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Impact of a Graded Exercise Program on V˙O2peak and Survival in Heart Failure Patients

SNOEK, JOHAN A.1,2; EIJSVOGELS, THIJS M. H.3; VAN ‘T HOF, ARNOUD W. J.2,4; PRESCOTT, EVA5; HOPMAN, MARIA T.3; KOLKMAN, EVELIEN6; DE KLUIVER, ED P.2

Medicine & Science in Sports & Exercise: November 2018 - Volume 50 - Issue 11 - p 2185–2191
doi: 10.1249/MSS.0000000000001688
CLINICAL SCIENCES

Introduction Although exercise therapy has the potential to improve health outcomes of patients with chronic heart failure (CHF), less than 50% of patients adhere to prescribed physical activity guidelines 1 yr after cardiac rehabilitation. We aimed to assess the effects of an extended cardiac rehabilitation program with 12 months of graded exercise therapy (GET) and resistance exercise training (RT) on exercise capacity and long-term survival in patients with CHF.

Methods This prospective cohort study included 60 CHF patients between 2009 and 2010. The GET-RT program consisted of exercise sessions at 6 d·wk−1. Total training time of aerobic exercises increased incrementally every other week without changing exercise intensity. Resistance exercise training consisted of 8 exercises with a durable resistance band. Guidance consisted of a step-down approach from in-hospital to home-based training. Cardiopulmonary exercise tests were performed at baseline, 3, 6, and 12 months. Subsequently, patients were propensity score matched on a 1:2 ratio with controls (n = 117) from a CHF registry of patients from the same clinic receiving usual out-patient care and the incidence of all-cause mortality was compared between both groups.

Results Baseline V˙O2 peak was 15.0 mL·min−1·kg−1 and significantly elevated at 3 months (+1.1 mL·min−1·kg−1 (95% CI, 0.4–1.8), 6 months (+2.9 mL·min−1·kg−1 (95% CI, 1.1–2.9) and 12 months (+2.6 mL·min−1·kg−1 (95% CI, 1.4–3.8). During 8 yr of follow-up 23 (38.3%) patients of the GET-RT program died versus 63 (53.8%) patients of the control group (P = 0.063).

Conclusions The 12-month GET-RT program was associated with an improved fitness during 1-yr follow-up, whereas a tendency toward better survival rates was observed during long-term follow-up.

1Sports Medicine Department, Isala, Zwolle, THE NETHERLANDS;

2Isala Heart Centre, Zwolle, THE NETHERLANDS;

3Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Centre, Nijmegen, THE NETHERLANDS;

4Maastricht UMC, Maastricht, THE NETHERLANDS;

5Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, DENMARK; and

6Diagram, Zwolle, THE NETHERLANDS

Address for correspondence: Johan Aernout Snoek, M.D., Sport Medicine Department Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands; E-mail: j.a.snoek@isala.nl.

Submitted for publication March 2018.

Accepted for publication June 2018.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.acsm-msse.org).

© 2018 American College of Sports Medicine