Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.
Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.
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DOI：
10.1001/jama.2009.457
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发表时间：
2009-04-08
影响因子：
120.7
通讯作者：
Weinfurt, Kevin P.
中科院分区：
文献类型：
--
作者：
Flynn, Kathryn E.;Pina, Ileana L.;Whellan, David J.;Lin, Li;Blumenthal, James A.;Ellis, Stephen J.;Fine, Lawrence J.;Howlett, Jonathan G.;Keteyian, Steven J.;Kitzman, Dalane W.;Kraus, William E.;Miller, Nancy Houston;Schulman, Kevin A.;Spertus, John A.;O'Connor, Christopher M.;Weinfurt, Kevin P.
先前关于运动训练对患者健康状况影响的研究结果并不一致。目的：探讨运动训练对心力衰竭患者健康状况的影响。在2331例射血分数≤35%的医学稳定的心力衰竭门诊患者中进行多中心随机对照试验。患者从2003年4月到2007年2月随机选取。常规护理加有氧运动训练，包括36次有监督的训练，然后是家庭训练，与单独的常规护理相比。随机化根据心力衰竭病因分层，这是所有模型中的协变量。堪萨斯城心肌病问卷（KCCQ）总体总结量表和关键亚量表基线，每3个月12个月，此后每年，长达4年。KCCQ的得分范围从0到100，得分越高，健康状况越好。根据意向-治疗原则，使用线性混合模型估计治疗组的效果。中位随访时间为2.5年。在3个月时，与单独进行常规护理（3.3,95%可信区间，2.5-4.1）相比，常规护理加运动训练导致KCCQ总体总结评分（平均值，5.2；95%可信区间，4.4-6.0）有更大的改善。运动训练组额外增加1.9分具有统计学意义（P < 0.001）。3个月后，两组的KCCQ评分都没有进一步的显著变化（斜率差异P = 0.85），运动组总体上有持续的、更大的改善（P < 0.001）。在KCCQ量表上的结果相似，没有检测到亚组相互作用。与没有训练的常规护理相比，运动训练使健康状况得到了适度但统计学上显著的改善。改善发生在早期，并随着时间的推移而持续。clinicaltrials.gov标识符：NCT00047437
Findings from previous studies of the effects of exercise training on patient-reported health status have been inconsistent. To test the effects of exercise training on health status among patients with heart failure. Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure with ejection fraction ≤ 35%. Patients were randomized from April 2003 through February 2007. Usual care plus aerobic exercise training, consisting of 36 supervised sessions followed by home-based training, vs usual care alone. Randomization was stratified by heart failure etiology, which was a covariate in all models. 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. 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, 5.2; 95% confidence interval, 4.4–6.0) compared with usual care alone (3.3; 95% confidence interval, 2.5–4.1). The additional 1.9-point increase 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. Exercise training conferred modest but statistically significant improvements in health status compared with usual care without training. Improvements occurred early and persisted over time. clinicaltrials.gov Identifier: NCT00047437
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影响因子：
24
作者：
Havranek, EP;Spertus, JA;Rumsfeld, JS
通讯作者：
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作者：
COATS, AJS;ADAMOPOULOS, S;SLEIGHT, P
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