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Randomized Controlled Trial
. 2012 Nov 6;60(19):1899-905.
doi: 10.1016/j.jacc.2012.08.958. Epub 2012 Oct 10.

Relation between volume of exercise and clinical outcomes in patients with heart failure

Steven J Keteyian  1 , Eric S Leifer, Nancy Houston-Miller, William E Kraus, Clinton A Brawner, Christopher M O'Connor, David J Whellan, Lawton S Cooper, Jerome L Fleg, Dalane W Kitzman, Alain Cohen-Solal, James A Blumenthal, David S Rendall, Ileana L Piña; HF-ACTION Investigators
Affiliations
Randomized Controlled Trial

Relation between volume of exercise and clinical outcomes in patients with heart failure

Steven J Keteyian et al. J Am Coll Cardiol. .

Abstract

Objectives: This study determined whether greater volumes of exercise were associated with greater reductions in clinical events.

Background: The HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial showed that among patients with heart failure (HF), regular exercise confers a modest reduction in the adjusted risk for all-cause mortality or hospitalization.

Methods: Patients randomized to the exercise training arm of HF-ACTION who were event-free at 3 months after randomization were included (n = 959). Median follow-up was 28.2 months. Clinical endpoints were all-cause mortality or hospitalization and cardiovascular mortality or HF hospitalization.

Results: A reverse J-shaped association was observed between exercise volume and adjusted clinical risk. On the basis of Cox regression, exercise volume was not a significant linear predictor but was a logarithmic predictor (p = 0.03) for all-cause mortality or hospitalization. For cardiovascular mortality or HF hospitalization, exercise volume was a significant (p = 0.001) linear and logarithmic predictor. Moderate exercise volumes of 3 to <5 metabolic equivalent (MET)-h and 5 to <7 MET-h per week were associated with reductions in subsequent risk that exceeded 30%. Exercise volume was positively associated with the change in peak oxygen uptake at 3 months (r = 0.10; p = 0.005).

Conclusions: In patients with chronic systolic HF, volume of exercise is associated with the risk for clinical events, with only moderate levels (3 to 7 MET-h per week) of exercise needed to observe a clinical benefit. Although further study is warranted to confirm the relationship between volume of exercise completed and clinical events, our findings support the use of regular exercise in the management of these patients.

Trial registration: ClinicalTrials.gov NCT00047437.

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Conflict of interest statement

Conflict of interest: Keteyian: Received grants or funding, personal income for consulting, and honoraria from the NIH, GE Healthcare, and Amgen; Leifer: Employee of NHLBI Houston-Miller: None; Kraus: Received grants or funding, personal income for consulting, and honoraria from the NIH, GE Healthcare, and Amgen; Brawner: None; O’Connor: Received grants or funding, personal income for consulting, and honoraria from the NIH, GE Healthcare, and Amgen; Whellan: Received grants or funding, personal income for consulting, and honoraria from the (NIH, GE Healthcare, and Amgen; Cooper: Employee of NHLBI; Fleg: Employee of NHLBI itzman: Received grants or funding, personal income for consulting, and honoraria from the NIH, GE Healthcare, and Amgen; Cohen-Solal: Received grants or funding from Servier, Astra Zeneca, Menarini, Takeda, Amgen, IPSEN Genzyme, GE Health Care, Novartis, Sorin; Piña: Received grants or funding, personal income for consulting, and honoraria from the NIH, GE Healthcare, and Amgen

Figures

Figure 1
Figure 1. Study Flow Chart
Flow of patients through the trial to the 3-month event-free group.
Figure 2
Figure 2. Hazard Ratios for All-cause Mortality or Hospitalization
Among patients event-free for at least three months, adjusted hazard ratios (filled circles, log scale) for all-cause mortality or hospitalization with 95% confidence intervals; reference category is 0–1 MET-hr per week. Unadjusted hazard ratios are plotted with open circles.
Figure 3
Figure 3. Hazard Ratios for Cardiovascular Mortality or Heart Failure Hospitalization
Among patients event-free for at least three months, adjusted hazard ratios (filled circles, log scale) for cardiovascular mortality or heart failure hospitalization with 95% confidence intervals; reference category is 0–1 MET-hr per week. Unadjusted hazard ratios are plotted with open circles.
Figure 4
Figure 4. Adjusted Kaplan-Meier Curves for Clinical Outcomes
Adjusted Kaplan-Meier curves for all-cause mortality or hospitalization (left panel) and cardiovascular mortality or heart failure hospitalization (right panel) in patients event-free for at least 3 months, stratified at the median exercise volume of 4 MET-hr per week.
Figure 4
Figure 4. Adjusted Kaplan-Meier Curves for Clinical Outcomes
Adjusted Kaplan-Meier curves for all-cause mortality or hospitalization (left panel) and cardiovascular mortality or heart failure hospitalization (right panel) in patients event-free for at least 3 months, stratified at the median exercise volume of 4 MET-hr per week.
See this image and copyright information in PMC

References

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