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NRI 96-031 – HSR&D Study

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NRI 96-031
Home Walking Exercise Training in Advanced Heart Failure
Teresita E. Corvera-Tindel PhD RN MN
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: October 1997 - December 2001

BACKGROUND/RATIONALE:
Heart failure is a major public health burden in the United States characterized by increased morbidity and mortality, and reduce exercise capacity with distressing symptoms of dyspnea and fatigue. Evaluating the effects of complementary intervention (such as exercise training) on functional status and QOL are clinically important and relevant to HF patients.
In the last decade, hospital-based and a home bicycle exercise programs for HF have been shown to improve peak oxygen consumption (VO2) and symptom scores, and restore autonomic balance. These programs may be costly for patients to perform. Improved peak VO2 may not necessarily translate into improved functional status and quality of life. To date, the effects of a home walking exercise program alone on functional status, QOL and autonomic tone has not been evaluated.

OBJECTIVE(S):
The specific aim was to compare functional status (FS), quality of life (QOL) and autonomic tone in 2 groups of advanced HF patients (nurse-managed home walking exercise (HWE) group vs. control group).

METHODS:
A randomized controlled trial comparing a 12-week nurse-managed progressive HWE protocol to usual activity was conducted in 79 HF patients (78[99%] male; mean age 62.6 ± 10.6 years; EF 27 ± 8.8%; 63 [80%] NYHA II, 15[20%] NYHA III-IV; HF duration 39.2 ± 41.8 months) from a VA medical center and a university affiliated medical center. The 12- week HWE program is once a day, 5x a week and initiated at 10 minutes and progressively increases in duration and intensity up to 60 minutes. Pre- and post-study measures were FS (peak VO2 and ventilatory threshold via CPX, 6-minute walk test (6MWT) and a Heart Failure Functional Status Inventory (HFFSI)), QOL (Cardiac Quality of life Index (C-QLI), SF-36, and Dyspnea-Fatigue Index (DFI) with global rating of symptoms), and autonomic tone (norepinephrine (NE) and heart rate variability (HRV)). Intention-to-treat analysis with repeated measures ANOVA was used to identify group differences.

FINDINGS/RESULTS:
63 (79%) patients completed the program. No adverse events related to exercise testing or training occurred. Mean compliance to the exercise prescription was 74%. Compared to the usual activity group, exercisers had longer walking distances by 6MWT (1264 ± 255 vs 1337 ± 272 feet, p= .001) and longer CPX exercise duration (6.4 ± 2.9 vs. 7.5 ± 3.0 minutes, p= .02); however, peak VO2 and HFFSI was not significant between groups. Although the DFI was not significant, exercisers reported improved global assessment of dyspnea and fatigue compared to usual activity patients (t= 2.42, p= .02). No significant findings were found on C-QLI, SF-36, and autonomic tone measures.

CONCLUSIONS: In HF patients, progressive home walking exercise is safe, increases walking distance and exercise duration, and decreases global symptom of dyspnea and fatigue.

IMPACT:
Clinicians at the VA health care system should consider a home walking programs for those HF patients who has difficulty accessing hospital-based cardiac rehabilitation programs. At a time when management of HF patients is moving out of the hospital and into the home with increasing frequency, these findings provide support for the safety and efficacy of home-based exercise.

PUBLICATIONS:

Conference Presentations

  1. Corvera-Tindel T, Doering LV, Machuca K, Dracup K. Combined Effects of Physical Training and Beta-Blocker Use on Functional Performance and Depression in Heart Failure. Paper presented at: Sigma Theta Tau International Honor Society Nursing Odyssey Annual Conference; 2003 Oct 29; Ontario, Canada.
  2. Corvera-Tindel T, Doering LV, Aquino C, Roper J, Dracup K. The Role of Physical Functioning and Depression on Quality of Life in Patients with Heart Failure. Paper presented at: Heart Failure Society of America Annual Scientific Meeting; 2003 Sep 22; Las Vegas, NV.
  3. Corvera-Tindel T, Doering LV, Gomez T, Dracup K. Predictors of Noncompliance to Exercise Training in Heart Failure. Paper presented at: American Heart Association Annual Scientific Sessions; 2002 Nov 13; Chicago, IL.
  4. Corvera-Tindel T, Doering LV, Gomez T, Dracup K. Predictors of Noncompliance to Exercise Training in Heart Failure. Paper presented at: American Heart Association Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Annual Scientific Sessions; 2002 Oct 13; Washington, DC.
  5. Corvera-Tindel T, Doering LV, Machuca K, Dracup K. Combined Effects of Physical Training and Beta-Blocker Use on Functional Performance and Depression in Heart Failure. Paper presented at: American Heart Association Asia - Pacific Annual Scientific Forum; 2002 Apr 20; Honolulu, HI.
  6. Corvera-Tindel T, Doering LV, Dracup K, Woo MA, Khan S. Nurse-Managed home walking program improves exercise suration and reduces symptoms in heart failure. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC.
  7. Corvera T. Specific Activity Scale in a Predictor of Peak Oxygen Consumption in Heart Failure. Paper presented at: American Heart Association Annual Scientific Sessions; 1999 Nov 8; Atlanta, GA.


DRA: Health Systems
DRE: Treatment - Observational
Keywords: Chronic heart failure, Functional status, Nursing
MeSH Terms: Endarterectomy, Carotid, Health Status, Nursing, Decision Making, Organizational, Decision Support Systems, Management

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