Effects on quality of life, symptoms and daily activity 6 months after termination of an exercise training programme in heart failure patients

Abstract

Background: Exercise training in heart failure patients improves exercise capacity, physical function, and quality-of-life. Prior studies indicate a rapid loss of these effects following termination of the training. We wanted to assess any sustained post-training effects on patients global assessment of change in quality-of-life (PGACQoL) and physical function. Methods: Fifty-four stable heart failure patients were randomised to exercise or control. The 4-month exercise programme consisted of bicycle training at 80% of maximal intensity three times/week, and 49 patients completed the active study period. At 10 months (6 months post training) 37 patients were assessed regarding PGACQoL, habitual physical activity, and dyspnea-fatigue-index. Results: Both post-training patients (n=17) and controls (n=20) deteriorated PGACQoL during the 6-month extended follow-up, although insignificantly. However, post-training patients improved PGACQoL slightly but significantly from baseline to 10 months (P=0.006), differing significantly (P=0.023) from controls who were unchanged. Regarding dyspnea-fatigue-index, post-training patients were largely unchanged and controls deteriorated insignificantly, during the extended follow-up as well as from baseline to 10 months. Both groups decreased physical activity insignificantly during the extended follow-up, and from baseline to 10 months post-training patients tended to decrease whereas controls significantly (P=0.007) decreased physical activity. Conclusion: There was no important sustained benefit 6 months after termination of an exercise training programme in heart failure patients. A small, probably clinically insignificant sustained improvement in PGACQoL was seen in post-training patients. Controls significantly decreased the habitual physical activity over 10 months and post-training patients showed a similar trend. Exercise training obviously has to be continuing to result in sustained benefit.

Introduction

Several studies have shown beneficial effects of physical endurance training in patients with depressed left ventricular function and/or clinical heart failure [1], [2]. Benefit has been shown in terms of exercise capacity, oxygen uptake, ability to carry out daily activities, quality of life, and left ventricular function [1], [2]. The effects have been found to be due mainly to improved peripheral muscular function and improved autonomic balance/reduced sympathetic activation, and are largely independent of central hemodynamics [1], [2]. It seems, however, that there is quite rapid deterioration following discontinuation of the exercise training [1], [2], indicating that the training must be continued in order to obtain sustained beneficial effects. It is not known if patients who have participated in a training programme will spontaneously continue to carry out exercise training or increase their level of physical activity long-term (i.e. 6 months) after discontinuing the formal training programme. Neither is it known if controls will pick up the exercise training or change their physical activity after having participated in such a study.

In a study of 49 patients with symptomatic heart failure we showed that a 16-week physical exercise training programme improved patients global assessment of change in quality of life (PGACQoL) and maximum exercise capacity [3]. After completion of the active study period the patients were followed for an additional 6 months, at the end of which they were interviewed regarding PGACQoL, habitual physical activity, and ability to carry out daily activities. Here we report the results of this extended follow-up.