Exercise studies in HF

Heart Failure and A Controlled Trial

Investigating Outcomes of Exercise
TraiNing
(HF-ACTION)
HF-ACTION design
• >2,000 patients
• NYHA class II-IV
• LV EF <35%
• Currently taking ACE-I and beta-blocker
HF-ACTION: Exercise protocol
Intensity
Training Duration (% of Mode of
phase Location Freq. (min) HRR) exercise

Initial, Walk or
supervised Clinic 3 15-30 60 cycle
Walk or
Supervised Clinic 3 30-35 70 cycle

Clinic/ Walk or
Home 3/2 30-35 70 cycle
Walk or
Maintenance Home 5 40 60-70 cycle

Total sessions: 36 over 6 months

From: Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized
Controlled Trial
JAMA. 2009;301(14):1439-1450. doi:10.1001/jama.2009.454

Copyright © 2015 American Medical

Association. All rights reserved.
From: Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure:
HF-ACTION Randomized Controlled Trial
From: Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized
Controlled Trial
JAMA. 2009;301(14):1439-1450. doi:10.1001/jama.2009.454

Copyright © 2015 American Medical

Association. All rights reserved.
From: Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized
Controlled Trial
JAMA. 2009;301(14):1439-1450. doi:10.1001/jama.2009.454

Copyright © 2015 American Medical

Association. All rights reserved.
From: Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized
Controlled Trial
JAMA. 2009;301(14):1439-1450. doi:10.1001/jama.2009.454

Copyright © 2015 American Medical

Association. All rights reserved.
From: Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized
Controlled Trial
JAMA. 2009;301(14):1439-1450. doi:10.1001/jama.2009.454

Copyright © 2015 American Medical

Association. All rights reserved.
 Home-based aerobic and resistance
training for HF
Participants
• Stable patients with systolic dysfunction
• Mean age 60
• EF 25%
• 50% white; 50% women
• NYHA classes II and III (42 vs 58%)

Arch Phys Med Rehabil. 2011 Sep;92(9):1371-81. doi: 10.1016/j.apmr.2011.02.022.

 Home-based aerobic and resistance
training for HF
Aerobic Intervention
• Mode: walking
• Intensity: 50-70% of HRR and/or RPE 12-15
• Frequency: 3x/wk
• Duration: 30-60 minutes
Resistance Intervention
• Mode: UE and LE exer with elastic bands
• Intensity: 3 sets of 12-15 reps, RPE 12-15
• Frequency: 2-3x/wk (non-consecutive days)
• Duration: 45-60 minutes

Arch Phys Med Rehabil. 2011 Sep;92(9):1371-81. doi: 10.1016/j.apmr.2011.02.022.

10-Item Continuous Scale-Physical Functional
Performance CS-PFP10 test
Low difficulty:
• pot carry,
• jacket don/doff,
• scarf pick up,
• reach
Moderate difficulty
• sweep,
• transfer laundry from washer and dryer
High difficulty:
• floor sit down and return to stand,
• grocery carry over 53m including 4 steps,
• climb a flight of stairs, and
• 6-minute walk test
From CS-PFP Home: http://archive.coe.uga.edu/cs-pfp/index.html
 Minnesota Living with Heart Failure
questionnaire (MLHFQ)
• Most common HR-QOL measure used in HF
• 6 point Likert scale
• 0 = no to 5 = very much
• 21 questions on frequent symptoms. Example topics:
• Leg swelling
• Sleep
• SOB
• Fatigue
• Anxiety and depression
• Walking, climbing stairs
• Household work
• Earning a living
• Sexual activity
• Recreational activities
• Score: best = 0, worst = 105
• MCID: 5 points
http://license.umn.edu/technologies/94019_minnesota-living-with-heart-failure-questionnaire
MLHFQ vs. NHYA Class
 Home-based aerobic and resistance
training for HF
Control (n=12) Exercise (n=12)
Pre Post Δ Pre Post Δ
CS-PFP10 38 39 1 45 56 11
MLHFQ 50 47 -3 56 33 -23
6MWT 307 310 3 364 411 47
BNP 106 108 2 184 308 124

Gary Arch Phys Med Rehabil. 2011 Sep;92(9):1371-81. doi: 10.1016/j.apmr.2011.02.022.

Moderate continuous
training (MCT)
vs. aerobic interval
training (AIT)
in heart failure
• Increase VO2 peak
• 14 vs. 46%

Circulation. 2007; 115: 3086-3094

MCT vs. AIT in CHF
LV Volumes and Resting Hemodynamics
MCT AIT
Baseline Follow-Up Baseline Follow-Up
LVEDV, mL 246 230 248 203
LVESV, mL 173 161 177 134
SV, mL 64 63 57 67
EF, % 33 34 28 38
HR rest, bpm 55 54 65 61
CO, L/min 3.5 3.4 3.5 3.9

Circulation. 2007; 115: 3086-3094

 Inspiratory muscle training in chronic
heart failure

http://www.usa.philips.com/healthcare-product/HCHS730010/treshold-inspiratory-muscle-trainer
 IMT for Heart Failure
600
500
400
300 P-IMT
IMT
200
100
0
Before After
J Am Coll Cardiol. 2006 Feb 21;47(4):757-63. 21
 P-IMT (n = 16) IMT (n = 16)
Before After Before After
6-MWD (M) 432 411 449 550
Dyspnea (Borg CR10) 3.1 3.1 3.7 1.5
MLHFQ 30 30 27 6
Peak exercise
Ve peak 47 49 48 62
VO2 peak (ml/kg/min) 17 17 17 21
VCO2 peak 1.3 1.3 1.4 1.5
Ventilatory efficiency
(Ve/VCO2 slope) 37 37 35 30
Recovery gas exchange
T1/2VO2 (min) 1.5 1.5 1.6 1.0
T1/2VCO2 (min) 1.6 1.6 1.6 1.3
T1/2Ve (min) 1.6 1.6 1.6 1.3
http://dx.doi.org/10.1016/j.jacc.2005.09.052 22