Heart failure
Usefulness of a Home-Based Exercise Program for Overweight and Obese Patients With Advanced Heart Failure

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Exercise is an important behavior for long-term weight control in overweight and obese patients. However, little evidence exists confirming such findings in patients with advanced heart failure (HF). Using a prospective, experimental design, the effects of 24 weeks of a low-level, home-based walking program on weight loss were studied in overweight and obese (body mass index ≥27 kg/m2) patients with advanced HF who were randomized to exercise (n = 48) and control (n = 51) groups. Weight changes between the 2 groups at baseline and 6 months were compared using repeated-measures analysis of variance. Patients were on average aged 53.3 ± 10.1 years and predominantly male (75%), Caucasian (57%), and married (55%). Most patients were in New York Heart Association class III or IV (67%), with a mean ejection fraction of 25%. Patients in the exercise group showed significant weight reduction from baseline to 6 months compared with those in the control group (−6.37 ± 11.7 vs −0.33 ± 9.3 kg, p = 0.002). No significant differences were noted between the 2 groups in 6-minute walk distance or depression, although the changes were in the anticipated direction. Modest weight losses of >5% were associated with cardiopulmonary exercise test–documented workload levels at 6 months (r = 0.331, p = 0.006), as well as decreased depression (r = −0.315, p = 0.01) and hostility (r = −0.355, p = 0.005). The number of hospital admissions was significantly smaller for patients in the exercise group compared with those in the control group (0.63 ± 0.94 vs 1.07 ± 0.95, p <0.05). In conclusion, the findings demonstrate the beneficial effects of a low-level, home-based walking program on weight loss in overweight and obese patients with advanced HF.

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Setting and participants

The present study was a substudy of a larger prospective, controlled trial of patients with advanced HF who participated in a 6-month, supervised, home-based walking program designed to measure clinical outcomes, including mortality and rehospitalization events. Only data from overweight and obese patients (BMI ≥27 kg/m2) who completed the 6-month follow-up (n = 99, or 57.2% of the 173 patients who enrolled in the parent study) were analyzed for this study. The participants were randomized to

Results

A total of 110 participants in the parent study met the criteria for overweight and obesity (exercise group n = 53, control group n = 57), but only 99 patients (exercise group n = 48, control group n = 51) had complete baseline and 6-month follow-up data for the present analyses. However, there were no differences in the baseline demographic and clinical characteristics of participants who were included or excluded for this substudy. The mean age of participants was 53.34 ± 10.1 years, with no

Discussion

Our findings are comparable with those of other studies examining overweight and obese but otherwise healthy adults that show that exercisers lose significantly more weight during treatment than nonexercisers.8 Our findings confirm the beneficial effects of a low-level, home-based exercise program on weight loss in overweight and obese patients with systolic HF. These findings challenge the assumption that patients with relatively advanced HF who have the double burden of obesity have

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This research was partially supported by a grant from the American Heart Association Western Division, California (National Cardiovascular Research, 133-09, principal investigator: Dr. Dracup).

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