Exercise for Heart Failure

Summarized by Robert W. Griffith, MD
March 26, 2004

Introduction

Although exercise is known to improve symptoms of chronic heart failure, it's not often prescribed, perhaps because its effect on the final out come isn't well established. This gap in our knowledge has been filled by an analysis of the results of nine clinical trials, recently published in the British Medical Journal.

What was done

A unit at the Royal Brompton Hospital, London, undertook an analysis of all published controlled studies of exercise training since 1990 in patients with chronic heart failure; the training had to have lasted at least 8 weeks, and follow up at least 3 months.

Nine studies qualified for this analysis, reporting on over 800 patients; roughly half of them received exercise training, and the remainder did not, serving as controls. All the patients had stable chronic congestive heart failure due to failure of the left ventricle (i.e. the left ejection fraction was less than 50%).

Training consisted of exercises involving both legs - cycling, walking, treadmill, calisthenics, rowing, swimming, and occasionally resistance training. All the activities were supervised, initially, and then were continued by the patient at home in some instances. Duration ranged from 30 to 60 minutes, two to four days a week.

The date of death or admission to hospital were recorded, and used to evaluate the benefits of exercise training.

What was found

There were 88 (22%) deaths in the exercise training patients, and 105 (26%) in the control patients. The likelihood of dying for those doing the exercise training was calculated to be less - 0.67 times - than that in the control group. Either death or admission to hospital occurred in 127 patients in the training group and in 173 of the controls.

The average time to death in the training group was 618 days, and that for the controls was 421 days. And the average time to admission to hospital was 426 days for the training group and 371 days for the controls.

The above differences between the exercise training group and the controls were statistically significant (i.e. they couldn't have occurred by chance alone).

Comment

Not all patients with chronic heart failure receive exercise training, largely because its beneficial effects on the outcome are not widely known. The results of this analysis, however, show that exercise training significantly improves survival time. In view of the generally poor outlook for patients with congestive failure, it's high time that appropriate physical therapy is recommended for all such patients. The number of days of 'extra time' may not seem a lot when you're well, but they're quite significant when you're quite sick!

Source

• Exercise training meta-analysis of trials in patients with chronic heart failure.  ExTraMATCH Collaborative, BMJ, 2004, vol. 328, pp. 189--192

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