In a multicenter, randomized study, O’Connor and colleagues tested the efficacy and safety of exercise training among patients with heart failure. The subjects were 2,331 medically stable outpatients with heart failure and reduced ejection fraction randomized at 82 centers within the United States, Canada, and France. The median follow-up was 30 months. The interventions consisted of usual care plus aerobic exercise training, consisting of 36 supervised sessions followed by home-based training, or usual care alone. The main outcome measures were: (a) composite primary end point of all-cause mortality or hospitalization; (b) prespecified secondary end points of all-cause mortality, cardiovascular mortality or cardiovascular hospitalization; and (c) cardiovascular mortality or heart failure hospitalization. The median age was 59 years, 28% were women, and 37% had New York Heart Association class III or IV symptoms. Heart failure etiology was ischemic in 51%, and median left ventricular ejection fraction was 25%. Exercise adherence decreased from a median of 95 minutes per week during months 4 through 6 of follow-up to 74 minutes per week during months 10 through 12. A total of 759 patients (65%) in the exercise-training group died or were hospitalized compared with 796 patients (68%) in the usual care group. There were: (a) nonsignificant reductions in the exercise training group for mortality (189 patients [16%] in the exercise training group vs 198 patients [17%] in the usual care group; (b) cardiovascular mortality or cardiovascular hospitalization (632 [55%] in the exercise training group vs 677 [58%] in the usual care group; and (c) cardiovascular mortality or heart failure hospitalization (344 [30%] in the exercise training group vs 393 [34%] in the usual care group. In a prespecified supplementary analyses adjusting for highly prognostic baseline characteristics, the HRs were 0.89 for all-cause mortality or hospitalization, 0.91for cardiovascular mortality or cardiovascular hospitalization, and 0.85 for cardiovascular mortality or heart failure hospitalization. Other adverse events were similar between the groups.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that in the primary analysis, exercise training resulted in nonsignificant reductions in the primary end point of all-cause mortality or hospitalization and in key secondary clinical end points. After adjustment for highly prognostic predictors of the primary end point, exercise training was associated with modest significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: If you experience heart failure, the findings suggest you continue exercising on a regular basis as long as possible. The amount of exercise is something you need to work out with our health care provider.

CM O’Connor et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 2009;301:1439-1450.