This Article Full Text Full Text (PDF) All Versions of this Article: 108/5/554    most recent 01.CIR.0000081780.38477.FAv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Giannuzzi, P. Articles by Tavazzi, L. Search for Related Content PubMed PubMed Citation Articles by Giannuzzi, P. Articles by Tavazzi, L. Related Collections Other heart failure

(Circulation. 2003;108:554.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Antiremodeling Effect of Long-Term Exercise Training in Patients With Stable Chronic Heart Failure

Results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial

Pantaleo Giannuzzi, MD; Pier Luigi Temporelli, MD; Ugo Corrà, MD; Luigi Tavazzi, MD, for the ELVD-CHF Study Group

From the Fondazione Salvatore Maugeri, IRCCS, Veruno (P.G., P.L.T., U.C.), and Ospedale S. Matteo, IRCCS, Pavia (L.T.), Italy.

Correspondence to Dr Pantaleo Giannuzzi, MD, Fondazione Salvatore Maugeri, IRCCS, Via Revislate, 13, 28013 Veruno (NO), Italy. E-mail pgiannuzzi{at}fsm.it

Received January 30, 2003; revision received May 8, 2003; accepted May 9, 2003.

Background— The effects of exercise training (ET) on left ventricular (LV) remodeling in chronic heart failure are not definitively established, and the safety of ET in these patients is still debated.

Methods and Results— This multicenter study investigated the long-term effect of moderate ET on LV remodeling, work capacity, and quality of life (QoL) in 90 patients with stable chronic heart failure caused by LV systolic dysfunction, randomized to a 6-month ET program (T, n=45) or a control group (C, n=45). All patients underwent resting echocardiography, a cardiopulmonary exercise test, 6-minute walking test, and QoL assessment at entry and after 6 months. At entry, end-diastolic (EDV) and end-systolic (ESV) volume, ejection fraction, work capacity, peak O₂, and walking distance were similar in the 2 groups. After 6 months, LV volumes diminished in T (EDV, from 142±26 to 135±26 mL/m², P<0.006; ESV, from 107±24 to 97±24 mL/m², P<0.05) but increased in C (EDV, from 147±41 to 156±42 mL/m², P<0.01; ESV, from 110±34 to 118±34 mL/m², P<0.01). Ejection fraction improved in T (P<0.001) but was unchanged in C (P=NS). Significant improvement in work capacity (P<0.001), peak O₂ (P<0.006), walking distance (P<0.001), and QoL (P<0.01) was observed in T but not in C (P=NS). T showed a trend toward fewer (P=0.05) hospital readmissions for worsening dyspnea in the absence of other adverse cardiac events.

Conclusions— In stable chronic heart failure, long-term moderate ET has no detrimental effect on LV volumes and function; rather, it attenuates abnormal remodeling. Furthermore, ET is safe and effective in improving exercise tolerance and QoL.

Key Words: exercise • heart failure • remodeling

This article has been cited by other articles:

				S. Sixt, S. Beer, M. Bluher, N. Korff, T. Peschel, M. Sonnabend, D. Teupser, J. Thiery, V. Adams, G. Schuler, et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease Eur. Heart J., September 30, 2009; (2009) ehp398v1. [Abstract] [Full Text] [PDF]

				M. C. de Waard and D. J. Duncker Prior exercise improves survival, infarct healing, and left ventricular function after myocardial infarction J Appl Physiol, September 1, 2009; 107(3): 928 - 936. [Abstract] [Full Text] [PDF]

				J.-Y. Tabet, P. Meurin, F. Beauvais, H. Weber, N. Renaud, G. Thabut, A. Cohen-Solal, D. Logeart, and A. B. Driss Absence of Exercise Capacity Improvement After Exercise Training Program: A Strong Prognostic Factor in Patients With Chronic Heart Failure Circ Heart Fail, November 1, 2008; 1(4): 220 - 226. [Abstract] [Full Text] [PDF]

				L. Groban, H. Jobe, M. Lin, T. Houle, D. A. Kitzman, and W. Sonntag Effects of Short-Term Treadmill Exercise Training or Growth Hormone Supplementation on Diastolic Function and Exercise Tolerance in Old Rats J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2008; 63(9): 911 - 920. [Abstract] [Full Text] [PDF]

				M. Beer, D. Wagner, J. Myers, J. Sandstede, H. Kostler, D. Hahn, S. Neubauer, and P. Dubach Effects of Exercise Training on Myocardial Energy Metabolism and Ventricular Function Assessed by Quantitative Phosphorus-31 Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging in Dilated Cardiomyopathy J. Am. Coll. Cardiol., May 13, 2008; 51(19): 1883 - 1891. [Abstract] [Full Text] [PDF]

				A. J. Chicco, S. A. McCune, C. A. Emter, G. C. Sparagna, M. L. Rees, D. A. Bolden, K. D. Marshall, R. C. Murphy, and R. L. Moore Low-Intensity Exercise Training Delays Heart Failure and Improves Survival in Female Hypertensive Heart Failure Rats Hypertension, April 1, 2008; 51(4): 1096 - 1102. [Abstract] [Full Text] [PDF]

				O. J. Kemi, M. A. Hoydal, P. M. Haram, A. Garnier, D. Fortin, R. Ventura-Clapier, and O. Ellingsen Exercise training restores aerobic capacity and energy transfer systems in heart failure treated with losartan Cardiovasc Res, October 1, 2007; 76(1): 91 - 99. [Abstract] [Full Text] [PDF]

