Table 1.

Physical activity/exercise randomized controlled trials assessing functional outcomes and health-related quality of life in older adults with heart failure

Study author	Sample & Setting	Intervention	Main findings	Limitations	Strengths
Austin et al. (2004)	N = 185 Age: 71.8 ± 6.5 % Female: 44.5 % Minority: n.s. Clinic individual- based & Community center group-based	2 months with cardiac rehabilitation program including 2x/week education sessions followed by 4 month community based exercise program (aerobic and resistance training) 1x/week for 60 minutes Control: standard care (8 weekly clinic-supervised monitoring of status)	significant improvement at 6 months in intervention group for 6MWT (p<.001) and in MLWHFQ sores (p<.01) compared to control	cardiac rehabilitation program not explained (unknown level/type of exercise)	high participant adherence rate (94%); significant other/partner encouraged to attend community program with participant
Borland et al. (2014)	N = 48 Age: 70.5 ± 8.0 % Female: 20.8 % Minority: n.s. Clinic group-based	3 months with 60 minute twice- weekly, group-based aerobic exercise on cycle ergometry and resistance training Control: wait list; usual care	no difference in steps per day; significant improvement in intervention group at in 6MWT (p=.014), HRQoL [measured with SF-36 (p=.018)], and exercise tolerance (p=.008) compared to control	small percentage female subjects, unknown minority population	All participants attended ≥ 80% of sessions; detailed participant comorbidities
Brubaker et al. (2009)	N = 59 Age: 70.2 ± 5.1 % Female: 33.9 % Minority: 18.6 Clinic group-based	4 months with 60 minute supervised clinic walking and cycle ergometry sessions 3 days/week Control: attention control (bi-weekly phone call)	no statistical difference between groups in 6MWT or MLWHFQ score at end of intervention	older study data (>10 yrs old at publication) prior to pharmacologic standards for HF patients	focus on HF patients with reduced ejection fraction; minority population included
Davidson et al. (2010)	N = 105 Age: 72 ± n.s. % Female: 38.1 % Minority: n.s. Clinic individual and group-based	3 month multidisciplinary individualized exercise program with initial instruction in clinic followed by 1x/wk exercise at community gym near home; goal was 30 minutes moderate physical activity each session Control: usual care (1 information session w/ nurse & f/u with provider)	significant improvement in intervention group 6MWT compared to control (3 months p=.001; 12 months p<.001); significant improvement in intervention group in MLWHFQ at 3 months (p=.01), however at 12 months follow- up there was no significant difference between groups in MLWHFQ	unknown minority inclusion; 6MWT performed at each weekly visit (compensatory intervention)	multi-disciplinary approach; detailed participant comorbidities; individually tailored; reports 12 month readmission statistics (significantly lower in intervention group (p <.001))
Gary et al. (2010)	N = 74 Age: 65.8 ± 13.5 % Female: 57.1 % Minority: 28.4 Individual home- based	3 months with weekly home visits for individual exercise supervision and instruction; 3 groups: exercise therapy (EX), combined exercise and behavioral therapy (CBT/EX), and control (C); behavioral therapy encouraged to walk 3x/week; 30–45 minutes per session Control: usual follow-up care	at 6 month follow-up significant increase in 6MWT in CBT/EX group (p=.002); MLWHFQ improved most in CBT/EX but did not reach significance	small sample size for each group; one academic center; intervention dosage difference between EX & CBT/EX groups (EX 1 weekly visit, CBT/EX 2x/week visit)	included behavioral component; female and minority population well represented; included subjects with major depression
Gary et al. (2004)	N = 32 Age: 68 ± 11.0 % Female: 100 % Minority: 41 Individual home- based	3 month home walking program at 40–60% intensity, 40 min/day, 3 days/week with weekly visits for education Control: heart disease and women’s health education	significant increase in 6MWT distance by intervention group (p=0.002); no difference in perceived function; MLWHFQ scores significantly improved in intervention group (p=.019)	small sample size for each group	minority population represented; included comorbid conditions and subjects with depression
Jolly et al. (2009)	N = 169 Age: 68 ± 12.9 % Female: 25.4 % Minority: 14.9 Individual home- based	3 hospital-based classes followed by 6 month home-based walking and resistance program 20–30 minutes at 70% intensity; encouraged to perform 5 times/week; Home visits at 4, 10, 20 weeks with phone f/u at 6, 15, 24 weeks Control: heart failure education	at 6 and 12 months the intervention group scored higher on MLWHFQ but it was non-significant; at 12 months the control group reported larger decline in physical function but was nonsignificant	self-report on physical activity; adherence dropped from initial 81% to 54% at 20 weeks	larger sample size; follow-up at 6 and 12 months; detailed analysis of within-group differences
