University of Nebraska Medical Center researchers are encouraged by results of a pilot study showing a new model may be effective in improving the health and quality of life of heart failure patients. Results show an added benefit to medications for heart failure.
Researchers found exercise improved physical functioning – the ability to engage in physical activities. It also reduced shortness of breath and fatigue associated with heart failure.
Heart failure — a condition in which the pumping power of the heart is decreased — leads to fatigue, shortness of breath and a lower quality of life. About 5 million Americans have heart failure, and as more people get older, heart failure is going to become an even bigger problem.
Structured, supervised exercise programs for heart failure patients aren’t reimbursed by most insurance companies and Medicare.
The study evaluated 42 heart failure patients during Heart Failure Exercise and Resistance Training – called Heart Camp. The camp was part of a $220,500 research study funded by the National Institutes of Health. Researchers evaluated whether an aerobic and resistance exercise program could build confidence in their ability to exercise and continue exercising independently.
“This is a new model to consider as a way to help heart failure patients,” said Bunny Pozehl, Ph.D., associate professor, UNMC College of Nursing Lincoln Division, who led the study. “The only option is to do traditional cardiac rehabilitation which really isn’t an option for many because it isn’t paid for by most insurance companies and Medicare.”
Dr. Pozehl launched the small study after years of working with heart failure patients at the BryanLGH Heart Institute in Lincoln.
“I’d see patients in the heart failure clinic and tell them of the need to stay active and exercise,” Dr. Pozehl said. “This becomes difficult because insurance doesn’t pay for rehabilitation programs where patients receive guidance and education for exercise. Patients were apprehensive about initiating exercise on their own for fear of causing further damage to their heart. Many patients don’t know how much exercise they can do and how to evaluate their symptoms and response to exercise.”
Research involved monitoring two groups of study participants for more than 24 weeks – an exercise group and an attention control group. The exercise group was taught how to exercise properly, shown their progress and met regularly for exercise. The attention control group met regularly to receive general information about heart disease, diet, medications and how to relax.
In the first three weeks of the study, the exercise group received exercise instruction in a structured, hospital-based rehabilitation setting with weekly group meetings. The next nine weeks consisted of education and support sessions on a bi-weekly basis and exercise training that was performed independently in the hospital setting. The final 12 weeks of the study, researchers monitored study participants’ adherence to exercise from personal diaries and exercise logs and subjects maintained the exercise behavior on their own.
Dr. Pozehl said she and her colleagues also found the attention control group showed some positive outcomes which indicated potential benefit perceived from attention and support in a group setting.
“Rehabilitation is pretty expensive,” One of main thrusts was to test a new model rather than the traditional 12 weeks of traditional, structured cardiac rehabilitation. Traditionally, if heart failure patients want to engage in rehabilitation, they have to pay for it themselves. Insurance companies and Medicare won’t begin to pay until there is clear evidence of beneficial effects of exercise. Twenty years ago we would have said someone with heart failure shouldn’t exercise, but we are beginning to demonstrate through research that exercise is beneficial,” she said.
Dr. Pozehl said study participants told her the exercise model improved their lives. One patient, a man in his 40s, who had been an athlete in high school and college, told her she gave him his life back. “He realized he still could be active and live his life,” she said.
Dr. Pozehl and colleagues will propose a larger study to determine whether the model works.
Co-investigators of the study were Kathleen Duncan, Ph.D., assistant dean, and Melody Hertzog, Ph.D., both of the UNMC College of UNMC College of Nursing Lincoln Division, and Joe Norman, Ph.D., UNMC School of Allied Health Professions.