				S. E Selig and D. L Hare Evidence-based approach to exercise prescription in chronic heart failure Br. J. Sports Med., July 1, 2007; 41(7): 407 - 408. [Full Text] [PDF]

				M. J. Haykowsky, Y. Liang, D. Pechter, L. W. Jones, F. A. McAlister, and A. M. Clark A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients: The Benefit Depends on the Type of Training Performed J. Am. Coll. Cardiol., June 19, 2007; 49(24): 2329 - 2336. [Abstract] [Full Text] [PDF]

				U. Wisloff, A. Stoylen, J. P. Loennechen, M. Bruvold, O. Rognmo, P. M. Haram, A. E. Tjonna, J. Helgerud, S. A. Slordahl, S. J. Lee, et al. Superior Cardiovascular Effect of Aerobic Interval Training Versus Moderate Continuous Training in Heart Failure Patients: A Randomized Study Circulation, June 19, 2007; 115(24): 3086 - 3094. [Abstract] [Full Text] [PDF]

				M. C. de Waard, J. van der Velden, V. Bito, S. Ozdemir, L. Biesmans, N. M. Boontje, D. H.W. Dekkers, K. Schoonderwoerd, H. C.H. Schuurbiers, R. d. Crom, et al. Early Exercise Training Normalizes Myofilament Function and Attenuates Left Ventricular Pump Dysfunction in Mice With a Large Myocardial Infarction Circ. Res., April 13, 2007; 100(7): 1079 - 1088. [Abstract] [Full Text] [PDF]

				R. Ventura-Clapier, B. Mettauer, and X. Bigard Beneficial effects of endurance training on cardiac and skeletal muscle energy metabolism in heart failure Cardiovasc Res, January 1, 2007; 73(1): 10 - 18. [Abstract] [Full Text] [PDF]

				B. A.F. van Tol, R. J. Huijsmans, D. W. Kroon, M. Schothorst, and G. Kwakkel Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: A meta-analysis Eur J Heart Fail, December 1, 2006; 8(8): 841 - 850. [Abstract] [Full Text] [PDF]

				R. V. Milani, C. J. Lavie, M. R. Mehra, and H. O. Ventura Understanding the Basics of Cardiopulmonary Exercise Testing Mayo Clin. Proc., December 1, 2006; 81(12): 1603 - 1611. [Abstract] [Full Text] [PDF]

				F. Giallauria, R. Lucci, A. De Lorenzo, M. D'Agostino, D. Del Forno, and C. Vigorito Favourable effects of exercise training on N-terminal pro-brain natriuretic peptide plasma levels in elderly patients after acute myocardial infarction Age Ageing, November 1, 2006; 35(6): 601 - 607. [Abstract] [Full Text] [PDF]

				G. Cioffi, L. Tarantini, S. De Feo, G. Pulignano, D. Del Sindaco, C. Stefenelli, and C. Opasich Pharmacological left ventricular reverse remodeling in elderly patients receiving optimal therapy for chronic heart failure Eur J Heart Fail, October 1, 2005; 7(6): 1040 - 1048. [Abstract] [Full Text] [PDF]

				P. Meurin, M. C. Iliou, A. B. Driss, B. Pierre, S. Corone, P. Cristofini, J. Y. Tabet, and on behalf of the Working Group of Cardiac Rehabili Early Exercise Training After Mitral Valve Repair: A Multicentric Prospective French Study Chest, September 1, 2005; 128(3): 1638 - 1644. [Abstract] [Full Text] [PDF]

				O. J. Kemi, P. M. Haram, J. P. Loennechen, J.-B. Osnes, T. Skomedal, U. Wisloff, and O. Ellingsen Moderate vs. high exercise intensity: Differential effects on aerobic fitness, cardiomyocyte contractility, and endothelial function Cardiovasc Res, July 1, 2005; 67(1): 161 - 172. [Abstract] [Full Text] [PDF]

				A D Gavin and A D Struthers Allopurinol reduces B-type natriuretic peptide concentrations and haemoglobin but does not alter exercise capacity in chronic heart failure Heart, June 1, 2005; 91(6): 749 - 753. [Abstract] [Full Text] [PDF]

				A. Dayan, M. S. Feinberg, R. Holbova, N. Deshet, and M. Scheinowitz Swimming Exercise Training Prior to Acute Myocardial Infarction Attenuates Left Ventricular Remodeling and Improves Left Ventricular Function in Rats Ann. Clin. Lab. Sci., January 1, 2005; 35(1): 73 - 78. [Abstract] [Full Text] [PDF]

				V. M. Conraads, P. Beckers, J. Vaes, M. Martin, V. Van Hoof, C. De Maeyer, N. Possemiers, F. L. Wuyts, and C. J. Vrints Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure Eur. Heart J., October 2, 2004; 25(20): 1797 - 1805. [Abstract] [Full Text] [PDF]

				B. Pieske Reverse remodeling in heart failure - fact or fiction? Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D66 - D78. [Abstract] [Full Text] [PDF]

				R. V. Milani, C. J. Lavie, and M. R. Mehra Cardiopulmonary Exercise Testing: How Do We Differentiate the Cause of Dyspnea? Circulation, July 27, 2004; 110(4): e27 - e31. [Full Text] [PDF]