Is Exercise Adherence Associated With Clinical Outcomes in Patients With Advanced Heart Failure
Authors: Lorraine S Evangelista, Michele A Hamilton, Gregg C Fonarow, Kathleen Dracup
Journal: Circulation (2009)

NIH Public Access Author Manuscript Phys Sportsmed. Author manuscript; available in PMC 2010 July 26. NIH-PA Author Manuscript Published in final edited form as: Phys Sportsmed. 2010 April ; 38(1): 28–36. doi:10.3810/psm.2010.04.1759. Is Exercise Adherence Associated with Clinical Outcomes in Patients with Advanced Heart Failure? Lorraine S. Evangelista, RN, PhD 1, Michele A. Hamilton, MD 2, Gregg C. Fonarow, MD 2, and Kathleen Dracup, RN, DNSc 3 1 University of California Los Angeles, School of Nursing, Los Angeles, CA Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA University of California School of Nursing, San Francisco, CA Abstract NIH-PA Author Manuscript Background—There is limited research to support the effect of exercise adherence on clinical outcomes in patients with heart failure (HF). This secondary analysis was conducted on the intervention arm of an exercise training study in patients with HF to assess whether adherence and the dose of treatment exposure were associated with clinical outcomes, functional performance (maximum oxygen consumption [VO 2 ], anaerobic threshold, and workload), and quality of life (QOL). Methods—Seventy-one patients (average age, 54.0 ± 12.5 years; male, 66%; Caucasian, 66%; married, 61%; New York Heart Association class II III, 97.2%; and average ejection fraction, 26.4% ± 6.5%) were included in the current study. Patients with an increase ≥ 18% in the amount of exercise from baseline to 6 months, as measured by pedometers, were categorized as adherers (n = 38); patients who had no change or an increase in the amount of exercise of < 18% were categorized as nonadherers (n = 33). Results—The 2 groups were significantly different in the composite endpoint of all-cause hospitalization, emergency room admissions, and death/urgent transplantation (hazard ratio, 0.31; confidence interval, 0.159–0.635; P < 0.001). Adherers had greater improvements in functional performance and QOL compared with nonadherers (P < 0.001). NIH-PA Author Manuscript Conclusion—These findings suggest that among patients with advanced HF, adherence to exercise is associated with more favorable clinical outcomes. There is also a positive dose- response relationship between the amount of exercise performed and improvement in functional performance and QOL. Introduction Chronic heart failure (HF) is a major cause of morbidity and mortality worldwide. By focusing on the multiple needs of patients with HF, exercise training offers opportunities to address the disability associated with this chronic, progressive disease. Exercise training in HF has been shown in a meta-analysis of randomized trials to improve exercise capacity, functional status, and quality of life (QOL). 1 – 3 However, there is a paucity of research Correspondence: Lorraine S. Evangelista, RN, PhD, University of California Los Angeles, School of Nursing, Los Angeles, CA 90095-6918. Tel: 310-825-8609, Fax: 310-794-7482, levangel@ucla.edu. Conflict of Interest Statement Lorraine S. Evangelista, RN, PhD, Michele A. Hamilton, MD, Gregg C. Fonarow, MD, and Kathleen Dracup, RN, DNSc disclose no conflicts of interest.