Long-term Adherence To Exercise In Adults With Preserved Ejection Fraction Heart Failure

Background Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multi-component behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on a subgroup of participants with HFpEF. Methods and Results The randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and were the target of this sub-group analysis. We tested adherence to exercise [defined as greater than or equal to 120 minutes of moderate-intensity (40-80% of heart rate reserve) exercise per week validated with a heart rate monitor] at 6, 12, and 18 months. We also tested intervention effects on symptoms (PROMIS-29 and Dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire, KCCQ), and physical function (6-minute walk test, 6MWT). Participants with HFpEF (n=59) were a mean of 64.6 ±9.3 years old, 54% male, 46% non-white with a mean ejection fraction of 55±6. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared to enhanced usual care at both 12 (43% vs. 14%, phi=.32, medium effect) and 18 months (56% vs. 0%, phi=.67, large effect). HEART Camp significantly improved walking distance on the 6MWT (η2 = 0.13, large effect) and the KCCQ overall (η2=0.09, medium effect), clinical summary (η2=0.16, large effect), and total symptom (η2=0.14, large effect) scores. Conclusions A multi-component, behavioral intervention can be used to improve long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF. Our results provide strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence, and improve clinical outcomes, in this population. Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multi-component behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on a subgroup of participants with HFpEF. The randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and were the target of this sub-group analysis. We tested adherence to exercise [defined as greater than or equal to 120 minutes of moderate-intensity (40-80% of heart rate reserve) exercise per week validated with a heart rate monitor] at 6, 12, and 18 months. We also tested intervention effects on symptoms (PROMIS-29 and Dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire, KCCQ), and physical function (6-minute walk test, 6MWT). Participants with HFpEF (n=59) were a mean of 64.6 ±9.3 years old, 54% male, 46% non-white with a mean ejection fraction of 55±6. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared to enhanced usual care at both 12 (43% vs. 14%, phi=.32, medium effect) and 18 months (56% vs. 0%, phi=.67, large effect). HEART Camp significantly improved walking distance on the 6MWT (η2 = 0.13, large effect) and the KCCQ overall (η2=0.09, medium effect), clinical summary (η2=0.16, large effect), and total symptom (η2=0.14, large effect) scores. A multi-component, behavioral intervention can be used to improve long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF. Our results provide strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence, and improve clinical outcomes, in this population.