Exercise training in older patients with systolic heart failure: Adherence, exercise capacity, inflammation and glycemic control

Figures & data

Figure 1.  Flowchart of patient selection. All patients alive with a diagnosis of CHF referred to an outpatient clinic or discharged from hospital form January 1, 2002 to January 31, 2005. *Other causes were mainly musculoskeletal disability impeding exercise training and/or transportation (n = 61), dementia (n = 32), valvular heart disease (n = 11), co-morbidity with limited life-span (n = 10), other reasons (n = 19), could not be contacted (n = 12).

Table I.  Baseline characteristics of patients completing 8 weeks training and drop-outs. Values are given as mean (SD) or number (%).

	Completed 8 weeks training N = 52	Drop-out N = 14	p-value
Age	68.2 (11.3)	67.1 (11.1)	0.60
Women	11 (21)	4 (29)	0.72
Clinical characteristics
LVEF	31 (9)	32 (8)	0.98
NYHA functional class III-IV	9 (17)	2 (14)	1.00
CCS I-IV	6 (11)	3 (21)
NT-proBNP [pmol/L]	133 (120)	115 (149)	0.24
Medication
ACE inhibitor or ARB	51 (98)	14 (100)	1.00
Beta-blockers	46 (88)	10 (71)	0.12
CVD-risk factors
BMI [kg/m^2]	27 (5)	32 (4)	0.003
Current smoker	9 (17)	6 (43)	0.07
Alcohol [units/week]	7 (11)	16 (18)	0.13
Systolic blood pressure [mm hg]	121 (19)	128 (23)	0.27
Diabetes	14 (27)	3 (21)	1.00
Socioeconomic factors
Occupation: unskilled	11 (21)	4 (29)	0.77
Married/cohabitating	34 (65)	8 (57)	0.75

Table II.  Functional tests before and after 8 weeks exercise training program in 52 patients with systolic heart failure. Values are mean (SD).

Paramter	Baseline N = 52	After 8 weeks N = 52	p-value
Maximal workload [watts]	90.1 (4.9)	94.8 (5.1)	0.002
Exercise time [s]	831 (58)	891 (61)	0.002
6MWT [m]	446 (16)	469 (15)	0.001
ISWT [m]	358 (28)	382 (30)	0.006
STS [n per 30 seconds]	12.5 (0.5)	14.1 (0.5)	0.0001

Table III.  Serological markers before and after 8 weeks exercise training in 52 patients with systolic heart failure. Values are mean (SD).

Parameter	Baseline	After 8 weeks	p-value
Metabolic markers:
HbA1c [%]	6.4 (1.2)	6.4 (1.2)	0.75
Glucose [mmol/L]	6.5 (2.3)	6.3 (2.3)	0.77
Insulin [pmol/L]	67.8 (63.7)	74.0 (85.6)	0.20
Glycerol [umol/L]	140.3 (118.6)	125.6 (54.1)	0.84
Free fatty acids [umol/L]	268.1 (177.4)	297.7 (197.1)	0.09
Inflammatory markers:
hsCRP [mg/L]	3.9 (6.9)	5.4 (9.2)	0.25
Orosomucoid [g/L x 10]	9.0 (2.8)	9.4 (2.9)	0.12
IL-6 [ng/L]	34.4 (64.8)	35.9 (69.5)	0.48
TNF-alpha [ng/L]	9.8 (12.9)	10.0 (13.0)	0.48
U-orosomucoid [mg/L]	10.4 (21.8)	9.4 (16.5)	0.40
U-alb/creatinin	9.4 (25.3)	7.9 (20.3)	0.12
Other serological markers:
Homocystein [umol/L]	15.3 (5.7)	15.6 (6.1)	0.36
HDL-cholesterol [mmol/L]	1.25 (0.35)	1.24 (0.37)	0.42
Triglycerides [mmol/L]	1.51 (0.81)	1.50 (0.85)	0.59
Cortisol [mg/L]	139.4 (48.8)	137.7 (40.6)	0.99
Epinephrine [mg/L]	281.1 (152.8)	264.5 (149.5)	0.15
NT-proBNP [pmol/L]	133.4 (120.2)	136.0 (127.6)	0.88
IGF-1 [ug/L]	66.6 (23.7)	63.6 (23.8)	0.70

Table IV.  Quality of life score (Minnesota living with heart failure) before and after 8 weeks exercise training program in 52 patients with systolic heart failure. Values are mean (SD).

Parameter	Baseline N = 52	After 8 weeks N = 52	p-value
Total	33.0 (19.3)	32.5 (20.7)	0.73
Physical dimension	13.8 (9.0)	13.6 (9.6)	0.80
Emotional dimension	7.4 (6.0)	7.1 (6.5)	0.52