Ageing and Health and Department of Clinical Pharmacology, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Dundee, UK.
Circ Heart Fail. 2012 Mar 1;5(2):209-16. doi: 10.1161/CIRCHEARTFAILURE.111.963132. Epub 2012 Jan 23.
Little is known about the optimum way to deliver exercise to older, functionally impaired patients with heart failure. We tested whether an exercise program tailored to the needs of these patients could improve exercise capacity and quality of life or reduce costs to the National Health Service.
The study design was a parallel-group, single-blind, randomized controlled trial. Patients aged ≥70 years with symptomatic heart failure and left ventricular systolic dysfunction were randomized to either 24 weeks of exercise training or usual care. Six-minute walk distance was the primary outcome; markers of physical function, quality of life, health status, and daily activity were measured at baseline and 8 and 24 weeks. Carer strain and healthcare costs were also recorded. A total of 107 participants were randomized (mean age, 80 years; men, 72 [67%]). Six-minute walk distance did not improve compared to that of the control group at 8 weeks (-16.9 m; 95% CI, -41.8 to 7.9 m; P=0.18) or at 24 weeks (-5.3 m; 95% CI, -32.6 to 22.0 m; P=0.70). For secondary outcomes, only the sit-to-stand test improved significantly at 24 weeks (-6.4 s; 95% CI, -12.2 to 0.6 s; P=0.03); there was no difference in change for the Minnesota Living With Heart Failure score (0.1 points; 95% CI, -0.9 to 1.1 points; P=0.83) at 24 weeks. Carer strain did not decrease at 24 weeks (difference, -0.5 points; 95% CI, -8.3 to 7.3 points; P=0.80), and there was no difference in overall healthcare costs.
This exercise intervention did not improve exercise capacity or quality of life in older patients with heart failure and was not cost saving to the National Health Service. Clinical Trial Registration- URL: http://www.controlled-trials.com. Unique identifier: ISRCTN51615566.
对于功能受损的老年心力衰竭患者，我们对最适合的运动方式知之甚少。我们研究了专门针对这些患者需求的运动方案是否能够提高运动能力和生活质量，或者是否能降低国民保健服务（NHS）的成本。
研究设计为平行组、单盲、随机对照试验。将年龄≥70 岁、有症状心力衰竭和左心室收缩功能障碍的患者随机分为运动训练组或常规治疗组，进行 24 周的治疗。6 分钟步行距离是主要结局；在基线时以及 8 周和 24 周时，还测量了身体功能、生活质量、健康状况和日常活动的标志物。同时还记录了照顾者的压力和医疗保健费用。共有 107 名患者被随机分配（平均年龄 80 岁，男性 72 例[67%]）。与对照组相比，8 周时 6 分钟步行距离没有改善（-16.9m；95%CI，-41.8 至 7.9m；P=0.18），24 周时也没有改善（-5.3m；95%CI，-32.6 至 22.0m；P=0.70）。对于次要结局，只有坐站试验在 24 周时显著改善（-6.4s；95%CI，-12.2 至 0.6s；P=0.03）；24 周时明尼苏达州心力衰竭生活质量评分的变化没有差异（0.1 分；95%CI，-0.9 至 1.1 分；P=0.83）。24 周时照顾者的压力没有减轻（差值，-0.5 分；95%CI，-8.3 至 7.3 分；P=0.80），整体医疗保健费用也没有差异。
对于老年心力衰竭患者，这种运动干预并未提高运动能力或生活质量，也没有为国民保健服务节省成本。
临床试验注册- 网址：http://www.controlled-trials.com。唯一识别码：ISRCTN51615566。
