Effects of Exercise Training on Health Status in Patients With Chronic Heart Failure: HF-ACTION Randomized Controlled Trial
Open accessAbstract
CONTEXT: Findings from previous studies of the effects of exercise training on patient-reported health status have been inconsistent. OBJECTIVE: To test the effects of exercise training on health status among patients with heart failure. DESIGN, SETTING, AND PATIENTS: Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure with left ventricular ejection fraction of 35% or less. Patients were randomized from April 2003 through February 2007. INTERVENTIONS: Usual care plus aerobic exercise training (n = 1172), consisting of 36 supervised sessions followed by home-based training, vs usual care alone (n = 1159). Randomization was stratified by heart failure etiology, which was a covariate in all models. MAIN OUTCOME MEASURES: Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary scale and key subscales at baseline, every 3 months for 12 months, and annually thereafter for up to 4 years. The KCCQ is scored from 0 to 100 with higher scores corresponding to better health status. Treatment group effects were estimated using linear mixed models according to the intention-to-treat principle. RESULTS: Median follow-up was 2.5 years. At 3 months, usual care plus exercise training led to greater improvement in the KCCQ overall summary score (mean, 5.21; 95% confidence interval, 4.42 to 6.00) compared with usual care alone (3.28; 95% confidence interval, 2.48 to 4.09). The additional 1.93-point increase (95% confidence interval, 0.84 to 3.01) in the exercise training group was statistically significant (P < .001). After 3 months, there were no further significant changes in KCCQ score for either group (P = .85 for the difference between slopes), resulting in a sustained, greater improvement overall for the exercise group (P < .001). Results were similar on the KCCQ subscales, and no subgroup interactions were detected. CONCLUSIONS: Exercise training conferred modest but statistically significant improvements in self-reported health status compared with usual care without training. Improvements occurred early and persisted over time. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00047437.
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Self-reported health status and depressive symptoms also improved modestly with aerobic exercise training.
“Self-reported health status198 and depressive symptoms199 also improved modestly with aerobic exercise training.”
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Cites
Gill, J. (2005) · Encyclopedia of Social Measurement · doi:10.1016/b0-12-369398-5/00166-3 · Cited by 3,126 · see citing works
O'Connor (2009) · doi:10.1001/jama.2009.454 · Cited by 2,173 · see citing works
Green, C. P., Porter, C. B., Bresnahan, D. R., & Spertus, J. A. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00531-3 · Cited by 1,827 · see citing works
Self-citationBelardinelli, R., Georgiou, D., Cianci, G., & Purcaro, A. (1999) · Circulation · doi:10.1161/01.cir.99.9.1173 · Cited by 1,099 · see citing works
Some Conceptual and Statistical Issues in Analysis of Longitudinal Psychiatric Data
Gibbons, R. D. (1993) · Archives of General Psychiatry · doi:10.1001/archpsyc.1993.01820210073009 · Cited by 719 · see citing works
Gelman, A., Carlin, J. B., Stern, H. S., Dunson, D. B., Vehtari, A., & Rubin, D. B. (2013) · Chapman & Hall/CRC eBooks · doi:10.1201/b16018-21 · Cited by 631 · see citing works
Monitoring clinical changes in patients with heart failure: A comparison of methods
Spertus, J. A., Peterson, E. D., Conard, M. W., Heidenreich, P. A., Krumholz, H. M., Jones, P. G., McCullough, P. A., Piña, I. L., Tooley, J. F., Weintraub, W. S., et al. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.12.010 · Cited by 564 · see citing works
Self-citationEffects of physical training in chronic heart failure
Coats, A. J. S. (1990) · The Lancet · doi:10.1016/0140-6736(90)90536-e · Cited by 443 · see citing works
Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure
Krumholz, H. M., Butler, J., Miller, J. B., Vaccarino, V., Williams, C. S., de Leon, C. F. M., Seeman, T. E., Kasl, S. V., & Berkman, L. F. (1998) · Circulation · doi:10.1161/01.cir.97.10.958 · Cited by 343 · see citing works
Differential Effects of β-Blockers in Patients With Heart Failure
Metra, M., Giubbini, R., Nodari, S., BOLDI, E., Modena, M. G., & Cas, L. D. (2000) · Circulation · doi:10.1161/01.cir.102.5.546 · Cited by 330 · see citing works
McKelvie, R. S., Teo, K. K., Roberts, R., McCartney, N., Humen, D., Montague, T., Hendrican, K., & Yusuf, S. (2002) · American Heart Journal · doi:10.1067/mhj.2002.123310 · Cited by 322 · see citing works
Quality of life in patients with advanced heart failure.
