Corvera_tIndel TE (VA GLAHS), Chu J
(VA GLAHS), Doering LV
(UCLA, School of Nursing)
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.
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.
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.
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.
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.