Exercise training is an established treatment method in the rehabilitation of patients with symptoms of coronary artery disease, eg, as myocardial infarction and angina. The aim of treatment is to increase the patients exercise capacity, which in the long term is presumed to help reduce morbidity and premature death. This approach has also been tested in the rehabilitation of patients with heart failure as a complement to other treatment, eg, medication. An estimated 200 000 individuals in Sweden suffer from heart failure. A prerequisite for starting an exercise training program is that the patients heart-failure status must be stable and that physical exertion does not lead to angina. The target group in Sweden is estimated to be approximately 50 000 individuals annually.
Results have been published from 15 randomized controlled studies that tested physical exercise as adjuvant therapy in the rehabilitation of severely ill patients with chronic heart failure. Together the studies included around 600 patients aged 50 to 70 years. The exercise programs were carried out under medical supervision. Various exercise methods were used, eg, walking and bicycle ergometer. The exercise sessions were repeated 2 to 3 times per week and continued between 1 and 6 months. Changes in exercise capacity, quality of life, morbidity, and mortality were used as outcome measures. All of the studies found that patients exercise capacity increased between 20 percent and 38 percent. Six of the nine studies that investigated quality of life found a better quality of life in the exercise group compared to the group that did not have a training program. Three other studies found no impact on quality of life. No definitive conclusions can be drawn concerning the extent to which exercise training influences cardiac complications or mortality.
There are no scientific studies showing evidence on the cost-effectiveness of the method.
There is moderate* evidence on the effects of exercise training, but no* evidence on its cost effectiveness. To render valid judgements concerning the effects of exercise training on heart failure, it is essential to use sufficiently large studies with long-range followup. It would be advantageous to study exercise training programs where patients could participate without special supervision. These studies should also address the health economic aspects.
*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.
This summary is based on a report prepared at SBU in collaboration with André Biskop, MD, Leningrad County Cardiology Hospital, St. Petersburg, Russia and Hans Persson, MD PhD, Danderyd Hospital, Stockholm. It has been reviewed by Prof. Mona Britton, Karolinska Institute and SBU, Stockholm.
Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.
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