TY - JOUR
T1 - Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure
AU - HF-Wii study team
AU - Jaarsma, Tiny
AU - Perkiö Kato, Naoko
AU - Ben Gal, Tuvia
AU - Bäck, Maria
AU - Chialà, Oronzo
AU - Evangelista, Lorraine
AU - Mårtensson, Jan
AU - Piepoli, Massimo F.
AU - Vellone, Ercole
AU - Klompstra, Leonie
AU - Strömberg, Anna
N1 - Publisher Copyright:
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2021/12
Y1 - 2021/12
N2 - Aims: Improvement in exercise capacity is the primary goal of physical activity programmes for patients with heart failure (HF). Although activity programmes are effective for some patients, others do not benefit. Identifying factors related to a lack of improvement in submaximal exercise capacity may help us interpret findings and design new interventions. The aim of this study is to identify factors contributing to a lack of improvement in submaximal exercise capacity 3 months after physical activity advice or an exergame intervention in patients with HF. Additionally, we aimed to assess differences in lack of improvement in submaximal exercise capacity of patients whose baseline exercise capacity predicted a worse compared with better prognosis of HF. Methods and results: This secondary analysis of the HF-Wii study analysed baseline and 3 month data of the 6 min walk test (6MWT) from 480 patients (mean age 67 years, 72% male). Data were analysed separately in patients with a pre-defined 6 min walking distance at baseline of <300 m (n = 79) and ≥300 m (n = 401). Among patients with a baseline 6MWT of ≥300 m, 18% had deteriorated submaximal exercise capacity. In the multiple logistic regression analysis, lower baseline levels of self-reported physical activity [odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60–0.97], lower baseline levels of cognitive function (OR = 0.87, 95%CI = 0.79–0.96) were significantly associated with lack of improvement in exercise capacity at 3 months. Not randomized to exergaming (OR = 0.63, 95%CI = 0.37–1.09) was likely (P = 0.097) to be associated with lack of improvement in exercise capacity at 3 months. Among the 79 patients with baseline 6MWT of <300 m, 41% (n = 32) did not improve 6MWT distance at 3 months. Independent predictors for the lack of improvement for 6MWT were New York Heart Association class III/IV (OR = 4.68, 95%CI = 1.08–20.35), higher levels of serum creatinine (OR = 1.02, 95%CI = 1.003–1.03), lower cognitive function (OR = 0.86, 95%CI = 0.75–0.99), and fewer anxiety symptoms (OR = 0.84, 95%CI = 0.72–0.98). Conclusions: Lower self-reported physical activity and cognitive impairment predict lack of improvement in submaximal exercise capacity in HF patients. Patients who have a worse prognosis (score <300 m at the 6MWT) are often frail and gain less in exercise capacity. These patients may need a more comprehensive approach to have an effect on exercise capacity, including an individually tailored exercise programme with aerobic exercise (if tolerated) and strength exercises.
AB - Aims: Improvement in exercise capacity is the primary goal of physical activity programmes for patients with heart failure (HF). Although activity programmes are effective for some patients, others do not benefit. Identifying factors related to a lack of improvement in submaximal exercise capacity may help us interpret findings and design new interventions. The aim of this study is to identify factors contributing to a lack of improvement in submaximal exercise capacity 3 months after physical activity advice or an exergame intervention in patients with HF. Additionally, we aimed to assess differences in lack of improvement in submaximal exercise capacity of patients whose baseline exercise capacity predicted a worse compared with better prognosis of HF. Methods and results: This secondary analysis of the HF-Wii study analysed baseline and 3 month data of the 6 min walk test (6MWT) from 480 patients (mean age 67 years, 72% male). Data were analysed separately in patients with a pre-defined 6 min walking distance at baseline of <300 m (n = 79) and ≥300 m (n = 401). Among patients with a baseline 6MWT of ≥300 m, 18% had deteriorated submaximal exercise capacity. In the multiple logistic regression analysis, lower baseline levels of self-reported physical activity [odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60–0.97], lower baseline levels of cognitive function (OR = 0.87, 95%CI = 0.79–0.96) were significantly associated with lack of improvement in exercise capacity at 3 months. Not randomized to exergaming (OR = 0.63, 95%CI = 0.37–1.09) was likely (P = 0.097) to be associated with lack of improvement in exercise capacity at 3 months. Among the 79 patients with baseline 6MWT of <300 m, 41% (n = 32) did not improve 6MWT distance at 3 months. Independent predictors for the lack of improvement for 6MWT were New York Heart Association class III/IV (OR = 4.68, 95%CI = 1.08–20.35), higher levels of serum creatinine (OR = 1.02, 95%CI = 1.003–1.03), lower cognitive function (OR = 0.86, 95%CI = 0.75–0.99), and fewer anxiety symptoms (OR = 0.84, 95%CI = 0.72–0.98). Conclusions: Lower self-reported physical activity and cognitive impairment predict lack of improvement in submaximal exercise capacity in HF patients. Patients who have a worse prognosis (score <300 m at the 6MWT) are often frail and gain less in exercise capacity. These patients may need a more comprehensive approach to have an effect on exercise capacity, including an individually tailored exercise programme with aerobic exercise (if tolerated) and strength exercises.
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U2 - 10.1002/ehf2.13584
DO - 10.1002/ehf2.13584
M3 - Article
C2 - 34480412
AN - SCOPUS:85114330366
SN - 2055-5822
VL - 8
SP - 4539
EP - 4548
JO - ESC Heart Failure
JF - ESC Heart Failure
IS - 6
ER -