On the prediction of physiological and psychological responses to aerobic training in patients with stable congestive heart failure

Abstract

Background: Physiological and psychological markers of patients with congestive heart failure (CHF) who will respond to aerobic training are needed as a guide to appropriate therapy.

Methods: Seventeen of 21 patients with stable CHF completed a 16-week supervised progressive walking program 5 times per week. Cycle ergometer determinations of peak oxygen intake and peak power output at entry and 16 weeks were supplemented by a 6-minute walk, a disease-specific Quality of Life (QOL) questionnaire, and a standard gamble.

Results: Peak oxygen intake increased by 2.6 +/- 1.5 mL/(kgmin) over an initial value of 15.6 mL/(kgmin), with parallel gains in peak power and the 6-minute walk. Marked improvements in QOL and standard gamble scores also developed. Initial cardiorespiratory status (heart volume, ejection fraction, oxygen pulse, and peak oxygen intake) was correlated more closely (P = 0.09 to 0.18) with delta peak oxygen intake than with delta peak power or delta walking distance. Physiological gains bore little relationship to initial psychological status. Gains in CHF Questionnaire and Standard Gamble scores were strongly associated with initial scores for these variables (dyspnea, P = .02; mastery, P = .005; standard gamble, P = .001), but could not be predicted from either initial physiological status or gains in physiological condition.

Conclusions: Initial cardiorespiratory status provides little indication of which patients with CHF respond well to training. Gains in QOL score are influenced by initial scores, and seem to show a "ceiling" effect.