Impact of a Graded Exercise Program on VO2peak and Survival in Heart Failure Patients

Introduction Although exercise therapy has the potential to improve health outcomes of patients with Chronic Heart Failure (CHF), less than 50% of patients adhere to prescribed physical activity guidelines one year after Cardiac Rehabilitation (CR). We aimed to assess the effects of an extended CR program with 12-months of Graded Exercise Therapy (GET) and resistance exercise training (RT) on exercise capacity and long-term survival in patients with CHF. Methods This prospective cohort study included sixty CHF patients between 2009 and 2010. The GET-RT-program consisted of exercise sessions at 6 days/week. Total training time of aerobic exercises increased incrementally every other week without changing exercise intensity. RT consisted of 8 exercises with a durable resistance band. Guidance consisted of a step-down approach from in-hospital to home-based training. Cardio-pulmonary exercise tests were performed at baseline, 3, 6 and 12 months. Subsequently patients were propensity score matched on a 1:2 ratio with controls (n=117) from a CHF-registry of patients from the same clinic receiving usual out-patient care and the incidence of all-cause mortality was compared between both groups. Results Baseline VO2 peak was 15.0 ml/min/kg and significantly elevated at 3 months (+1.1 ml/min/kg (95%CI: 0.4-1.8), 6 months (+2.9 ml/min/kg (95%CI: 1.1-2.9) and 12 months (+2.6 ml/min/kg (95%CI: 1.4-3.8). During 8 years of follow-up n=23 (38.3%) patients of the GET-RT-program died versus n=63 (53.8%) patients of the control group (p= 0.063). Conclusion The 12 month GET-RT-program was associated with an improved fitness during one-year follow-up, whereas a tendency towards better survival rates was observed during long-term follow-up. Corresponding author also for requests for reprint: Johan Aernout Snoek, MD, Sport Medicine Department Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands. Tel +31 38 4245689. Fax +31 38 4247682. Email: j.a.snoek@isala.nl This research received no specific grant from any funding agency in the public, commercial, or non-for-profit sectors. Dr Eijsvogels is financially supported by a grant from the Dutch Heart Foundation (2017T051). The authors declare that there is no conflict of interest. The results of the study do not constitute endorsement by ACSM and are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 5 June 2018 © 2018 American College of Sports Medicine

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