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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.
Objectives: Hospital-based exercise training for heart failure (HF) patients has shown promise in improving functional status and reducing symptoms. However, for many patients, accessibility of hospital-based programs is limited. The purpose of this study was to test the effects of a nurse-managed home walking program on the outcomes of functional status and symptoms in HF patients. Methods: A randomized controlled trial comparing a 12-week nurse-managed progressive home walking protocol to usual activity was conducted in 75 HF patients (74[99%] male; mean age 62.2 +/- 10.4 years; EF 27 +/- 9%; 62 [83%] NYHA II, 13 [17%] NYHA III-IV) from a VA medical Center and a university affiliated medical center. Measures of functional status were: peak VO2 and exercise duration via cardiopulmonary exercise testing (CPX), 6-minute walk test (6MWT), and Heart Failure Functional Status Inventory (HFFSI). The Dyspnea-Fatigue Index (DFI) measured symptoms. Intention-to-treat analysis with repeated measures ANOVA was used to identify group differences. Results: 59 (79%) patients completed the program. No adverse events related to exercise testing or training occurred. Mean compliance to the exercise prescription was 87.4%. Compared to the usual activity group, exercisers had longer walking distances by 6MWT (1285 +/- 235 vs. 1388 +/- 266 feet, p = .000) and longer CPX exercise duration (6.6 +/- 3.0 vs. 7.9 +/- 3.2, p = .01). On the Dyspnea-Fatigue Index, exercisers reported improved global assessment of dyspnea and fatigue compared to usual activity patients (p = .03). Conclusions: In HF patients, progressive home walking exercise is safe, increases exercise duration, and decreases global symptom assessment of dyspnea and fatigue by patients. Impact statement: 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.
