Factors limiting habitual exercise in patients with chronic heart failure: a multicenter prospective cohort study
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Physical activity (PA) in the daily life is strongly related to prognosis in patients with or at high risk of heart failure (HF). However, factors limiting habitual exercise and their prognostic impacts remain unknown in HF patients. We sent questionnaires asking factors limiting habitual exercise in the daily life to 8370 patients with Stage A/B/C/D HF in our nationwide registry and received valid responses from 4935 patients (mean age 71.8 years, 71.0% male). Among the 5 components consisting of “busyness”, “weak will”, “dislike, “socioeconomic reasons” and “diseases” in the questionnaires, “busyness” (34.5%) and “diseases” (34.7%) were the most frequently reported factors limiting habitual exercise, while “socioeconomic reasons” were the least (15.3%). Multiple Cox proportional hazard models indicated that “busyness”and “diseases” were associated with better (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.39–0.72, P < 0.001) and worse prognosis (HR 1.57, 95% CI 1.21–1.98, P < 0.001), respectively, while other components were not. Furthermore, it was noted that, while prognostic relevance of “busyness” limiting exercise did not differ by age or sex, negative impact of “diseases” was particularly evident in patients with age < 75 years (P for interaction < 0.01). Factors limiting habitual exercise were associated with “busyness” and “diseases”, but not with “weak will”, “dislike, or “socioeconomic reasons”. While “busyness” was associated with better prognosis regardless of age and sex, “diseases” was associated with worse prognosis in younger populations. Thus, physicians may pay more attentions to the reasons that limit exercise in the daily lives of HF patients rather than the low amount of exercise itself.
KeywordsPhysical activity Exercise Chronic heart failure Prognosis Busyness Diseases
This study was supported in part by the Grants-in Aid from the Ministry of Health, Labour, and Welfare (Grant Nos. 201412015B, 201120009B, 200825012B) and the Agency for Medical Research and Development (15ek0210043h0001), Tokyo, Japan.
Compliance with ethical standards
Conflict of interest
The Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine is supported in part by unrestricted research grants from Daiichi Sankyo Co., Ltd. (Tokyo, Japan), Bayer Yakuhin, Ltd. (Osaka, Japan), Kyowa Hakko Kirin Co., Ltd. (Tokyo, Japan), Kowa Pharmaceutical Co., Ltd. (Tokyo, Japan), Novartis Pharma K.K. (Tokyo, Japan), Dainippon Sumitomo Pharma, Co., Ltd. (Osaka, Japan), Nippon Boehringer Ingelheim Co., Ltd. (Tokyo, Japan), Astellas Pharma (Tokyo, Japan), AstraZeneca (Osaka, Japan), Chugai Pharmaceutical (Tokyo, Japan), GlaxoSmithKline (Tokyo, Japan), Mitsubishi Tanabe Pharma (Osaka, Japan), Mochida Pharmaceutical (Tokyo, Japan), MSD (Tokyo, Japan), Otsuka Pharmaceutical (Tokyo, Japan), Shionogi (Osaka, Japan) and Takeda Pharmaceutical (Tokyo, Japan). H.S. has received lecture fees from Bayer Yakuhin, Ltd. (Osaka, Japan), Daiichi Sankyo Co., Ltd. (Tokyo, Japan) and Novartis Pharma K.K. (Tokyo, Japan).
- 4.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200CrossRefGoogle Scholar
- 5.Piepoli MF, Conraads V, Corrà U, Dickstein K, Francis DP, Jaarsma T, McMurray J, Pieske B, Piotrowicz E, Schmid JP, Anker SD, Solal AC, Filippatos GS, Hoes AW, Gielen S, Giannuzzi P, Ponikowski PP (2011) Exercise training in heart failure: from theory to practice. A consensus document of the heart failure association and the european association for cardiovascular prevention and rehabilitation. Eur J Heart Fail 13:347–357CrossRefGoogle Scholar
- 6.Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A, American College of Sports Medicine; American Heart Association (2007) Physical activity and public health: updated recommendation for adults from the American college of sports medicine and the American heart association. Circulation 116:1081–1093CrossRefGoogle Scholar
- 9.O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, Piña IL, Investigators HF-ACTION (2009) Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1439–1450CrossRefGoogle Scholar
- 10.Flynn KE, Piña IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O’Connor CM, Weinfurt KP, Investigators HF-ACTION (2009) Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1451–1459CrossRefGoogle Scholar
- 11.Blumenthal JA, Babyak MA, O’Connor C, Keteyian S, Landzberg J, Howlett J, Kraus W, Gottlieb S, Blackburn G, Swank A, Whellan DJ (2012) Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA 308:465–474PubMedPubMedCentralGoogle Scholar
- 12.Luo N, Teng TK, Tay WT, Anand IS, Kraus WE, Liew HB, Ling LH, O’Connor CM, Piña IL, Richards AM, Shimizu W, Whellan DJ, Yap J, Lam CSP, Mentz RJ, ASIAN-HF; HF-ACTION investigators (2017) Multinational and multiethnic variations in health-related quality of life in patients with chronic heart failure. Am Heart J 191:75–81CrossRefGoogle Scholar
- 13.Edelmann F, Gelbrich G, Düngen HD, Fröhling S, Wachter R, Stahrenberg R, Binder L, Töpper A, Lashki DJ, Schwarz S, Herrmann-Lingen C, Löffler M, Hasenfuss G, Halle M, Pieske B (2011) Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 58:1780–1791CrossRefGoogle Scholar
- 14.Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, Abdelhamed A, Haykowsky MJ (2013) Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol 62:584–592CrossRefGoogle Scholar
- 16.Hegde SM, Claggett B, Shah AM, Lewis EF, Anand I, Shah SJ, Sweitzer NK, Fang JC, Pitt B, Pfeffer MA, Solomon SD (2017) Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist). Circulation 136:982–992CrossRefGoogle Scholar
- 17.Miura Y, Fukumoto Y, Miura T, Shimada K, Asakura M, Kadokami T, Ando S, Miyata S, Sakata Y, Daida H, Matsuzaki M, Yasuda S, Kitakaze M, Shimokawa H (2013) Impact of physical activity on cardiovascular events in patients with chronic heart failure. A multicenter prospective cohort study. Circ J 77:2963–2972CrossRefGoogle Scholar
- 19.Vegh EM, Kandala J, Orencole M, Upadhyay GA, Sharma A, Miller A, Merkely B, Parks KA, Singh JP (2014) Device-measured physical activity versus six-minute walk test as a predictor of reverse remodeling and outcome after cardiac resynchronization therapy for heart failure. Am J Cardiol 113:1523–1528CrossRefGoogle Scholar
- 20.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, College American, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128:e240–e327PubMedGoogle Scholar
- 22.Matsuzawa Y (2005) Metabolic syndrome: definition and diagnostic criteria in Japan. J Jpn Soc Intern Med 94:188–203Google Scholar
- 26.Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, O’Connor C, Whellan D, Keteyian SJ, Coats A, Davos CH, Dalal HM, Dracup K, Evangelista L, Jolly K, Myers J, McKelvie RS, Nilsson BB, Passino C, Witham MD, Yeh GY, Zwisler AO, Collaboration ExTraMATCH II (2018) Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail 20:1735–1743CrossRefGoogle Scholar