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Home exercise safe, improves CV performance in adults with ICDs
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In a new study, prescribed home exercise was safe and improved CV performance without increasing the occurrence of shocks, hospitalizations or death among adults with an implantable cardioverter defibrillator for primary or secondary prevention.
“These observations should help dispel concerns by providers and patients alike about the benefits and safety of moderately strenuous exercise after an ICD,” the researchers wrote in Circulation. “Having an ICD should not relegate persons to lifelong sedentary activity because of fear of recurrent arrhythmias or ICD shocks.”
Researchers compared the effects of home aerobic exercise vs. usual care in 160 patients (124 men; mean age, 55 years) with an ICD to address safety concerns related to exercise after implantation. Of those, 43% had ischemic heart disease, 30% had nonischemic dilated cardiomyopathy and all were receiving beta-blockers. Patients had their ICD for a mean duration of 3 ± 3.7 years (P = 0.82) when enrolled.
Patients were randomly assigned to usual care or a home aerobic exercise training and maintenance program. Patients prescribed home exercise performed 8 weeks of aerobic training (1 hour/day, 5 days/week) starting at 60% to 65% heart rate reserve, subsequently attaining 80% to 85% heart rate reserve. After the training phase, patients were prescribed 16 weeks of maintenance exercise (about 150 minutes/week) at a continued heart rate reserve of 80%.
The primary outcome of the study was peak oxygen consumption (peak VO2) after aerobic training. Mean peak VO2 was significantly increased at 8 weeks with home exercise vs. usual care (26.7 mL/kg/min vs. 23.9 mL/kg/min; P = .002). This trend persisted during maintenance exercise at 24 weeks (26.9 mL/kg/min vs. 23.4 mL/kg/min; P < .001), according to the results. Furthermore, cardiopulmonary functions including exercise time (P = .001), oxygen consumption at anaerobic threshold (P = .009), oxygen pulse (P = .07) and metabolic equivalents (P = .005) improved compared with home exercise vs. usual care.
Overall, patients prescribed home exercise demonstrated high adherence (more than 75% of prescribed goals). Those with greater adherence (> 80%) to the exercise program had significantly higher peak VO2 and associated exercise outcomes compared with patients who were less adherent.
The researchers reported no deaths and no sudden cardiac arrests among patients prescribed home exercise.
“Aerobic exercise that was strenuous enough to confer cardiopulmonary benefits was implemented without a concomitant increase in arrhythmias, ICD therapies or hospitalizations,” the researchers wrote.
There were no significant differences in the frequency of ICD shocks at the 6-month follow-up (exercise program, 3.5% vs. usual care, 5.3%). In addition, the frequency of antitachycardia pacing therapies and hospitalizations did not differ between the two groups.
Disclosure: The researchers report no relevant financial disclosures.
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