Walking Exercise for Heart Failure
Effects of a Home Walking Exercise Program on Heart Failure
What is the problem and what is known about it so far?
Many hospital-based exercise-training programs have shown benefits for people with heart failure. These programs include using exercise methods and equipment that are not very available to many patients. To date, the effects of a low-intensity walking program on "functional status" (ability to exercise and do normal activities) and symptoms (breathing difficulty and fatigue) in patients with heart failure have not been investigated.
Why did the researchers do this particular study?
The purpose of the study was to determine the effects of a low-intensity walking exercise program on functional status and symptoms in patients with heart failure.
Who was studied?
Patients with moderate to severe heart failure for more than 3 months, managed by primary care providers and cardiologists, were recruited from a Veterans Affairs medical center and a university-affiliated medical center. Subjects were randomly assigned to an exercise group or a control group that did not take part in the exercise program.
How was the study done?
The study compared a 12-week home walking exercise (HWE) program to a "usual activity" control group. The final study group included 42 patients on the exercise program and 37 on the control program. HWE was once a day, 5 days per week. Exercise duration was progressively increased from 10 minutes with 40% maximal heart rate to 60 minutes and 65% maximal heart rate in the last 6 weeks. Control group patients were instructed to maintain their normal daily activities and asked not to begin a regular exercise program. Functional status was measured by peak oxygen consumption during a 6-minute walk test and self-administered questionnaires that quantified the patient's assessment of overall functional status and symptoms. Measurements were made at the beginning of the study and at 12 weeks in both training and control groups. Nurses visited the patients at home to answer questions and reinforce assigned physical activity.
What did the researchers find?
Compared to the "usual activity" group, the home walking exercise program significantly increased the walking distances measured by the 6-minute walk test (1264 vs 1337 feet), and improved general rating of symptoms. No adverse events related to exercise training occurred. Overall, 74% of the planned training was completed by the people in the group.
What were the limitations of the study?
One limitation to this study is that 99% of the study population were men. The benefit of a home walking exercise program to women with heart failure is therefore unknown. Research assistants' knowledge of the group assignment may have affected some patients' 6-minute walk test performance. However, this is unlikely because there were patients in both groups with 6-minute walk tests that improved, remained the same or worsened. Lastly, the nurse visits may have influenced the study results even though they were instructed to avoid providing additional information or nursing support.
What are the implications of the study?
This study demonstrates that a low-intensity home walking exercise program for patients with heart failure is safe and effective in improving functional status and overall perception of symptoms. Clinicians are encouraged to consider the use of home walking exercise programs for patients with heart failure without access to hospital-based cardiac rehabilitation programs.