Dracup, K., Walden, J. A., Stevenson, L. W., & Brecht, M. L. (1992) · PubMed · Cited by 319 · see citing works
Exercise based rehabilitation for heart failure
Rees, K., Taylor, R. R., Singh, S., Coats, A. J., & Ebrahim, S. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003331.pub2 · Cited by 253 · see citing works
Exercise Training in Patients with Heart Failure A Randomized, Controlled Trial
Keteyian, S. J., Levine, A. B., Brawner, C. A., Kataoka, T., Rogers, F. J., Schairer, J. R., Stein, P. D., Levine, T. B., & Goldstein, S. (1996) · Annals of Internal Medicine · doi:10.7326/0003-4819-124-12-199606150-00004 · Cited by 235 · see citing works
Self-citationWhellan, D. J., O’Connor, C. M., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., Leifer, E., Kraus, W. E., Kitzman, D. W., Blumenthal, J. A., et al. (2007) · American Heart Journal · doi:10.1016/j.ahj.2006.11.007 · Cited by 234 · see citing works
Self-citationGARY, R. A., Sueta, C. A., Dougherty, M. C., Rosenberg, B. S., Cheek, D. J., Preisser, J. S., Neelon, V. J., & McMurray, R. G. (2004) · Heart & Lung · doi:10.1016/j.hrtlng.2004.01.004 · Cited by 191 · see citing works
Shah, M. R., Hasselblad, V., Gheorghiade, M., Adams, K. F., Swedberg, K. B., Califf, R. M., & O’Connor, C. M. (2001) · The American Journal of Cardiology · doi:10.1016/s0002-9149(01)01975-0 · Cited by 188 · see citing works
Self-citationShephard, R. J. (2010) · Yearbook of Sports Medicine · doi:10.1016/s0162-0908(09)79486-3 · Cited by 172 · see citing works
Predictors of the onset of depressive symptoms in patients with heart failure
Havranek, E. P., Spertus, J. A., Masoudi, F. A., Jones, P. G., & Rumsfeld, J. S. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.09.034 · Cited by 158 · see citing works
Self-citationEffects of exercise training on chronotropic incompetence in patients with heart failure
Keteyian, S. J., Brawner, C. A., Schairer, J. R., Levine, T. B., Levine, A. B., Rogers, F. J., & Goldstein, S. (1999) · American Heart Journal · doi:10.1016/s0002-8703(99)70106-7 · Cited by 155 · see citing works
Self-citationPires, L. A., Abraham, W. T., Young, J. B., & Johnson, K. M. (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.06.024 · Cited by 110 · see citing works
Exercise training in patients with heart failure: clinical outcomes, safety, and indications
McKelvie, R. S. (2007) · Heart Failure Reviews · doi:10.1007/s10741-007-9052-z · Cited by 104 · see citing works
A strategy to use soft data effectively in randomized controlled clinical trials
Kraemer, H. C., & Thiemann, S. (1989) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.57.1.148 · Cited by 100 · see citing works
A strategy to use soft data effectively in randomized controlled clinical trials.
