Efficacy and Cost of an Exercise Programme for Functionally Impaired Older Heart Failure Patients: A Randomized Controlled Trial

BACKGROUND: -Little is known about the optimum way to deliver exercise to older, functionally impaired heart failure patients. We tested whether an exercise programme tailored to the needs of older heart failure patients could improve exercise capacity and quality of life or reduce costs to the NHS. METHODS AND RESULTS: -Parallel-group, single-blind randomised controlled trial. Patients aged 70 years and over with symptomatic heart failure and left ventricular systolic dysfunction were randomised to either 24 weeks exercise training or to usual care. Six minute walk distance was the primary outcome; markers of physical function, quality of life, health status and daily activity were measured at baseline, 8 & 24 weeks. Carer strain and health costs were also recorded. 107 participants were randomised, mean age 80 years. 72/107 (67%) were male. Six minute walk distance did not improve compared to control group at 8 weeks (-16.9m, 95% CI -41.8 to 7.9 m, p=0.18) or at 24 weeks (-5.3m, 95%CI -32.6 to 22.0m, p=0.70). For secondary outcomes only the sit to stand test improved significantly at 24 weeks (-6.4s, 95%CI -12.2 to 0.6, p=0.03); there was no difference in change for the Minnesota score (0.1 points, 95%CI -0.9 to 1.1, p=0.83) at 24 weeks. Carer strain did not decrease (difference -0.5 points, 95%CI -8.3 to 7.3, p=0.80) at 24 weeks, and there was no difference in overall health care costs. CONCLUSIONS: -This exercise intervention did not improve exercise capacity or quality of life in older heart failure patients and was not cost saving to the NHS.Clinical Trial Registration-URL: www.controlled-trials.com. Unique identifier: ISRCTN51615566.