Home-based exercise improves functional
performance and quality of life in women with
diastolic heart failure
Rebecca A. Gary, RN, PhD,
a
Carla A. Sueta, PhD, MD,
b
Molly Dougherty, RN, PhD,
c
Beth Rosenberg,
EdD, MD,
b
Dennis Cheek, RN, PhD, FAHA,
c
John Preisser, PhD,
d
Virginia Neelon, RN, PhD,
c
and Robert
McMurray, PhD,
e
Athens, Georgia, and Chapel Hill, North Carolina
BACKGROUND: Diastolic heart failure (DHF) is common in older women. There have been no clinical
trials that have identified therapies to improve symptoms in these patients. A total of 32 women with
New York Heart Association class II and III DHF (left ventricular ejection fraction 45% and symptoms
of dyspnea or fatigue) were randomized into a 12-week home-based, low-to-moderate intensity (40%
and 60%, respectively) exercise and education program (intervention) or education only program
(control).
METHODS AND RESULTS: The intervention group improved in the 6-minute walk test from 840
366 ft to 1043 317 ft versus 824 367 ft to 732 408 ft in the control group (P = .002). Quality of
life also improved in the intervention group compared with the control group as measured by the Living
with Heart Failure Questionnaire (41 26 to 24 18 vs 27 18 to 28 22 at 12 weeks, P = .002; 24
18 to 19 18 vs 28 22 to 32 27 at the 3-month follow-up, P = .014) and the Geriatric Depression
Scale (6 4 to 4 4 vs 5 3 to 7 5 at 12 weeks, P = .012; 4 4 to 4 4 vs 7 5 to 7 5 at the
3-month follow-up, P = .009).
CONCLUSIONS: Women with DHF exhibit significant comorbidities and physical limitations. Home-
based, low-to-moderate intensity exercise, in addition to education, is an effective strategy for improving
the functional capacity and quality of life in women with DHF. Further study is needed to assess the
long-term effect of exercise on clinical outcomes. (Heart Lung® 2004;33:210-8.)
INTRODUCTION
Progressive exertional intolerance, experienced
as increasing fatigue and dyspnea on exertion,
causes considerable impairment in the quality of
life (QOL) of patients with heart failure (HF). HF
impacts every aspect of daily life, particularly the
ability to perform routine physical activities of daily
living (PADL), and is a major cause of morbidity and
disability. Because women’s roles are more com-
monly associated with the performance of PADL,
they are particularly affected by the physical symp-
toms of exertional intolerance.
1-4
Women with diastolic heart failure (DHF) typi-
cally are older in age at illness onset, more debili-
tated, and sedentary; live alone; and have multiple
chronic illnesses, particularly hypertension and di-
abetes.
5-11
For these reasons, older women with
DHF are at particular risk to experience a downward
trajectory of declining physical function, progressive
symptom severity, loss of independence, and place-
ment in a long-term care facility.
1,8,12-14
Despite the enormous burden of DHF among
older women, no study has directed specific atten-
tion to improving physical symptoms in this popu-
lation. Because the level of exertional intolerance is
directly proportionate to QOL in older women with
HF, research aims that address physical symptoms
are especially relevant.
4,15
Therefore, this study eval-
uates the effectiveness of home-based exercise on
From the
a
Medical College of Georgia, Athens, Georgia,
b
Depart-
ment of Cardiology,
c
School of Nursing,
d
Department of Biosta-
tistics, and
e
Department of Exercise Science, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina.
Supported by the American Nurses Foundation and General
Clinic Research Center Grant RR00046.
Reprint requests: Rebecca A. Gary, RN, PhD, Assistant Professor,
School of Nursing, 1905 Barnet Shoals Road, Medical College of
Georgia, Athens, GA 30605.
0147-9563/$ – see front matter
Copyright © 2004 by Elsevier Inc.
doi:10.1016/j.hrtlng.2004.01.004
210 www.heartandlung.org JULY/AUGUST 2004 HEART & LUNG