A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study
1 Department of Public Health and Epidemiology, University of Birmingham, Public Health Building, Birmingham B15 2TT, UK
2 Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
3 University Department of Medicine, City Hospital, Birmingham, UK
4 Department of Cardiology, University Hospital Birmingham NHS Trust, Birmingham, UK
5 Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
6 Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK
7 Department of Cardiac and Pulmonary Rehabilitation, University Hospitals of Leicester, Leicester, UK
8 Department of Health Economics, University of Birmingham, Birmingham, UK
* Corresponding author. Tel: +44 121 414 7552, Fax: +44 121 414 7878, Email: c.b.jolly{at}bham.ac.uk
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Abstract |
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Aims: Supervised exercise can benefit selected patients with heart failure, however the effectiveness of home-based exercise remains uncertain. We aimed to assess the effectiveness of a home-based exercise programme in addition to specialist heart failure nurse care.
Methods and results: This was a randomized controlled trial of a home-based walking and resistance exercise programme plus specialist nurse care (n = 84) compared with specialist nurse care alone (n = 85) in a heart failure population in the West Midlands, UK. Primary outcome: Minnesota Living with Heart Failure Questionnaire (MLwHFQ) at 6 and 12 months. Secondary outcomes: composite of death, hospital admission with heart failure or myocardial infarction; psychological well-being; generic quality of life (EQ-5D); exercise capacity. There was no statistically significant difference between groups in the MLwHFQ at 6 month (mean, 95% CI) (–2.53, –7.87 to 2.80) and 12 month (–0.55, –5.87 to 4.76) follow-up or secondary outcomes with the exception of a higher EQ-5D score (0.11, 0.04 to 0.18) at 6 months and lower Hospital Anxiety and Depression Scale score (–1.07, –2.00 to –0.14) at 12 months, in favour of the exercise group. At 6 months, the control group showed deterioration in physical activity, exercise capacity, and generic quality of life.
Conclusion: Home-based exercise training programmes may not be appropriate for community-based heart failure patients.
Key Words: Heart failure • Exercise therapy • Randomized controlled trial
Received June 20, 2008; Revised September 30, 2008; Accepted November 12, 2008