(Circulation. 1999;99:1173-1182.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure
Effects on Functional Capacity, Quality of Life, and Clinical Outcome
Presented at the 46th Meeting of the American College of Cardiology, Anaheim, Calif, March 16–19, 1997.
From Servizio di Cardiologia Riabilitativa, Istituto Cardiologico "G.M. Lancisi" (R.B., G.C., A.P.), Ancona, Italy, and Department of Medicine, Columbia University (D.G.), New York, NY.
Correspondence to Romualdo Belardinelli, MD, Via Rismondo, 5, 60100 Ancona, Italy. E-mail R.Bellardinelli{at}fastnet.it
Background—It is still a matter of debate whether exercise training (ET) is a beneficial treatment in chronic heart failure (CHF).
Methods and Results—To determine whether long-term moderate ET
improves functional capacity and quality of life in patients with CHF
and whether these effects translate into a favorable outcome,
110 patients with stable CHF were initially recruited, and 99 (59±14
years of age; 88 men and 11 women) were randomized into 2 groups. One
group (group T, n=50) underwent ET at 60% of peak
O2, initially 3 times a week for 8
weeks, then twice a week for 1 year. Another group (group NT, n=49) did
not exercise. At baseline and at months 2 and 14, all patients
underwent a cardiopulmonary exercise test, while 74 patients
(37 in group T and 37 in group NT) with ischemic heart disease
underwent myocardial scintigraphy. Quality of life was
assessed by questionnaire. Ninety-four patients completed the protocol
(48 in group T and 46 in group NT). Changes were observed only in
patients in group T. Both peak O2 and
thallium activity score improved at 2 months (18% and 24%,
respectively; P<0.001 for both) and did not change
further after 1 year. Quality of life also improved and paralleled
peak O2. Exercise training was
associated both with lower mortality (n=9 versus n=20 for those with
training versus those without; relative risk (RR)=0.37; 95% CI, 0.17
to 0.84; P=0.01) and hospital readmission for heart
failure (5 versus 14; RR=0.29; 95% CI, 0.11 to 0.88;
P=0.02). Independent predictors of events were
ventilatory threshold at baseline (ß-coefficient=0.378) and
posttraining thallium activity score (ß-coefficient -0.165).
Conclusions—Long-term moderate ET determines a sustained improvement in functional capacity and quality of life in patients with CHF. This benefit seems to translate into a favorable outcome.
Key Words: exercise training • heart failure • quality of life • prognosis
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F. W. Booth, M. V. Chakravarthy, S. E. Gordon, and E. E. Spangenburg Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy J Appl Physiol, July 1, 2002; 93(1): 3 - 30. [Abstract] [Full Text] [PDF]
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C. Cheetham, D. Green, J. Collis, L. Dembo, and G. O'Driscoll Effect of aerobic and resistance exercise on central hemodynamic responses in severe chronic heart failure J Appl Physiol, July 1, 2002; 93(1): 175 - 180. [Abstract] [Full Text] [PDF]
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J.-L. Liu, J. Kulakofsky, and I. H. Zucker Exercise training enhances baroreflex control of heart rate by a vagal mechanism in rabbits with heart failure J Appl Physiol, June 1, 2002; 92(6): 2403 - 2408. [Abstract] [Full Text] [PDF]
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U. Wisloff, J. P. Loennechen, S. Currie, G. L. Smith, and O. Ellingsen Aerobic exercise reduces cardiomyocyte hypertrophy and increases contractility, Ca2+ sensitivity and SERCA-2 in rat after myocardial infarction Cardiovasc Res, April 1, 2002; 54(1): 162 - 174. [Abstract] [Full Text] [PDF]
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G. Malfatto, G. Branzi, B. Riva, L. Sala, G. Leonetti, and M. Facchini Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure Eur J Heart Fail, March 1, 2002; 4(2): 159 - 166. [Abstract] [Full Text] [PDF]
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G. E. Billman Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention J Appl Physiol, February 1, 2002; 92(2): 446 - 454. [Abstract] [Full Text] [PDF]
