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Volume: 38
Number: 4
Index: December 2010
Clinical Focus:Respiratory Care
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December 2010
Clinical Focus: Respiratory Medicine
  • Asthma and the athlete
    • Vocal cord dysfunction
    • Exercise-induced asthma
    • Exercise-induced bronchospasm
  • COPD
    • Obesity and COPD
    • Relationship between COPD and nutrition intake
  • Treatment options for steroid-induced osteoporosis in men
  • Treatments for asthma
    • Bronchodilators, anticholinergics
    • Corticosteroids
    • Metered-dose vs other types of inhalers
  • Respiratory infections in winter sports athletes
  • Asthma in elite athletes
  • Pulmonary rehabilitation and physical activity
  • Fitness and long-term oxygen therapy/lung transplantation
  • Airflow function and the metabolic syndrome
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doi: 10.3810/psm.2010.04.1759
The Physician and Sportsmedicine: Volume 38: No.1
Is Exercise Adherence Associated with Clinical Outcomes in Patients with Advanced Heart Failure?
Lorraine S. Evangelista, RN, PhD; Michele A. Hamilton, MD; Gregg C. Fonarow, MD; And Kathleen Dracup, RN, DNSc
Abstract: Background There is limited research to support the effect of exercise adherence on clinical outcomes in patients with heart failure (HF). This secondary analysis was conducted on the intervention arm of an exercise training study in patients with HF to assess whether adherence and the dose of treatment exposure were associated with clinical outcomes, functional performance (maximum oxygen consumption [VO2], anaerobic threshold, and workload), and quality of life (QOL). Methods Seventy-one patients (average age, 54 ± 12.5 years; male, 66%; Caucasian, 66%; married, 61%; New York Heart Association class II–III, 97.2%; and average ejection fraction, 26.4% ± 6.5%) were included in the current study. Patients with an increase ≥ 18% in the amount of exercise from baseline to 6 months, as measured by pedometers, were categorized as adherers (n = 38); patients who had no change or an increase in the amount of exercise of <18% were categorized as nonadherers (n = 33). Results The 2 groups were significantly different in the composite endpoint of all-cause hospitalization, emergency room admissions, and death/urgent transplantation (hazard ratio, 0.31; 95% confidence interval, 0.159–0.635; P < 0.001). Adherers had greater improvements in functional performance and QOL compared with nonadherers (P< 0.001). Conclusion These findings suggest that among patients with advanced HF, adherence to exercise is associated with more favorable clinical outcomes. There is also a positive dose-response relationship between the amount of exercise performed and improvement in functional performance and QOL.

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