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10-year exercise training in chronic heart failure: a randomized controlled trial |
Belardinelli R, Georgiou D, Cianci G, Purcaro A |
Journal of the American College of Cardiology 2012 Oct 16;60(16):1521-1528 |
clinical trial |
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
OBJECTIVES: This study investigated the effect of a very long-term exercise training program is not known in chronic heart failure (CHF) patients. BACKGROUND: We previously showed that long-term moderate exercise training (ET) improves functional capacity and quality of life in New York Heart Association class II and III CHF patients. METHODS: We studied 123 patients with CHF whose condition was stable over the previous 3 months. After randomization, a trained group (T group, n = 63) underwent a supervised ET at 60% of peak oxygen consumption (VO2), 2 times weekly for 10 years, whereas a nontrained group (NT group, n = 60) did not exercise formally. The ET program was supervised and performed mostly at a coronary club with periodic control sessions twice yearly at the hospital's gym. RESULTS: In the T group, peak VO2 was more than 60% of age- and gender-predicted maximum VO2 each year during the 10-year study (p < 0.05 versus the NT group). In NT patients, peak VO2 decreased progressively with an average of 52 +/- 8% of maximum VO2 predicted. Ventilation relative to carbon dioxide output (VE/VCO2) slope was significantly lower (35 +/- 9) in T patients versus NT patients (42 +/- 11, p < 0.01). Quality-of-life score was significantly better in the T group versus the NT group (43 +/- 12 versus 58 +/- 14, p < 0.05). During the 10-year study, T patients had a significant lower rate of hospital readmission (hazard ratio: 0.64, p < 0.001) and cardiac mortality (hazard ratio: 0.68, p < 0.001) than controls. Multivariate analysis selected peak VO2 and resting heart rate as independent predictors of events. CONCLUSIONS: Moderate supervised ET performed twice weekly for 10 years maintains functional capacity of more than 60% of maximum VO2 and confers a sustained improvement in quality of life compared with NT patients. These sustained improvements are associated with reduction in major cardiovascular events, including hospitalizations for CHF and cardiac mortality.
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