David Brill
Exercise training is safe and of great benefit to patients with heart failure (HF), experts concluded following the recent presentation of a new study.
HF-ACTION*, the largest-ever randomized trial to assess the effects of exercise in HF patients, was greeted as a success despite failing to meet its primary endpoint.
Participation in a structured exercise program produced a modest reduction in all-cause mortality or hospitalization, which only achieved significance after adjustment for prognostic factors (adjusted hazard ratio 0.89; P=0.03).
Exercise training also improved quality of life among HF patients, a substudy of the trial showed.
Discussing the findings of HF-ACTION, which involved 2,331 patients with an average age of 59, Professor Philip Poole-Wilson of Imperial College, London, UK, said that the data were "compelling" and had wide implications.
"They missed their primary endpoint and there are those who would say ‘well that’s the end of it, let’s go home.’ I think that would be a very wrong interpretation," he said.
"I think that this trial does support the use of exercise and will strengthen the guidelines for both primary care and for the treatment of HF.
"The one thing this trial does not show is what type of exercise to advocate, and I think we’re going to see a lot more studies in that area," he added.
HF-ACTION was conducted at 82 sites in Europe, Canada and the US, with patients followed up for an average of 2.5 years.
A 15 percent reduction in the risk of cardiovascular mortality and HF hospitalization – a secondary endpoint of the study – was also seen after adjustment (adjusted hazard ratio 0.85; P=0.03).
"The HF-ACTION study results support a structured exercise training program for patients with reduced left ventricular function and HF symptoms in addition to evidence-based therapy," said Professor Christopher O’Connor, the study’s principal investigator who presented the findings to the media.
He added that the additional benefits of exercise in HF-ACTION came on a background of excellent medical and device therapy – superior to that seen in any previous HF clinical trial population. More than 90 percent of the patients were on optimal medical therapy and around 40 percent had implantable cardioverter defibrillators, he said.
The exercise program comprised 36 supervised sessions, after which patients were given an exercise bike or treadmill for use at home and encouraged to undertake five weekly sessions of 40 minutes each.
After 3 months, 52 percent of patients were completing at least three such sessions per week. At one-year follow-up, just 25 percent of patients were completing the full five sessions each week.
O’Connor, director of the Heart Center at Duke University Medical Center, US, stressed that adherence is much harder to achieve in lifestyle intervention trials than drug trials, noting that by the conclusion of the study most patients were exercising for just 50 or 60 minutes per week.
Professor Mariell Jessup, a HF specialist from the University of Pennsylvania, said that for many years it was thought that the best treatment for HF was to go to bed and avoid exertion.
"Exercise in HF-ACTION was safe and it improved outcomes so it’s a very encouraging and positive trial. Now when patients come into the office you can say that you need to exercise and it’s perfectly safe for you to do so."
*HF-ACTION: Heart Failure – A Randomized Controlled Trial Investigating Outcomes of Exercise Training.
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