McKelvie et al. (2002)	N = 181 Age: 65.9 ± 1.1 % Female: 19 % Minority: n.s Individual clinic- and home-based	3 months supervised training in clinic (treadmill, cycle and upper-body cycle, resistance training; 30 minute session at 60–70% HR) followed by 9 months unsupervised home-based cycle and resistance training Control: instruction to continue usual physical activity	significant increases at 3 months in arm and leg strength in intervention group (p=0.014 and p<0.001, respectively) compared to control; no significant difference between groups in 6MWT or MLWHFQ score at 6 or 12 months	underrepresented female population, unknown minority population; only 43% participants attended ≥ 80% sessions	equipment provided to all intervention participants for home use; measurements at 3 months and 12 months f/u; inclusion of medications
Nilsson et al. (2008)	N = 80 Age: 70.1 ± 7.9 % Female: 21.3 % Minority: n.s. Clinic group-based	4 month program with aerobic dancing 50 min twice weekly and high intensity walking, sidestepping and leg lifts; 4 individual counseling sessions re: nutrition, physical activity, symptom reporting; 4 and 12 month f/u Control: usual care without exercise	significant improvement in intervention group at 6 months in 6MWT (p<.001) and MLWHFQ (p<.005) and at 12 months (6MWT p<.001 and MLWHFQ p=.003) compared to control	unknown minority population; no comorbid conditions cited; excluded frail; control group received intensive visits and education	Tested high-intensity interval training; included medication usage and adherence; investigators offered optional 2 additional sessions between 4- 12 months; 12 month f/u
Wall et al. (2010)	N = 19 Age: 69 ± 4.25 % Female: 42 % Minority: 0 Individual home- based	12 month home-based program using a treadmill at varied speeds for at least 15 minutes 3 times weekly; 3 visits at clinic, weekly home visit for 1 month, then monthly home visit for months 2–12 Control: chronic disease management program without exercise training	no differences in CHFQ results at any time point; Significant decrease in self- perceived fatigue by control group (p=.015) at 6 months, nonsignificant difference at 12 months	small sample size; no minority representation; limited analysis of YPAS for perceived activity level; limited comparability to similar studies for function	equipment provided to all intervention participants for home use; medication usage and adherence; long-term study with 78.9% participation at 12 months
Witham et al. (2005)	N = 82 Age: 80.5 ± 5.0 % Female: 45.2 % Minority: n.s. Clinic group-based and individual home- based	3 months outpatient supervised seated exercise followed by 3 months at home exercise; 20 min. session for 2– 3 times/week; weekly phone call during home-based exercise Control: usual heart failure care without exercise training	at 3 months preservation of FLP scores in intervention group with decline in control but did not reach significance; CHFQ scores did not differ between groups at any time point; no difference between groups in 6MWT at any time point	no discussion of clinical significance; unknown minority inclusion	75% participant adherence to protocol (attending > 80% of sessions);included subjects with multiple comorbidities; older aged of study population; testing of seated-only exercises; supervised intervention 0–3 months with measurement at 6 months
Yeh et al. (2011)	N = 100 Age: 67.4 ± 12.0 % Female: 46 % Minority: 14 Community group- based	3 month Tai Chi group-based program for 1 hour 2x/week; 6 month f/u Control: time-matched education	no significant differences between groups for 6MWT at study completion; significant improvement in MLWHFQ scores in intervention group (p=.02) at 3 months compared to education match; at 6 months follow-up, MLWHFQ differences were non-significant	significant (p=.01) change in use of statin medications in education group during intervention	multisite participation; 75% adherence to exercise protocol during 0–3 months; video of exercises for home use included; at 6 month f/u 68% reported performing exercises 2x/week

N=number of participants randomized, Age=mean age ± s.d., n.s.=not stated, 6MWT=Six Minute Walk Test, SF-36=Short Form Health Survey Questionnaire, MLWHFQ=Minnesota Living With Heart Failure Questionnaire, CHFQ=Chronic Heart Failure Questionnaire, FLP=Functional Limitations Profile, YPAS=Yale Physical Activity Survey