The following is a summary of “Obesity Status and Physical Rehabilitation in Older Patients Hospitalized With Acute HF: Insights From REHAB-HF” published in the December 2022 issue of Heart Failure by Peters et al.

While the effects of baseline obesity on the REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial were not examined, the physical function, frailty, quality of life (QOL), and depression of older patients hospitalized with acute decompensated heart failure (ADHF) were all improved by a novel, early, transitional, multidomain rehabilitation intervention. This research looked at a new rehabilitation intervention for ADHF and tested whether or not there were any significant interactions based on BMI subgroups. About 3-month outcomes were compared between those with a low and high body mass index at the start (BMI≥30 kg/m2and BMI<30 kg/m2, respectively) using measures like the Short Physical Performance Battery (primary outcome), the 6-minute walk distance (6MWD), and the Kansas City Cardiomyopathy Questionnaire (KCCQ). 

About 6 outcomes included readmission to the hospital and death from any cause. Adjustments were made for age, gender, clinical site, and ejection fraction category in all analyses, and a baseline measure was used to modify the results at 3 months. About  (P≤ 0.10) was set as the threshold for significance when evaluating treatment interaction by body mass index. About half (204 people) of the 349 people who participated in the study had a body mass index (BMI) of less than 30; another 145 people had a BMI of between 30 and 39. BMI≥30 kg/m2 individuals were younger (age 71± 7 years vs. 75± 9 years), more likely to be female (57% vs. 46%), and had significantly lower baseline physical function and QOL. Adjusted Short Physical Performance Battery(SPPB) effect sizes were marginally greater for participants with BMI<30 kg/m2 than those with BMI <30 kg/m2: +1.7 (95% CI: 0.8-2.7) vs. +1.1 (95% CI: 0.1 to 2.2), respectively. The difference in SPPB effect size between individuals with and without BMI 30 kg/m2 (interaction P = 0.02) was driven primarily by changes in the SPPB’s balance component, which showed a +0.6 (95% CI: 0.2-1.0) for those with a leaner frame and a 0.0 (-0.6 to 0.5) for those with a heavier frame. 

In contrast, participants whose body mass index was below 30 kg/m2 had smaller adjusted 6MWD and KCCQ effect sizes than those whose BMI was above 30 kg/2 (+21 m [-17 to 59] vs. +53 m [6-100] and +5.0 m [-4 to 14] vs. +11 m [0.5 to 22]). For clinical outcomes at 6 months, there was no with significant interaction by BMI (all interaction P > 0.30). Rehabilitation therapy helps older people with ADHF regardless of their body mass index. It is possible that the innovative components of the rehabilitation intervention are responsible for the greater improvement in individuals with obesity on the multidomain measure of physical function (6MWD) than on the 6MWD or the KCCQ.