The most important results of this study are the dramatic differences in the hospitalisation rate and also in the survival rate of the training group vs. the control group (p<0.1). The underlying physiological reasons for this are manifold and were explained previously. This has virtually not been demonstrated by any previous study. The impact of this for any health system, insurance and government policy cannot be overestimated.
The above described facts prove beyond any doubt the essential role of exercise training for CHF patients. However, there is still an ongoing discussion about the specific type and/or method, the optimal intensity and exercise duration. The TOUCH study tried to contribute towards answering certain questions in this discussion. Using specific strength training methods is a relatively new approach in the therapy of CHF. This is of particular interest considering the muscular dysfunction and the disease specific muscle atrophy respectively [1,2].

Conclusion
The patients of all training groups could be reclassified according to the NYHA-system by one class. It can be also stated that at no time during the intervention cardiac problems occurred. Furthermore, it can be pointed out that an outpatient training therapy finds a high acceptance in these patients and is practicable at the same time. The results and experiences point at the safe feasibility of different outpatient training interventions and suggest specific positive adaptations in patients with chronic heart failure. The role of this type of treatment from a financial point of view for the NHS or any health care system is also highly important as explained below. There are clear hints that the therapy spectrum could be supplemented significantly in the near future by specific training interventions.

Hospitalisation Details
An average of 10 days per hospitalisation
160-200 Euros a day (small country hospital)
250 Euros a day (major hospital)
= approx. 230 Euros
230 Euros x 10 days = 2300 Euros per patient and hospitalisation

Rehab Details
Training/Exercise intervention per month 111 Euros
After 1 – 3 years 40% of all patients who were included in the study are still exercising twice a week in a referral programme setting and finance their own training with 65 Euros each month.
Total training/exercising hours during the study: 9936 = 10.000
1 incidence occurred during a maximal incremental test on a cycle ergometer.

Cost Calculation
Control Group
9 hospitalisations = 36%

Intervention Group
10 hospitalisations = 15.4%
  • 1 hospitalisations = average of 10 days
  • One day in a German hospital costs an average of 230 Euros

    The following figures in the cost calculation refer to all the patients who completed the study (also see “Methodology”), excluding the subjects who dropped out for personal reasons.

    Control group
    20.700 Euros = 828 Euros per patient in 6 months = 138 Euros per month
    Intervention group
    23.000 Euros = 330 Euros per patient in 6 months = 55 Euro per month

    Savings
    Intervention group
    46 Euros (6 Euros per session) paid by the health insurance per month. In addition another 65 Euros paid by the patient as a substitute for rent and equipment in this specific setting of the study. Plus an average of 55 Euros hospitalisation per month.

    46 + 55 = 101 Euros a month
    Without exercise intervention 138 Euros.

    Savings = 37 Euros per patient and month

    If 50 % of all CHF patients in the UK (approx. 1.000.000/ Germany 1.450.000) would undergo a specific exercise intervention for CHF the overall savings (excluding any savings in medication) the savings in CHF related costs would be:

    37 Euros × 500.000 = 18.500.000 Euros savings a month

    Key Findings of the TOUCH Study

    1. Safety
  • 10.000 hours of exercise/training sessions with patients of the NYHA
        classes II and III without a single incident
  • The effectiveness of a multi-disciplinary approach has been
        proven. The therapy included a weekly examination of
        each patient before exercising by a cardiac nurse
        and the supervision of the training by a qualified sport scientist.

    2. New approach in exercise therapy for CHF; higher intensities are safe and effective
  • High intensities were used in both resistance training methods were proven
        to be safe. In the hypertophic maximal strength training group
        even maximal workloads were accomplished without any problems
  • The blood pressure behaviour was measured during different exercise
        interventions using the FinaPress (see fig 12). The aim was
        to investigate whether there is a difference between endurance
        training and forms of resistance training under special
        consideration of dangerous blood pressure peaks. The result was
        that there is no significant difference between the various
        interventions and that at all times the blood pressure was
        acceptably high.

    3. Extreme improvements regarding cardiac parameters
  • Heart size decreased significantly [LVEDD = left ventricular end-diastolic
        diameter] and the EF increased dramatically, which proves that
        the heart size can be reduced by exercise in these patients
        whose heart is due to compensation mechanisms much too large.
        This effect cannot be produced to this extent by conventional
        drug therapy, telemedicine or dietary interventions.

    4. Cost effectiveness
  • The cost calculations on page 29 prove that a systematic exercise therapy
        in an outpatient setting such as in Exercise Referral Programmes as found
        in the UK and other countries in the EU are cost effective and that patients
        to pay a contribution towards the overall costs. This could lead to dramatic
        are willing cost savings of £2 billion (UK), and 3 billion Euro (Germany).