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Corvera_tIndel TE (VA GLAHS), Chu J
(VA GLAHS), Doering LV
(UCLA, School of Nursing)
Objectives:
In heart failure (HF), exercise has been recommended to improve functional status (FS) and quality of life (QOL). Chronic conditions such as arthritis may significantly influence a HF patient’s FS and QOL. To date, the influence of other chronic conditions on the outcomes of FS and QOL after 12-week exercise training program among Veterans with HF has not been evaluated. OBJECTIVES: We sought to evaluate the combined effects of a home walking exercise (HWE) program and arthritic condition on FS and QOL.
Methods:
A randomized controlled trial comparing a 12-week HWE program to usual activity was conducted in 78 HF patients (71[99%] male; mean age 61.9 ? 10.3 years; EF 28 ? 9%; 59 [82%] NYHA II, 13 [18%] NYHA III-IV) from a VA medical Center and a university affiliated medical center. Then, patients were classified into 4 groups: 1) non-arthritic usual activity group (n = 26), 2) arthritic usual activity group (n= 11), 3) non-arthritic HWE group (n= 24), and 4) arthritic HWE group (n= 17). Functional status and QOL were measured by 6-minute walk test (6MWT) and the cardiac–quality of life index (C-QLI), respectively. For the C-QLI, a higher score corresponds to higher QOL. An intention-to-treat analysis with repeated measures ANOVA was used to identify group differences, followed by post-hoc Bonferroni comparisons.
Results:
Sixty-three (80%) patients completed the program. After controlling for age, body mass index and left ventricular ejection fraction, there was a trend toward significant increase in 6-MWT distance after 12-week in the non-arthritic HWE group (pre: 1291 ? 187 feet vs. post: 1416 ? 249 feet) compared to the non-arthritic usual activity group (pre: 1305 ? 246 feet vs post: 1294 ? 256 feet), p= .05. After controlling for age, body mass index and left ventricular ejection fraction, there was a statistically significant reduction in QOL scores (indicating poor QOL) after the 12-week HWE program in the arthritic HWE group (pre: 22 ? 4 scores vs. post: 20 ? 4 scores) compared to the non-arthritic usual activity group (pre: 18 ? 6 vs post: 19 ? 6 scores), p = .04.
Implications:
In HF, those without arthritic conditions are likely to improve their FS following a 12-week HWE program. On the other hand, Veterans with HF and arthritis have no significant improvement in FS, but with a significant reduction in QOL following a 12-week HWE program.
Impacts:
It is likely that a walking exercise program is not best suited for HF Veterans with chronic arthritis. Hence, a tailored exercise rehabilitation program should be designed for this group of HF patients to accommodate the limitations associated with arthritic conditions.
