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].
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.
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
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.
9 hospitalisations = 36%
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.
20.700 Euros = 828 Euros per patient in 6 months = 138 Euros per month
23.000 Euros = 330 Euros per patient in 6 months = 55 Euro per month
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
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.
- 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.
- 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.
- 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).