Adam Z Banks1, Robert J Mentz2, Amanda Stebbins3, Catherine R Mikus4, Phillip J Schulte3, Jerome L Fleg5, Lawton S Cooper5, Eric S Leifer5, Dalynn T Badenhop6, Steven J Keteyian7, Ileana L Piña8, Dalane W Kitzman9, Mona Fiuzat2, David J Whellan10, William E Kraus4, Christopher M O'Connor2. 1. Duke University Medical Center, Durham, North Carolina. Electronic address: adam.z.banks@duke.edu. 2. Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. Duke University Medical Center, Durham, North Carolina. 5. National Heart, Lung, and Blood Institute, Bethesda, Maryland. 6. University of Toledo Medical Center, Toledo, Ohio. 7. Henry Ford Hospital, Detroit, Michigan. 8. Montefiore-Einstein Medical Center, New York, New York. 9. Wake Forest School of Medicine, Winston Salem, North Carolina. 10. Thomas Jefferson University, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: In HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), exercise training improved functional capacity in heart failure with reduced ejection fraction (HFrEF). Previous studies have suggested that diabetes mellitus (DM) may be associated with an attenuated response to exercise. We explored whether DM attenuated the improvement in functional capacity with exercise. METHODS AND RESULTS: HF-ACTION randomized 2331 patients with HFrEF to medical therapy with or withoutexercise training over a median follow-up of 2.5 years. We examined the interaction between DM and exercise response measured by change in 6-minute walk distance (6MWD) and peak VO2. We also examined outcomes by DM status. In HF-ACTION, 748 (32%) patients had DM. DM patients had lower functional capacity at baseline and had lower exercise volumes at 3 months. There was a significant interaction between DM status and exercise training for change in peak VO2 (interaction P = .02), but not 6MWD. In the exercise arm, DM patients had a smaller mean increase in peak VO2 than non-DM patients (P = .03). There was no interaction between DM and exercise on clinical outcomes. After risk adjustment, DM was associated with increased all-cause mortality/hospitalization (P = .03). CONCLUSIONS: In HF-ACTION, DM was associated with lower baseline functional capacity, an attenuated improvement in peak VO2, and increased hospitalizations.
RCT Entities:
BACKGROUND: In HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), exercise training improved functional capacity in heart failure with reduced ejection fraction (HFrEF). Previous studies have suggested that diabetes mellitus (DM) may be associated with an attenuated response to exercise. We explored whether DM attenuated the improvement in functional capacity with exercise. METHODS AND RESULTS: HF-ACTION randomized 2331 patients with HFrEF to medical therapy with or without exercise training over a median follow-up of 2.5 years. We examined the interaction between DM and exercise response measured by change in 6-minute walk distance (6MWD) and peak VO2. We also examined outcomes by DM status. In HF-ACTION, 748 (32%) patients had DM. DMpatients had lower functional capacity at baseline and had lower exercise volumes at 3 months. There was a significant interaction between DM status and exercise training for change in peak VO2 (interaction P = .02), but not 6MWD. In the exercise arm, DMpatients had a smaller mean increase in peak VO2 than non-DMpatients (P = .03). There was no interaction between DM and exercise on clinical outcomes. After risk adjustment, DM was associated with increased all-cause mortality/hospitalization (P = .03). CONCLUSIONS: In HF-ACTION, DM was associated with lower baseline functional capacity, an attenuated improvement in peak VO2, and increased hospitalizations.
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