Abstract 4130: Ten-Year Outcome After Exercise Training in Chronic Heart Failure
We have previously shown that long-term moderate exercise training (ET) improves functional capacity and quality of life in patients with NYHA class II and III chronic heart failure (CHF) patients in sinus rhythm and stable condition. At 4 four years, both hospital readmission rate (RR=0.29,95%CI 011 to 0.88,P=0.02) and cardiac mortality ( RR 0.37, 95% CI, 0.17 to 0.84, P=0.01) were reduced. Similar results have been reported in a recent metanalysis on 800 CHF patients (ExTra-Match). However, it is unknown the effect of very long-term exercise training on the outcome. We studied 123 patients with CHF in stable condition over the last 3 months. Patients were 59±14 years old, 96 men, in NYHA class II (n=72) and III (n=51), sinus rhythm and ischemic (n=98) or non-ischemic(n=25) etiology. After randomization, a group (T, n= 63) underwent a supervised ET at 60% of peak VO2 2 times a week for 10 years, while a group (N, n=60) was not exercised. The ET program was performed at home (n=18) or in a coronary club (n=45) with periodic supervision at the hospital’s gym. At baseline and every 9 months a cardiopulmonary exercise stress test was performed until volitional fatigue. Quality of life (QOL) was assessed by questionnaire every 9 months.
Results: in trained patients, peak VO2 was maintained >60% of VO2max during the 10- year study (P<0.05 vs NT). In NT patients, peak VO2 was progressively decreasing with an average of 52±8% of predicted max. VE/VCO2 slope was significantly lower (35±9) in trained patients vs untrained (42±11, P<0.01). QOL score was significantly better in trained vs controls (43±12 vs 58±14, P<0.05). During the follow-up (10 years), trained patients had a significant lower rate of hospital readmission (RR 0.64, P<0.001) and cardiac mortality (RR 0.68, P<0.001) than untrained controls. Multivariate analysis selected peak VO2 and resting heart rate as independent predictors of events. In conclusion, moderate ET performed twice a week for 10 years is able to maintain functional capacity >60% of VO2max and to determine a sustained better QOL than untrained controls. These sustained improvements are associated with a better outcome.