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A. Maiorana, G. O'Driscoll, C. Cheetham, L. Dembo, K. Stanton, C. Goodman, R. Taylor, and D. Green The effect of combined aerobic and resistance exercise training on vascular function in type 2 diabetes J. Am. Coll. Cardiol., September 1, 2001; 38(3): 860 - 866. [Abstract] [Full Text] [PDF]
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C. T. Pu, M. T. Johnson, D. E. Forman, J. M. Hausdorff, R. Roubenoff, M. Foldvari, R. A. Fielding, and M. A. F. Singh Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure J Appl Physiol, June 1, 2001; 90(6): 2341 - 2350. [Abstract] [Full Text] [PDF]
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J.F. Forissier, P. Vernochet, P. Bertrand, B. Charbonnier, and C. Monpere Influence of carvedilol on the benefits of physical training in patients with moderate chronic heart failure Eur J Heart Fail, June 1, 2001; 3(3): 335 - 342. [Abstract] [Full Text] [PDF]
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U. Wisloff, J. P. Loennechen, G. Falck, V. Beisvag, S. Currie, G. Smith, and O. Ellingsen Increased contractility and calcium sensitivity in cardiac myocytes isolated from endurance trained rats Cardiovasc Res, June 1, 2001; 50(3): 495 - 508. [Abstract] [Full Text] [PDF]
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U. Wisloff, J. Helgerud, O. J. Kemi, and O. Ellingsen Intensity-controlled treadmill running in rats: {V}O2 max and cardiac hypertrophy Am J Physiol Heart Circ Physiol, March 1, 2001; 280(3): H1301 - H1310. [Abstract] [Full Text] [PDF]
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Recommendations for exercise training in chronic heart failure patients Eur. Heart J., January 2, 2001; 22(2): 125 - 135. [PDF]
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A. C Scott, D. P Francis, L C. Davies, P. Ponikowski, A. J S Coats, and M. F Piepoli Contribution of skeletal muscle 'ergoreceptors' in the human leg to respiratory control in chronic heart failure J. Physiol., December 15, 2000; 529(3): 863 - 870. [Abstract] [Full Text] [PDF]
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K. L. Grady, K. Dracup, G. Kennedy, D. K. Moser, M. Piano, L. W. Stevenson, and J. B. Young Team Management of Patients With Heart Failure : A Statement for Healthcare Professionals From the Cardiovascular Nursing Council of the American Heart Association Circulation, November 7, 2000; 102(19): 2443 - 2456. [Full Text] [PDF]
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J.-L. Liu, S. Irvine, I. A. Reid, K. P. Patel, and I. H. Zucker Chronic Exercise Reduces Sympathetic Nerve Activity in Rabbits With Pacing-Induced Heart Failure : A Role for Angiotensin II Circulation, October 10, 2000; 102(15): 1854 - 1862. [Abstract] [Full Text] [PDF]
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R. Hambrecht, S. Gielen, A. Linke, E. Fiehn, J. Yu, C. Walther, N. Schoene, and G. Schuler Effects of Exercise Training on Left Ventricular Function and Peripheral Resistance in Patients With Chronic Heart Failure: A Randomized Trial JAMA, June 21, 2000; 283(23): 3095 - 3101. [Abstract] [Full Text] [PDF]
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A. Maiorana, G. O'Driscoll, C. Cheetham, J. Collis, C. Goodman, S. Rankin, R. Taylor, and D. Green Combined aerobic and resistance exercise training improves functional capacity and strength in CHF J Appl Physiol, May 1, 2000; 88(5): 1565 - 1570. [Abstract] [Full Text] [PDF]
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C Berry and A.L Clark Catabolism in chronic heart failure Eur. Heart J., April 1, 2000; 21(7): 521 - 532. [PDF]
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H. M. Krumholz, D. W. Baker, C. M. Ashton, S. B. Dunbar, G. C. Friesinger, E. P. Havranek, M. A. Hlatky, M. Konstam, D. L. Ordin, I. L. Pina, et al. Evaluating Quality of Care for Patients With Heart Failure Circulation, March 28, 2000; 101 (12): e122 - e140. [Full Text] [PDF]
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R. Humphrey and R. Arena Surgical Innovations for Chronic Heart Failure in the Context of Cardiopulmonary Rehabilitation Physical Therapy, January 1, 2000; 80(1): 61 - 69. [Full Text] [PDF]
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