KRAEMER, H. C., & Thiemann, S. (1989) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.57.1.148 · Cited by 99 · see citing works
Belardinelli, R., Georgiou, D., Cianci, G., & Purcaro, A. (1999) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-199911000-00019 · Cited by 81 · see citing works
Chien, C.-L., Lee, C., Wu, Y., Chen, T., & Wu, Y. (2008) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(08)70041-2 · Cited by 72 · see citing works
Exercise training in elderly patients with chronic heart failure
Wielenga, R. P., Huisveld, I. A., Bol, E., Dunselman, P. H. J. M., Erdman, R. A. M., Baselier, M. R. P., & Mosterd, W. L. (1998) · Coronary Artery Disease · doi:10.1097/00019501-199809110-00010 · Cited by 50 · see citing works
Predictors of the onset of depressive symptoms in patients with heart failure
Havranek, E. P., Spertus, J. A., Masoudi, F. A., et al. (2005) · ACC Current Journal Review · doi:10.1016/j.accreview.2005.02.077 · Cited by 8 · see citing works
Self-citationYoung, J. B. (2003) · JAMA · doi:10.1001/jama.289.20.2685 · Cited by 4 · see citing works
Exercise training in elderly patients with chronic heart failure
Wielenga, R. P., Huisveld, I. A., Bol, E., et al. (1999) · Coronary Artery Disease · doi:10.1097/00019501-199901000-00011 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab368 · Cited by 13,344 · see citing works
2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536 · see citing works
Obesity and cardiovascular disease: a scientific statement from the American Heart Association
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J.-P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000973 · Cited by 3,691 · see citing works
Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases
Pedersen, B. K., & Saltin, B. (2015) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.12581 · Cited by 3,514 · see citing works
Kitzman, D. W., Brubaker, P., Morgan, T., Haykowsky, M., Hundley, G., Kraus, W. E., Eggebeen, J., & Nicklas, B. J. (2016) · JAMA · doi:10.1001/jama.2015.17346 · Cited by 921 · see citing works
Self-citationEzekowitz, J. A., O'Meara, E., McDonald, M. A., Abrams, H., Chan, M., Ducharme, A., Giannetti, N., Grzeslo, A., Hamilton, P. G., Heckman, G. A., et al. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.08.022 · Cited by 676 · see citing works
Self-citationInterpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care
Spertus, J. A., Jones, P. G., Sandhu, A. T., & Arnold, S. V. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.09.542 · Cited by 619 · see citing works
Self-citationPhysical rehabilitation for older patients hospitalized for heart failure
Kitzman, D. W., Whellan, D. J., Duncan, P., Pastva, A. M., Mentz, R. J., Reeves, G. R., Nelson, M. B., Chen, H., Upadhya, B., Reed, S. D., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2026141 · Cited by 594 · see citing works
Self-citationArmenian, S. H., Hudson, M. M., Mulder, R. L., Chen, M. H., Constine, L. S., Dwyer, M., Nathan, P. C., Tissing, W. J. E., Shankar, S., Sieswerda, E., et al. (2015) · The Lancet Oncology · doi:10.1016/s1470-2045(14)70409-7 · Cited by 570 · see citing works
Rumsfeld, J. S., Alexander, K. P., Goff, D. C., Graham, M. M., Ho, P. M., Masoudi, F. A., Moser, D. K., Roger, V. L., Slaughter, M. S., Smolderen, K. G., et al. (2013) · Circulation · doi:10.1161/cir.0b013e3182949a2e · Cited by 540 · see citing works
Self-citationLainscak, M., Blue, L., Clark, A. L., Dahlström, U., Dickstein, K., Ekman, I., McDonagh, T., McMurray, J. J., Ryder, M., Stewart, S., et al. (2011) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfq219 · Cited by 405 · see citing works
Obesity and the Obesity Paradox in Heart Failure
Horwich, T. B., Fonarow, G. C., & Clark, A. L. (2018) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2018.05.005 · Cited by 392 · see citing works
Herring, M. P. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.696 · Cited by 362 · see citing works
Kosiborod, M. N., Jhund, P. S., Docherty, K. F., Diez, M., Petrie, M. C., Verma, S., Nicolau, J. C., Merkely, B., Kitakaze, M., DeMets, D. L., et al. (2020) · Circulation · doi:10.1161/circulationaha.119.044138 · Cited by 350 · see citing works
Forman, D. E., Arena, R., Boxer, R., Dolansky, M. A., Eng, J. J., Fleg, J. L., Haykowsky, M., Jahangir, A., Kaminsky, L. A., Kitzman, D. W., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000483 · Cited by 319 · see citing works
