A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study

Abstract

Aims: Supervised exercise can benefit selected patients with heart failure, however the effectiveness of home-based exercise remains uncertain. We aimed to assess the effectiveness of a home-based exercise programme in addition to specialist heart failure nurse care.

Methods and results: This was a randomized controlled trial of a home-based walking and resistance exercise programme plus specialist nurse care (n=84) compared with specialist nurse care alone (n=85) in a heart failure population in the West Midlands, UK.

Primary outcome: Minnesota Living with Heart Failure Questionnaire (MLwHFQ) at 6 and 12 months.

Secondary outcomes: composite of death, hospital admission with heart failure or myocardial infarction; psychological well-being; generic quality of life (EQ-5D); exercise capacity. There was no statistically significant difference between groups in the MLwHFQ at 6 month (mean, 95% CI) (-2.53, -7.87 to 2.80) and 12 month (-0.55, -5.87 to 4.76) follow-up or secondary outcomes with the exception of a higher EQ-5D score (0.11, 0.04 to 0.18) at 6 months and lower Hospital Anxiety and Depression Scale score (-1.07, -2.00 to -0.14) at 12 months, in favour of the exercise group. At 6 months, the control group showed deterioration in physical activity, exercise capacity, and generic quality of life.

Conclusion: Home-based exercise training programmes may not be appropriate for community-based heart failure patients.

Figure 1

Flow of patients through the BRUM-CHF study. NYHA, New York Heart Association class; AF, atrial fibrillation; ISWT, incremental shuttle walking test; DNA, did not attend; F/U, follow-up.