < .001) or pedometer (R = .52 and R = -.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO(2peak) (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.

CONCLUSION

PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

Effects of an exercise adherence intervention on outcomes in patients with heart failure

The purpose of this study was to determine how an exercise adherence intervention affects the physiological, functional, and quality of life outcomes of patients with heart failure (HF). Sixteen HF patients were randomly assigned to an exercise-only group (n = 8) or to an exercise-with-adherence group (n = 8). Two of the 16 people died from nonexercise related causes during the study and were not included in the analysis. The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program (Phase 1) followed by 12 weeks of unsupervised home exercise (Phase 2). The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses. Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases. The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program.

Staying on course: the effects of an adherence facilitation intervention on home exercise participation

The purpose of this investigation was to test the effectiveness of an adherence facilitation intervention consisting of goal setting, graphic feedback, and provider guidance to support adherence to home exercise in a sample of patients with heart failure who had completed a supervised exercise program. The sample consisted of 13 patients with an ejection fraction of 40% or less who were randomly assigned to either the exercise only group (n=6) or the exercise with adherence facilitation group (n=7). The format of the intervention was graphic depiction of each patient's exercise goals in comparison to each patient's exercise participation. Graphs were mailed at 3-week intervals for 12 weeks. Results indicate that patients who received the intervention demonstrated higher exercise adherence and greater confidence in continuing to exercise in the future. The adherence facilitation intervention may be helpful to heart failure patients in adapting to a program of home exercise. (c)2002 CHF, Inc.