Self-citationExercise training for systolic heart failure: Cochrane systematic review and meta-analysis
Davies, E. J., Moxham, T., Rees, K., Singh, S., Coats, A. J. S., Ebrahim, S., Lough, F., & Taylor, R. S. (2010) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfq056 · Cited by 318 · see citing works
Iron Deficiency Predicts Impaired Exercise Capacity in Patients With Systolic Chronic Heart Failure
Jankowska, E. A., Rozentryt, P., Witkowska, A., Nowak, J., Hartmann, O., Ponikowska, B., Borodulin-Nadzieja, L., von Haehling, S., Doehner, W., Banasiak, W., et al. (2011) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2011.08.003 · Cited by 281 · see citing works
Depression and Cardiovascular Disorders
Whooley, M. A., & Wong, J. M. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185526 · Cited by 241 · see citing works
Joseph, S. M., Novak, E., Arnold, S. V., Jones, P. G., Khattak, H., Platts, A. E., Dávila-Román, V. G., Mann, D. L., & Spertus, J. A. (2013) · Circulation: Heart Failure · doi:10.1161/circheartfailure.113.000359 · Cited by 192 · see citing works
Self-citationGeorge, S. A., Bivens, T. B., Howden, E. J., Saleem, Y., Galbreath, M. M., Hendrickson, D., Fu, Q., & Levine, B. D. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2015.12.012 · Cited by 127 · see citing works
Cardiac Rehabilitation in Older Adults
Schopfer, D. W., & Forman, D. E. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.03.003 · Cited by 124 · see citing works
Lewis, E. F., Kim, H.-Y., Claggett, B., Spertus, J., Heitner, J. F., Assmann, S. F., Kenwood, C. T., Solomon, S. D., Desai, A. S., Fang, J. C., et al. (2016) · Circulation: Heart Failure · doi:10.1161/circheartfailure.114.001937 · Cited by 114 · see citing works
Self-citation<scp>Health‐related</scp> quality of life outcomes in <scp>PARAGON‐HF</scp>
Chandra, A., Polanczyk, C. A., Claggett, B. L., Vaduganathan, M., Packer, M., Lefkowitz, M. P., Rouleau, J. L., Liu, J., Shi, V. C., Schwende, H., et al. (2022) · European Journal of Heart Failure · doi:10.1002/ejhf.2738 · Cited by 33 · see citing works
The management of dyspnoea in chronic heart failure
Johnson, M. J., & Oxberry, S. G. (2010) · Current Opinion in Supportive & Palliative Care · doi:10.1097/spc.0b013e32833929aa · Cited by 26 · see citing works
Heart Failure With Preserved Ejection Fraction: Prevention and Management
Cilia, L., Saeed, A., Ganga, H. V., & Wu, W.-C. (2019) · American Journal of Lifestyle Medicine · doi:10.1177/1559827617695219 · Cited by 18 · see citing works
Sepehrvand, N., & Ezekowitz, J. A. (2015) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.115.002126 · Cited by 3 · see citing works
- Authors
- Flynn, K. E., Piña, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., Fine, L. J., Howlett, J. G., Keteyian, S. J., Kitzman, D. W., Kraus, W. E., Miller, N. H., Schulman, K. A., Spertus, J. A., O’Connor, C. M., & Weinfurt, K. P.
- Affiliations
- Duke University (US)
- Case Western Reserve University (US)
- Thomas Jefferson University (US)
- National Institutes of Health (US)
- Dalhousie University (CA)
- Henry Ford Health (US)
- Wake Forest University Health Sciences (US)
- Stanford Medicine (US)
- University of Missouri–Kansas City (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2009-04-08
- Volume
- 301
- Issue
- 14
- Pages
- 1451
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC2690699
- OpenAlex
- W1969639902
- Cited by
- 737
- References
- 30
- Citations by year
- 2026: 14 · 2025: 30 · 2024: 25 · 2023: 36 · 2022: 33 · 2021: 50 · 2020: 29 · 2019: 38 · 2018: 45 · 2017: 61 · 2016: 38 · 2015: 58 · 2014: 46 · 2013: 45 · 2012: 67
- FWCI
- 150.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R37AG018915)
- National Heart, Lung, and Blood Institute (U01HL063747, U01HL066494, U01HL068980, U01HL064257, U01HL064264, U01HL066482, U01HL066461, U01HL066497, U01HL066491, U01HL066501, U01HL064265, U01HL064250, U01HL068973)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- chronic heart failure, aerobic exercise training, health status, Kansas City Cardiomyopathy Questionnaire, patient-reported outcomes, home-based exercise, supervised exercise, left ventricular ejection fraction, heart failure etiology, sustained improvement
- MeSH terms
- Aged, Ambulatory Care, Chronic Disease, Exercise Test, Exercise Therapy, Female, Health Status, Heart Failure, Humans, Male, Middle Aged, Quality of Life, Self Care, Exercise, Treatment Outcome, Sickness Impact Profile
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