Exercise training improves health
outcomes of women with heart disease more than of men
In
the largest study to ever investigate the effects of exercise training in patients
with heart failure, exercise training reduced the risk for subsequent all-cause
mortality or all-cause hospitalization in women by 26 percent, compared with 10
percent in men.
While a causal relationship has previously been observed in
clinical practice between improved health outcomes and exercise, this trial is
the first to link the effects of exercise training to health outcomes in women
with cardiovascular disease. This study, an exploratory analysis, recently was
published in the Journal of the American College of Cardiology: Heart
Failure.
.
.
"Heart disease has a major impact on women. Our goal is for these findings to greatly impact the management of this challenging syndrome."
Heart
disease is the leading cause of death for women in the United States,
responsible for one-in-four female deaths. Although women are twice as likely
as men to develop heart failure following heart attack or cardiac ischemia,
they are less often directed to complete an exercise program.
Women
with cardiovascular disease are largely underrepresented in past exercise
research, and no large trial has previously studied the impact of exercise
training on health outcomes for women with heart failure. The randomized,
multicenter, international HF-ACTION (The Heart Failure
-- A Controlled Trial Investigating Outcomes
of Exercise Training) trial included the largest cohort of women
with heart failure to undergo exercise training, and examined potential gender
differences that could affect physical exercise prescription.
"These
findings are significant because they represent important implications for
clinical practice and patient behaviors," said Dr. Piña. "Findings
suggest physicians should consider exercise as a component of treatment for
female patients with heart failure, as they do for male patients."
The
clinical trial randomized 2,331 patients with heart failure and a left
ventricular ejection fraction of less than or equal to 35 percent to either a
formal exercise program plus optimal medical therapy, or to optimal medical
therapy alone. Prior to randomization, patients underwent symptom-limited
cardiopulmonary exercise tests to assess exercise capacity, as measured by peak
oxygen uptake (VO2).
Patients randomized to the exercise treatment arm
participated in supervised walking, or stationary cycling for 30 minutes three
days a week for six weeks. After completing 18 sessions, patients added 40
minutes of home-based exercise two days per week. After completing 36
supervised sessions, patients were fully transitioned to a five day per week,
40 minutes a day home-based exercise program.
The
primary outcome of this analysis was a composite of all-cause mortality or
hospitalization, stratified by gender. Women randomized to exercise training
saw a 26 percent reduction (p = 0.027) in risk of all-cause mortality or
hospitalization (HR 0.74, 95 percent CI 0.59-0.92) compared with a 10 percent
reduction in risk of these outcomes for men randomized to exercise (HR 0.99, 95
percent CI 0.86-1.13).
The
secondary outcomes included mortality alone, the composite of cardiovascular
mortality or cardiovascular hospitalization, and the composite of
cardiovascular mortality or heart failure hospitalization, all stratified by
gender. Exercise training was associated with greater reductions in risk among
women than men for all secondary endpoints, although the associated
treatment-by-gender interactions were not statistically significant.
There were
no significant apparent differences between men and women within either
treatment arm with respect to change in Peak VO2. Safety of exercise training
in patients with heart failure and improvements in health status were
previously reported for the HF-ACTION trial.
Story Source:
The
above story is based on materials provided by Montefiore Medical Center. Note:
Materials may be edited for content and length.
Journal Reference:
1.
Ileana L. Piña, Vera
Bittner, Robert M. Clare, Ann Swank, Andrew Kao, Robert Safford, Anil Nigam,
Denise Barnard, Mary N. Walsh, Stephen J. Ellis, Steven J. Keteyian. Effects
of Exercise Training on Outcomes in Women With Heart Failure: Analysis of
HF-ACTION (Heart Failure–A Controlled Trial Investigating Outcomes of
Exercise TraiNing) by Sex. JACC: Heart Failure, 2014; DOI: 10.1016/j.jchf.2013.10.007
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Montefiore Medical Center. "Exercise training improves
health outcomes of women with heart disease more than of men." Science Daily, 26 March 2014.
<www.sciencedaily.com/releases/2014/03/140326114330.htm>.
