Several small studies have reported...

Several small studies have reported benefits from exercise training in patients with chronic heart failure, if it were not that the overall risks and benefits of exercise in patients with this increasingly habitual condition have not been determined. The ExTraMATCH international collaborative cluster conducted a meta-analysis to compare the powers of exercise training with usual care in patients with chronic heart failure caused by means of left ventricular systolic dysfunction.

They searched electronic databases for randomized controll studies waysed since 1990 that included medically supervised exercise programs of at least eight weeks' duration in patients with stable heart failure and a left ventricular ejection fraction of les than 50 percent The investigators of the nine eligible studies provided original data for analysis. The issues of interest were time to death and time to admission to the hospital for any cause. The studies included nearly 400000 patients, and the mean follow-up period ranged from 22 to 1213 days. onward average, patients were about 60 years of age and had a 25 fresh York Heart Association classification for heart failure. Approximately 88 percent of participants were men Different forms and intensity of exercise were used, including supervised cycling or walking, aerobic training, calisthenics, and interval training. Intensity measures included targets of 60 to 80 percent peak oxygen consumption and 60 to 80 percent peak heart rate. No evidence of publication bias was found

The 88 deaths in the exercise clump occurred at a median time of 618 days compared with 421 days for the 105 deaths in the direct group. The significantly lower mortality in the exercise cluster was equivalent to a number necessityed to treat of 17 to obstruct one death within two years. The median time to admission to the hospital for any reason also was significantly longer in the exercise form into groups (426 compared with 371 days). No specific subgroup of patients, regardless of sex heart failure classification, or class of severity, appeared to benefit disproportionately from exercise. Exercise programs lasting more than 28 weeks appeared to have issues similar to shorter programs.

The authors infer that medically supervised exercise training significantly improves survival and makes hospital admission in patients with chronic heart failure caused by the agency of left ventricular systolic dysfunction. The consequence appears to apply to all representations of heart failure and across the abounding spectrum of patient characteristics. The authors call for more studies to better delineate the in the greatest degree effective types, duration, and intensity of exercise for patients with heart failure.

Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ January 24 2004;328:189-92

EDITOR'S NOTE: Many patients with heart disease are reluctant to exercise because of well-founded beliefs and everyday reports of heart patients dying during physical exertion (or memories of exercise-induced symptoms). This contemplation indicates that mortality and hospital readmission rates improved in stable patients with heart failure who took part in supervised exercise programs. The elucidation is in selection of patients and well-designed, supervised exercise plans. Family physicians may have to dispose of as much time persuading the overambitious cardiac patient to moderate strenuous exercise as encouraging the reluctant sedentary patient to start walking. As in greatest in number things, our skill in personalizing the research and giving adroit advice to individual patients is of paramount importance. Tenacity, knowing local resources, and calling upon family members to encourage patients and exercise with them are helpful.--A.D.W.

COPYRIGHT 2004 American Academy of Family Physicians

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