Basuni Radi

Early Exercise Program for Patients with Heart Failure after Hospital Discharge

Background: The exercise program (EP) demonstrated beneficial effects on survival and morbidity of patients with chronic and stable heart failure (HF), but there were no evidence of safety and benefit when the EP was implemented early. Objectives: This study aimed to investigate the effects of early EP for patients with HF. Methods: We randomly recruited 48 patients with systolic HF early after acute HF hospitalisation, with ejection fraction <40%, age <65 years, resting heart rate <100 bpm, and able to walk more than 100 meters as the intervention group (IG). They participated in in-hospital, low-to-moderate intensity, symptom-limited EP for 1 month. Meanwhile, 65 patients with similar characteristic or refused to be recruited to the IG were allocated as control group (CG) underwent usual care. Pre and post study measurement of 6-minutes walking test (6MWT) distance, NTproBNP level, quality of life parameters (Minnesota Living with Heart Failure Questionnaire and SF-36), and first major adverse cardiac event (mortality, rehospitalisation or clinical worsening) within 1 month study period. Results: Both groups had similar baseline characteristics. The patients in IG initiated the early EP on day 5.1+3.5 from hospital discharge. Major adverse cardioascular events were experienced by 9 (18.8%) of the IG and by 26 (40%) of the CG (p=0.016). At the end of study, the 6MWT distance of IG was higher than that of CG: 398.9 (95% CI: 383.8-414.0) versus 352.7 (95% CI: 318.4-387.0) meters, p=0.016. Mean NT-proBNP level did not change in IG (from 3774 to 3563 pg/mL, p=0.568) nor in CG (from 3784 to 4931 pg/mL, p=0.150). Quality of life parameters improved in IG, but not in CG. Conclusion: Early EP for patients with HF was safe and effective in improving physical fitness level and quality of life and it did not harm the myocardium.