Differential increase in peak oxygen uptake with cardiac rehabilitation among patients with stage B versus C heart failure.
Eijiro Yagi, Koichiro Matsumura, Kensuke Takabayashi and 9 others
PMID 41706054WHAT IT FOUND
Patients with earlier-stage heart failure gained fitness from cardiac rehabilitation faster than those with advanced heart failure.
Peak oxygen uptake increased by 0.36 mL/kg/min per month in stage B versus 0.22 in stage C. Both groups improved, but the difference was significant.
Key findings
01The increase in peak oxygen uptake per month was significantly greater in the stage B heart failure group (0.36 mL/kg/min) compared to the stage C group (0.22 mL/kg/min).
02Both groups showed significant improvements in peak oxygen uptake from baseline to follow-up, with stage B rising from 17.5 to 18.7 mL/kg/min and stage C rising from 14.6 to 16.1 mL/kg/min.
03Factors associated with improved peak oxygen uptake differed by stage: age, nutritional status, and muscle mass predicted gains in stage B, while diabetes, handgrip strength, and physical performance predicted gains in stage C.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective, so it cannot prove that heart failure stage caused the difference in rehabilitation response. Heart failure staging relied on proxy measures (hospitalization history and diuretic use) rather than symptom severity scales, which may have led to misclassification of some patients. Propensity score matching only adjusted for age and sex, leaving other clinical differences between the groups unbalanced. Adherence to the rehabilitation program and exact exercise doses were not fully tracked across the five centers. The authors note that ceiling effects (limited room for improvement in higher-functioning stage B patients) or floor effects (limited capacity in stage C patients) may have influenced the observed differences in improvement rates.
Declared interests
The authors declared no conflicts of interest with any financial organization.
The easy way to misread this
Do not interpret the faster improvement in stage B patients as evidence that stage C patients benefit less from cardiac rehabilitation. Both groups showed significant gains in peak oxygen uptake; the difference was in the rate of improvement, not the presence of benefit.
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