Prospective Aerobic Reconditioning Intervention Study

Exercise Conditioning in Elderly Patients With Heart Failure

The purpose of this study is :

• To determine if aerobic exercise conditioning can improve symptoms, cardiovascular function and quality of life in elderly patients with congestive heart failure.
• To describe the baseline clinical characteristics, cardiovascular function and neurohumoral function in elderly patients with congestive heart failure.
• To determine the specific cardiovascular and noncardiovascular mechanisms by which symptoms and quality of life may improve following exercise conditioning in elderly patients with congestive heart failure.

In patients over age 65, cardiovascular disease accounts for the largest percentage of deaths, hospital days, doctor visits, and overall health care expenditures. In addition, heart failure is the most common discharge diagnosis in the elderly. Heart failure can be defined as a state in which cardiac output is insufficient to meet metabolic demands. This is most frequently manifested by symptoms of fatigue and dyspnea. Inherent in this definition is that symptoms may be increased or only occur during times when metabolic demand is increased, such as during exercise. As such, exercise intolerance is a hallmark of the heart failure syndrome. Exercise intolerance correlates not only with disease severity and also with subsequent mortality. Exercise tolerance can be objectively quantified during maximal symptom limited standardized exercise protocols by analysis of exercise time, workload, METS (metabolic equivalents), and oxygen consumption (V02)' These measures have appropriately become accepted as standards for functional assessment in this disorder as well as outcome measures following therapeutic interventions in HF. P.A.R.I.S. is a randomized, attention-controlled, single-blind trial of supervised aerobic exercise training in older patients with heart failure. The primary outcome is exercise capacity and the main secondary outcome is quality of life. Mechanistic outcomes were also examined. In PARIS, which focused on cardiac mechanisms, there were HFPEF and HFREF patients studied in parallel. In PARIS-II, there were only HFPEF patients which focused on vascular mechanisms.

Main outcomes have been reported (see citations below).

Inclusion Criteria:

• Age greater than or equal to 60 years of age
• Symptoms of congestive heart failure
• Able to understand and give informed consent

Exclusion Criteria:

• Age <60 years
• Does not have CHF
• Significant change in cardiac medication <3 weeks
• Myocardial infarction <3 weeks
• CABG surgery <3 months
• Angina pectoris not controlled during daily activity by pharmacological therapy or at <4 METS activity
• Sustained hypertension with systolic> 190 and diastolic> 110 on medications
• Valvular heart disease as the primary etiology of CHF
• Significant aortic stenosis
• Stroke of <3 months or with any physical restriction impairment that would prevent participation in exercise programs
• Chronic obstructive pulmonary disease on therapy that limits exercise duration
• Uncontrolled diabetes mellitus
• Active treatment for cancer or other noncardiovascular conditions with life expectancy less than three years
• Anemia "10 gms Hb)
• Renal insufficiency (cr >2.5 mg/dl)
• Psychiatric disease - uncontrolled major psychoses, depressions, dementia, or personality disorder
• Dementia - MMSE ~24 "22 for ~8th grade education)
• Lack of an acoustic window sufficient to allow definition of endocardial borders on the screening echocardiogram.
• Plans to leave area or be admitted to a nursing home within 2 years.
• Inability to walk at least 420 feet in 6 minutes without a cane or other assistive device.
• Inability to exercise at or near home.
• At the discretion of the clinical staff, it is believed that the participant cannot or will not complete the protocol because of frailty, illness, or other reason.
• Participation in a regular exercise regimen more than one time per week for at least twenty minutes per session; including but not limited to walking, swimming, weight lifting, golfing, or taking an exercise class.
• Inability to ambulate without cane or other assistive device during biomechanics testing or treadmill.
• Inability to attend at least fourteen weeks of the facility-based intervention