Walking intervention does not lead to better physical function in HF, despite increased steps

A 6-month-long lifestyle walking intervention improves daily steps by about 25 percent in patients with heart failure (HF), although this improvement fails to translate to better functional capacity, according to the results of the WATCHFUL* trial.

WATCHFUL included 202 HF patients (mean age 65.0 years, 22.8 percent women) who had left ventricular ejection fraction <40 percent, New York Heart Association class II or III symptoms, and been on guidelines-recommended medication. None of them exceeded 450 metres on the baseline 6-minute walk test (6MWT).

The patients were randomly assigned to the intervention group or the control group for 6 months. Patients in the intervention group wore an activity tracker and underwent monthly telephone counselling from research nurses who encouraged the application of behaviour change techniques such as self-monitoring, goal-setting, and action planning to increase the patients’ daily step count. On the other hand, patients in the control group received usual care.

At baseline, 90.6 percent of patients had New York Heart Association class II. The median left ventricular ejection fraction was 32.5 percent, the median 6MWT was 385 metres, the average step count was 5,071 per day, and the average duration of moderate to vigorous physical activity per day was 10.9 minutes.

In the intention-to-treat analysis (n=186), the primary outcome of 6MWT at the end of the intervention at 6 months was higher by a mean of 7.4 metres (95 percent confidence interval [CI], −8.0 to 22.7) in the intervention versus the control group, but the difference did not reach significance (p=0.345).

In addition, the intervention led to increases in average daily step count (adjusted between-group difference, 1,420, 95 percent CI, 749–2,091) and average daily minutes of moderate to vigorous physical activity (adjusted between-group difference, 8.2, 95 percent CI, 3.0–13.3).

However, there were no significant between-group differences observed for the other secondary outcomes, namely N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score.

*Pedometer-Based Walking Intervention in Patients With Chronic Heart Failure With Reduced Ejection Fraction