• August 2019

    Study findings address response to structured aerobic exercise in patients with baseline chronic liver disease and long-term heart failure with reduced ejection fraction

Researchers recently published findings based on secondary analysis of a study, HF-ACTION, examining the impact of structured aerobic exercise on patients with long-term heart failure with reduced ejection fraction (HFrEF). The secondary analysis applied the association of baseline chronic liver disease (CLD) on the benefits of structured aerobic exercise for the patients.

HF-ACTION recruited 2,331 patients from 82 different centers across the United States, France and Canada from April 2003 to February 2007. The findings indicated that structured aerobic exercise together with traditional care was safe and contributed to modest improvements in functionality and quality of life for HFrEF patients. From the baseline data, Peter McCullough, MD, and co-workers had originally demonstrated an inverse relationship between baseline renal function and cardiopulmonary fitness in the HF-ACTION trial (McCullough PA, Franklin BA, Leifer E, Fonarow GC. Am J Nephrol. 2010;32(3):226-33. doi: 10.1159/000317544. Epub 2010 Jul 22.).

Current data shows that the prevalence of some form of renal dysfunction in ambulatory heart failure patients could be as high as 40%. Patients with CLD are known to be more sedentary and live with severe limitations in functionality; however, there are indications based on previous pilot and observational studies that aerobic exercise may improve functionality in CLD patients. This led researchers to consider how a structured aerobic program might affect HFrEF patients with CLD.

The secondary analysis found that patients with CLD experienced a slightly greater improvement in exercise duration from baseline to three months in response to the aerobic exercise training compared to patients without CLD. However, beyond that distinction, there was no interaction between CLD status at baseline and the treatment arm with respect to functional capacity, health-related quality of life or other measured clinical outcomes.

It is also worth noting that this study found that despite the high prevalence of CLD in HFrEF patients, which is associated with a poor prognosis, for the most part, there was not a variance in the response to structured aerobic exercise programming. While the exercise was not found to improve the patient’s condition, there was no indications from the analysis that patients should be denied a referral for a structured cardiac rehab program on the basis of CLD status alone. More so, the benefits of structured aerobic activity in terms of functional outcomes and health-related quality of life were comparable to HRrEF patients without CLD.