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Randomized Controlled Trial
. 2025 Jun;13(6):912-922.
doi: 10.1016/j.jchf.2024.11.006. Epub 2025 Jan 22.

Effects of Acute Phase Intensive Exercise Training in Patients With Acute Decompensated Heart Failure

Kentaro Kamiya  1 , Shinya Tanaka  2 , Hiroshi Saito  3 , Masashi Yamashita  4 , Ryusuke Yonezawa  5 , Nobuaki Hamazaki  6 , Ryota Matsuzawa  7 , Kohei Nozaki  6 , Yoshiko Endo  3 , Kazuki Wakaume  5 , Shota Uchida  8 , Emi Maekawa  9 , Yuya Matsue  10 , Makoto Suzuki  11 , Takayuki Inomata  12 , Junya Ako  9
Affiliations
Randomized Controlled Trial

Effects of Acute Phase Intensive Exercise Training in Patients With Acute Decompensated Heart Failure

Kentaro Kamiya et al. JACC Heart Fail. 2025 Jun.

Abstract

Background: Acute decompensated heart failure (ADHF) leads to hospitalizations and functional decline in older adults. Although cardiac rehabilitation (CR) is effective for stable heart failure, its impact on ADHF patients, particularly those without frailty, is unclear.

Objectives: The goal of this study was to evaluate the efficacy and safety of early in-hospital CR for patients hospitalized with ADHF who are not frail.

Methods: In this multicenter trial (ACTIVE-ADHF [Effects of Acute Phase Intensive Exercise Training in Patients with Acute Decompensated Heart Failure]), ADHF patients without physical frailty were randomized 2:1 to undergo either exercise-based CR or standard care. The intervention included early mobilization and structured exercise training. The primary outcome was the change in 6-minute walk distance (6MWD) from baseline to discharge. Secondary outcomes assessed physical and cognitive function, quality of life, and safety.

Results: A total of 91 patients were randomized to treatment, with 59 allocated to the intervention group and 32 to the control group. The primary outcome, 6MWD, improved significantly more in the intervention group, with a mean increase of 75.0 ± 7.8 m vs 44.1 ± 10.2 m in the control group, with an effect size of 30.9 ± 13.1 m (95% CI: 4.8-57.0; P = 0.021). The intervention group showed favorable results in secondary efficacy outcomes, including physical and cognitive function, physical activity, and quality of life. Safety outcomes were similar between groups, except for a greater reduction in B-type natriuretic peptide levels at 90 days' postdischarge in the intervention group.

Conclusions: In patients with ADHF without physical frailty, in-hospital exercise-based CR led to significant improvements in 6MWD at 2 weeks after randomization without compromising safety. (ACTIVE-ADHF [Effects of Acute Phase Intensive Exercise Training in Patients with Acute Decompensated Heart Failure]; UMIN000020919).

Keywords: acute heart failure; cardiac rehabilitation; exercise therapy; exercise tolerance; randomized controlled trial.

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Conflict of interest statement

Funding Support and Author Disclosures This work was partially supported by JSPS KAKENHI (grant numbers 15K16368 and 21H03309) and the Japanese Physical Therapy Association. Dr Kamiya has received funding outside of the submitted work from Eiken Chemical CO, Ltd and SoftBnak Corporation. Dr Yamashita holds company stock (<5% of the total) and has received a salary as one of the directors of an employer. Dr Matsue has received an honorarium from Otsuka Pharmaceutical Co, Novartis Pharma KK, Bayer Inc, and AstraZeneca; and has received research grants from Pfizer Japan Inc, Otsuka Pharmaceutical Co, EN Otsuka Pharmaceutical Co, Ltd, and Nippon Boehringer Ingelheim Co, Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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