Heart failure: Are hospital-based exercise programs helpful?

Many people with heart failure avoid placing strain on their bodies. For some people though the opposite makes sense: special exercise programmes could help to increase their physical capacity and quality of life.

Heart failure is a name for a group of illnesses that reduce the pumping capacity of the heart. A heart attack can eventually lead to heart failure, and infections can also weaken the muscles in the heart.

As many as 2 out of every 100 middle-aged Europeans is affected by this condition (0.5 - 2 %). The number increases to between 6 and 10 out of every 100 people in the age group 65 and older (6-10%). Heart failure means the body's organs do not get enough oxygen, because the heart is not pumping enough blood around the body. This affects the muscles in particular.

In severe cases, people find it difficult to get out of bed or to dress themselves. In mild to moderate cases, people only notice the reduced pumping capacity if they exert themselves, for example, when they walk up stairs. They quickly get out of breath. This, in turn, may lead people with heart failure to reduce their physical activity. But this further reduces their physical fitness. It starts a vicious circle that can strongly reduce their independence and quality of life.

People with heart failure have often been advised to avoid strenuous physical activity that could be a burden on their hearts. People with heart failure have also been less likely to participate in hospital-based rehabilitation programmes for people with heart disease.

Researchers from the Cochrane Collaboration wanted to find out whether exercise programmes were worthwhile for people with heart failure. They found 29 trials where hospitals had tested their exercise programmes. Altogether more than 1,100 people took part. It is important to note that the people in these programmes all had only mild to moderate heart failure. The majority of them were men in their 60s.

From hospital to hospital the content of the programmes varied greatly. The trials usually studied short-term exercise programmes that lasted about two months. The most common exercises were running and using either a stationary exercise bike indoors, or riding a normal bike outdoors.

The researchers drew several conclusions from studying these trials. The first was that the participants in the exercise programmes got fitter. They were able move about, run and work better than those who had not participated in the programmes. However their fitness was only tested at the end of the programme. So it is not clear if their increased fitness lasted over time, or whether they remained active.

In nine of the trials people were asked about their quality of life. In seven of the trials the people in the programmes had improved quality of life compared with the people who did not participate.

Problems like heart attacks rarely occurred during the exercise programmes.

The authors of the Cochrane study point out that the trials cannot provide a full picture for all people with heart failure, because the research has concentrated mostly on men with mild to moderate heart failure. More trials are needed to find out whether exercise programmes also have a positive impact on women, older people and people who have unstable heart conditions or more severe heart failure.

© IQWiG (Institute for Quality and Efficiency in Health Care)