Exercise training in older patients with heart failure

Cost-effectiveness of exercise training in older patients with heart failure

Whilst exercise training is known to be beneficial in younger people with heart failure, this evidence is not applicable to typical patients who are older. Furthermore, there is little evidence available on the cost-effectiveness of exercise training in older heart-failure patients. A 112-patient, two-arm, randomised trial was conducted to evaluate the effectiveness and cost-effectiveness of exercise training in older patients with heart failure. The exercise training programme consisted of eight weeks of twice–weekly, therapist-led, supervised small-group intermittent functional aerobic exercise and strength training, with the duration of sessions gradually increased to 60 minutes. This was followed by a 16-week, home-based exercise phase which included self-monitoring and telephone instruction and encouragement from the therapist. The results showed that the exercise training was neither effective nor cost-effective. Heart failure predominantly affects people aged over 70 years of age.

Outcome and Translation

The exercise intervention did not improve exercise capacity or quality of life in older patients with heart failure. There was no evidence of cost savings to the NHS. Therefore, this study does not support the adoption of exercise training for older heart-failure patients. The findings are of interest to cardiologists, cardiac rehabilitation workers and practitioners of medicine for older people.

HERU researchers involved in this research project: Marjon Van der Pol and Dwayne Boyers

External Collaborators: M McMurdo, M Witham, AD Struthers (Ninewells Hospital & University of Dundee); D Johnston (University of Aberdeen) and C Lang (Ninewells Hospital & University of Dundee)

Publications

McMurdo, M.E., Witham, M., Struthers, A., Boyers, D., Pol, M.van der and et al (2011) A randomised controlled trial of the effect of exercise training on exercise capacity in older patients with heart failure. Final Report to the Chief Scientist Office (CZH/4/4260), Scottish Government Chief Scientist Office (CSO).

Witham, M.D., Fulton, R.L., Greig, C.A., Johnston, D.W., Lang, C.C., Pol, M. van der, Boyers, D., Struthers, A.D. and McMurdo, M.E.T. (2012) 'Efficacy and cost of an exercise program for functionally impaired older patients with heart failure: a randomized controlled trial', Circulation-Heart Failure, 5(2), 209-216.

Presentations

Fulton, R., Witham, M., Creig, C., Johnston, D., Lang, C., Pol, M. van der, Boyers, D., Struthers, A. and McMurdo, M. (2011) 'A randomised controlled trial of exercise training for older heart failure patients', British Geriatric Society, Liverpool, May 2011.