Comparison of Supervised Hospitalbased versus Educated Home-based Exercise Training in Korean Heart Failure Patients

Background and Objectives: Although many clinical trials have shown that exercise training (ET) improves functional capacity and clinical outcomes in heart failure (HF) patients, data comparing supervised hospital-based and educated home-based ET in HF patients is lacking. Subjects and Methods: This was a single-center, non-randomized, prospective study of 82 HF patients with reduced ejection fraction (${\leq}40%$) who completed ET. The hospital-based group (n=30) underwent supervised ET at 60% of peak oxygen consumption ($VO_2$), while a physiotherapist-educated group (n=52) exercised at home without monitoring. The 2 groups were compared before and after the 3-month ET program with respect to functional capacity, quality of life (QOL), and cardiac events (all-cause mortality or hospitalization with worsening HF). Results: After ET, peak $VO_2$ increased in the hospital-based group ($19.4{\pm}4.4$ to $21.4{\pm}4.3mL/min/kg$, p=0.006) and remained unchanged in the home-based group ($18.9{\pm}4.6$ to $18.4{\pm}4.6mL/min/kg$, p=0.660). The change in peak $VO_2$ after ET was greater in the hospital-based group compared to the home-based group by 2.5 mL/min/kg (p=0.014). QOL improved in the hospital-based group ($43.1{\pm}18.0$ to $28.1{\pm}21.6$, p=0.003). During one year of follow-up, a comparison of the 2 groups did not reveal a statistical difference in cardiac events (hazard ratio, 0.66; 95% confidence interval, 0.2-2.8; p=0.570). Conclusion: Hospital-based ET was beneficial for HF patients, improving functional capacity and QOL. However, no significant advantages were observed in terms of a composite endpoint compared to home-based ET. Further investigations are required to address the effects and roles of the 2 ET programs for HF patients.