Abstract 1532: Long-term Physical Exercise Training in Patients With End-stage Chronic Heart Failure (NYHA IIIb): Sustained Benefit on Hemodynamics and Exercise Capacity After One Year
In patients (pts) with stable, moderate chronic heart failure (CHF), exercise training (ET) is well established to enhance exercise capacity. In contrast, the data about ET, especially for a long-term period, are limited in pts with end-stage CHF (NYHA III b). Therefore, aim of the present study was to determine, whether long-term physical ET for a period of 12 months improves central hemodynamics and exercise capacity in pts with end-stage CHF. Methods: 37 pts with CHF (LVEF 24±2%, NYHA class IIIb) were randomized to 12 months of ET (30 min bicycle ergometer training daily at 50 – 60% of maximal work load) or sedentary lifestyle (C). At begin, after 3, 6 and 12 months a spiroergometry and an echocardiography were performed. Results: Pts of the training group had a continuous increase in left ventricular ejection fraction (delta after 3 months +9.4±1.5%; after 6 months +15.5±2.0%; after 12 months +14.3±2.1%;p<0.05 for delta versus C). This positive effect was associated with a decline in end-diastolic diameter after 3, 6 and 12 months (delta after 3 months −6.6±1.2mm; after 6 months −7.6±1.1mm; after 12 months −9.7±1.9mm; p<0.05 for delta versus C). In pts of the training group, exercise capacity measured by VO2 max increased by +16% after 3 months (from 15.3±0.8 to 17.8±0.8 ml/min/kg), by +24% after 6 months (to 18.8±0.8 ml/min/kg) and by +27% after 12 months (to 19.4±0.9 ml/min/kg; p<0.05 for 3, 6 and 12 months versus begin and C). These changes were associated with an improvement in clinical symptoms evident by a decline in at least 1 NYHA-class in all pts of the training group after 3, 6 and 12 months. All the above-mentioned parameters remained unchanged in pts of the control group. Number of clinical events (cardiac decompensation, hospitalization, life-threatening arrhythmias, instable angina, revascularization, cardiovascular and all cause mortality) did not differ between the two groups. Conclusion: To our knowledge, this trial shows for the first time a sustained improvement of hemodynamics and exercise capacity by long-term exercise training in pts with end-stage CHF (NYHA IIIb). These beneficial effects occurred in the absence harmful side effects as life-threatening arrhythmias or a higher incidence of cardiac decompensations in the training group.