Telemonitoring helps gauge heart failure patients’ adherence to home-based exercise training after they have completed a hospital-based course, according to Australian researchers - and adherence is “critical” for sustaining the benefit of exercise training.

“Hospital-based training programs,” senior author Dr. Thomas H. Marwick told Reuters Health, “are effective for increasing functional capacity in heart failure. Obviously people can’t come to the hospital three times a week forever, and we know that the effects of training dissipate over time because people stop training when they aren’t supervised.”

To determine what factors might be important in the success of unsupervised training, Marwick of the University of Queensland, Brisbane, and colleagues studied 30 patients with chronic heart failure.

After completing four months of hospital-based training, the patients continued with eight months of home-based training, according to the report in the American Heart Journal. The patients were given heart rate monitors and were contacted weekly by telephone and e-mail. Heart rate data were downloaded every two weeks.

The researchers examined the heart rate monitoring data and used the information to divide patients into the most adherent and the least adherent groups. The higher rating was based on spending at least one monitored hour per week at greater than 60 percent maximum heart rate. Exercise diaries were also considered.

When patients left the hospital their peak oxygen consumption had increased by 26 percent, but fell to 8 percent after one year. Only the patients in the more adherent group continued to show improvement.

In addition, the more adherent patients showed sustained improvement in measures of quality-of-life, which were lost or attenuated in the non-adherent patients.

The researchers conclude that the response to home-based exercise training is related to compliance. The monitoring measures were well accepted by patients.

Thus, concluded Marwick, “this telemedicine program deals with this critical issue of keeping patients on task with their exercise program, during the post-hospital phase of their training.”

SOURCE: American Heart Journal, December 2005.