2.50
Hdl Handle:
http://hdl.handle.net/10755/158077
Type:
Presentation
Title:
Exercise in Heart Failure: Predictors of Improved Functional Status
Abstract:
Exercise in Heart Failure: Predictors of Improved Functional Status
Conference Sponsor:Western Institute of Nursing
Conference Year:2004
Author:Corvera, Teresita, PhD, RN
P.I. Institution Name:VA Greater Los Angeles Health Care System
Title:Nursing Research
Contact Address:, Los Angeles, CA, USA
Co-Authors:Lynn Doering, DNSc, RN, Kathleen Dracup, DNSc, RN
Exercise training is an emerging therapeutic strategy in heart failure (HF). The question of whether all HF patients enrolled in an exercise program achieve improvements in functional status remains uncertain. Objectives: To identify negative factors influencing lack of improvement in functional status (FS) following a short-term exercise program in patients with HF. The 6-minute walk test (6MWT) measured FS. Methods: In a randomized controlled trial, 41 HF patients (age 63.8 ± 10.1, LVEF 29.1 ± 8.5%, HF duration 37.4 ± 33.8, 31 [76%] NYHA II, 10 [24%] NYHA III/IV, 100% male) were enrolled in a 12-week home walking exercise (HWE) program. Based on Guyatt’s clinically significant change in 6MWT (> 99 feet), training group was classified into: ‘improved FS’ group – 19 (45%) and ‘not improved FS’ group - 23 (55%). Preliminary univariate analyses (t-test and Fisher Exact test) were performed to identify significant sociodemographic factors (age and ethnicity), exercise tolerance variables (peak oxygen consumption [VO2] and New York Heart Association [NYHA] functional class), clinical factors (HF duration, body mass index and Charlson Comorbidity Index score) and psychological variables (Multiple Affect Adjective Checklist [MAACL] mood scores of depression, anxiety and hostility). Then, a multivariate backward logistic regression was performed to identify predictors of lack of improvement in FS following the 12-week HWE program. Results: The average change in 6-MWT were 279.6 ± 130.7 feet and -15.2 ± 81.6 feet for ‘improved FS’ group and ‘not improved FS’ group, respectively. Univariately, significant variables were: sociodemographic factors- age (p = .04) and Caucasian ethnicity (p = .02); exercise tolerance- peak VO2 (p = .04); clinical factors- HF duration (p = .10) and Charlson Comorbidity Index score (p = .13); and psychological variables- MAACL anxiety (p = .20). In the multivariate model, a lower peak VO2, Caucasian ethnicity, shorter HF duration, lower anxiety scores and higher depression scores were significant predictors of no improvement in FS following a 12-week HWE program (see Table below). Conclusion: Predictors of lack of improvement in FS among HF patients enrolled in a short-term exercise program were lower baseline exercise capacity, Caucasian ethnicity, shorter HF duration, and lower anxiety and higher depression scores. Implications: It is important to consider the level of exercise capacity, ethnicity, duration of HF and emotional functioning in providing exercise recommendations for patients with HF. Psychosocial assessment and intervention for depression should be implemented in patients with HF to enhance benefits from an exercise program. Variable Coefficient S.E. Odds Ratio CIP Age.07.051.08.97 ? 1.20.18NYHA-2.411.63.09.00 ? 2.19.14Peak VO2-.53.20.59.40 ? .88.009*Caucasian ethnicity2.351.1510.491.11 ? 99.17.04*HF Duration-.04.02.97.94 ? .99.02*MAACL Anxiety scores-.83.38.44.21 ? .92.03*MAACL Depression scores.48.231.621.03 - 2.55.04*

Funding: VA Health Services Research & Development, Nursing Research Initiative 960311
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleExercise in Heart Failure: Predictors of Improved Functional Statusen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158077-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Exercise in Heart Failure: Predictors of Improved Functional Status</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Corvera, Teresita, PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">VA Greater Los Angeles Health Care System</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nursing Research</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Los Angeles, CA, USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Lynn Doering, DNSc, RN, Kathleen Dracup, DNSc, RN </td></tr><tr><td colspan="2" class="item-abstract">Exercise training is an emerging therapeutic strategy in heart failure (HF). The question of whether all HF patients enrolled in an exercise program achieve improvements in functional status remains uncertain. Objectives: To identify negative factors influencing lack of improvement in functional status (FS) following a short-term exercise program in patients with HF. The 6-minute walk test (6MWT) measured FS. Methods: In a randomized controlled trial, 41 HF patients (age 63.8 &plusmn; 10.1, LVEF 29.1 &plusmn; 8.5%, HF duration 37.4 &plusmn; 33.8, 31 [76%] NYHA II, 10 [24%] NYHA III/IV, 100% male) were enrolled in a 12-week home walking exercise (HWE) program. Based on Guyatt&rsquo;s clinically significant change in 6MWT (&gt; 99 feet), training group was classified into: &lsquo;improved FS&rsquo; group &ndash; 19 (45%) and &lsquo;not improved FS&rsquo; group - 23 (55%). Preliminary univariate analyses (t-test and Fisher Exact test) were performed to identify significant sociodemographic factors (age and ethnicity), exercise tolerance variables (peak oxygen consumption [VO2] and New York Heart Association [NYHA] functional class), clinical factors (HF duration, body mass index and Charlson Comorbidity Index score) and psychological variables (Multiple Affect Adjective Checklist [MAACL] mood scores of depression, anxiety and hostility). Then, a multivariate backward logistic regression was performed to identify predictors of lack of improvement in FS following the 12-week HWE program. Results: The average change in 6-MWT were 279.6 &plusmn; 130.7 feet and -15.2 &plusmn; 81.6 feet for &lsquo;improved FS&rsquo; group and &lsquo;not improved FS&rsquo; group, respectively. Univariately, significant variables were: sociodemographic factors- age (p = .04) and Caucasian ethnicity (p = .02); exercise tolerance- peak VO2 (p = .04); clinical factors- HF duration (p = .10) and Charlson Comorbidity Index score (p = .13); and psychological variables- MAACL anxiety (p = .20). In the multivariate model, a lower peak VO2, Caucasian ethnicity, shorter HF duration, lower anxiety scores and higher depression scores were significant predictors of no improvement in FS following a 12-week HWE program (see Table below). Conclusion: Predictors of lack of improvement in FS among HF patients enrolled in a short-term exercise program were lower baseline exercise capacity, Caucasian ethnicity, shorter HF duration, and lower anxiety and higher depression scores. Implications: It is important to consider the level of exercise capacity, ethnicity, duration of HF and emotional functioning in providing exercise recommendations for patients with HF. Psychosocial assessment and intervention for depression should be implemented in patients with HF to enhance benefits from an exercise program. Variable Coefficient S.E. Odds Ratio CIP Age.07.051.08.97 ? 1.20.18NYHA-2.411.63.09.00 ? 2.19.14Peak VO2-.53.20.59.40 ? .88.009*Caucasian ethnicity2.351.1510.491.11 ? 99.17.04*HF Duration-.04.02.97.94 ? .99.02*MAACL Anxiety scores-.83.38.44.21 ? .92.03*MAACL Depression scores.48.231.621.03 - 2.55.04* <br/><br/>Funding: VA Health Services Research &amp; Development, Nursing Research Initiative 960311 <br/></td></tr></table>en_GB
dc.date.available2011-10-26T20:29:10Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:29:10Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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