Can a walking intervention improve functional status and quality of life in HFrEF?

For patients with heart failure with reduced ejection fraction (HFrEF), a walking intervention may increase the number of daily steps taken. However, this improved walking activity level did not appear to be related to functional improvements in this patient population.

Dr Tomas Vetrovsky (Charles University, Czechia) and colleagues performed a multicentre, randomised, controlled study (NCT03041610) to assess the effect of a 6-month lifestyle walking intervention on functional capacity in patients with HFrEF [1]. The 202 participants were randomised 1:1 to usual care or the walking intervention. The intervention included behaviour change techniques, self-monitoring of daily step count with a wrist-worn wearable device, recording daily steps in a paper diary, goal setting, and phone counselling sessions. The primary outcome was the difference in walking distance, measured by a 6-minute walk test at 6 months.

At 6 months, no significant difference was observed between the control group and the experimental group in the primary outcome, with an adjusted between-group difference of 7.4 meters, numerically favouring the experimental group (95% CI -8.0 to 22.7; P=0.35). “Nonetheless, from baseline, the average daily step count was increased in the intervention group (+790 steps) and decreased in the control group (-667 steps). This difference was significant,” according to Dr Vetrovsky (difference 1,420 steps; 95% CI 749–2,091).

Similarly, the number of daily minutes of moderate to vigorous physical activity was increased in the intervention arm compared with the control arm (adjusted difference 8.2 minutes; 95% CI 3.0–13.3). Moreover, participants in the intervention arm reported an improvement in SF-36 ‘general health’ score, assessing health-related quality of life, compared with those in the control arm (adjusted difference 4.5; 95% CI 0.7–8.4). Other areas of the SF-36 and other secondary outcomes did not reveal differences between the 2 groups at 6 months.

“The increased walking activity that we observed in the intervention arm was not associated with an improvement in functional capacity,” concluded Dr Vetrovsky. “Further research is needed to understand why increased physical activity does not lead to improved functional outcomes in this population.”

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   1. Vetrovsky T, et al. Lifestyle walking intervention in patients with HFrEF: the WATCHFUL trial. FS06, AHA Scientific Sessions 2023, 11–13 November, Philadelphia, USA.

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Posted on 29 January 202429 January 2024