Abstract
Background
Despite exercise being one of few strategies to improve outcomes for individuals with
heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in
HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research
team has developed, tested, and refined Heart failure Exercise And Resistance Training
(HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise
in HF. We evaluated the effects of this intervention designed to promote adherence
to exercise in HF focusing on subgroups of participants with HFpEF and heart failure
with reduced ejection fraction (HFrEF).
Methods and Results
This randomized controlled trial included 204 adults with stable, chronic HF. Of those
enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined
as ≥120 minutes of moderate-intensity [40%–80% of heart rate reserve] exercise per
week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested
intervention effects on symptoms (Patient-Reported Outcomes Measurement Information
System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy
Questionnaire), and physical function (6-minute walk test). Participants with HFpEF
(n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean
ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention
group had significantly greater adherence compared with enhanced usual care at both
12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the
6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety
improved significantly in the intervention group.
Conclusions
A multicomponent, behavioral intervention is associated with improvements in long-term
adherence to exercise, physical function, and patient-reported outcomes in adults
with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large
HFpEF clinical trial to validate these findings and examine interventional mechanisms
and delivery modes that may further promote adherence and improve clinical outcomes
in this population.
Clinical Trial Registration
: URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670
Key Words
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Article info
Publication history
Published online: September 14, 2021
Accepted:
September 2,
2021
Received in revised form:
September 1,
2021
Received:
May 10,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
