Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure: Effects on Functional Capacity, Quality of Life, and Clinical Outcome
Abstract
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 &f1;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 &f1;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 VO2. 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 (beta-coefficient=0.378) and posttraining thallium activity score (beta-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.
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Whether physiological adaptations from exercise training will ultimately reduce mortality and morbidity in heart failure is yet to be determined by a large prospective trial, although at least one small trial showed a reduction in hospitalizations and improved 1-year survival.
“Whether these physiological adaptations will ultimately reduce mortality and morbidity is yet to be determined by a large prospective trial, although there is at least one small trial which showed a reduction in hospitalizations and improved 1-year survival.41”
From Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) (2003) · cites this paper as [41]
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BackgroundSelf-care abilities of patients with heart failure
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Doehner, W., Rauchhaus, M., Ponikowski, P., Godsland, I. F., von Haehling, S., Okonko, D. O., Leyva, F., Proudler, A. J., Coats, A. J. S., & Anker, S. D. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.02.093 · Cited by 294 · see citing works
Kemi, O. J., Haram, P. M., Loennechen, J. P., Osnes, J., Skomedal, T., Wisløff, U., & Ellingsen, Ø. (2005) · Cardiovascular Research · doi:10.1016/j.cardiores.2005.03.010 · Cited by 291 · see citing works
Pu, C. T., Johnson, M. T., Forman, D. E., Hausdorff, J. M., Roubenoff, R., Foldvari, M., Fielding, R. A., & Singh, M. A. F. (2001) · Journal of Applied Physiology · doi:10.1152/jappl.2001.90.6.2341 · Cited by 290 · see citing works
“Aerobic exercise interventions have been shown to be tolerable in middle-aged and young-old patients with stable CHF and result in improved aerobic capacity without improving central hemodynamic features (contractility, stroke volume, ejection fraction, chamber diameter, filling times) of the disease (1, 18–20, 24, 62…”
BackgroundImpact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure
Taylor, R. S., Walker, S., Smart, N. A., Piepoli, M. F., Warren, F. C., Ciani, O., Whellan, D. J., O’Connor, C. M., Keteyian, S. J., Coats, A. J. S., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.12.072 · Cited by 288 · see citing works
Exercise-based rehabilitation for heart failure: systematic review and meta-analysis
Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J. S., Dalal, H. M., Lough, F., Rees, K., Singh, S. J., & Taylor, R. S. (2015) · Open Heart · doi:10.1136/openhrt-2014-000163 · Cited by 286 · see citing works
Iron Deficiency Predicts Impaired Exercise Capacity in Patients With Systolic Chronic Heart Failure
Jankowska, E. A., Rozentryt, P., Witkowska, A., Nowak, J., Hartmann, O., Ponikowska, B., Borodulin-Nadzieja, L., von Haehling, S., Doehner, W., Banasiak, W., et al. (2011) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2011.08.003 · Cited by 281 · see citing works
Guidelines for Rehabilitation in Patients With Cardiovascular Disease (JCS 2012)
JCS Joint Working Group (2014) · Circulation Journal · doi:10.1253/circj.cj-66-0094 · Cited by 284 · see citing works
“, those with (1) left ventricular dysfunction (LVEF <40%), (2) prolonged occlusion of the left anterior descending artery (patients who failed in reperfusion therapy), (3) patients with severe three-vessel disease, and (4) elderly patients (≥70 years old).”
BackgroundMethodInfluentialYeh, G. Y., Wood, M. J., Lorell, B. H., Stevenson, L. W., Eisenberg, D. M., Wayne, P. M., Goldberger, A. L., Davis, R. B., & ScD., R. S. P. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2004.04.016 · Cited by 274 · see citing works
“Trials have shown exercise to be associated with mprovements in exercise capacity, left ventricular hemoynamics, and quality of life (2,3); attenuation of neuroormonal activation and ventricular remodeling (4,5); nd decreased risk of hospitalization and death (6).”
Background10-Year Exercise Training in Chronic Heart Failure
Belardinelli, R., Georgiou, D., Cianci, G., & Purcaro, A. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.06.036 · Cited by 263 · see citing works
Self-citationExercise based rehabilitation for heart failure
Rees, K., Taylor, R. R., Singh, S., Coats, A. J., & Ebrahim, S. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003331.pub2 · Cited by 253 · see citing works
Giannuzzi, P. (2003) · European Heart Journal · doi:10.1016/s0195-668x(03)00198-2 · Cited by 252 · see citing works
Wisløff, U. (2002) · Cardiovascular Research · doi:10.1016/s0008-6363(01)00565-x · Cited by 248 · see citing works
Selig, S. E., Carey, M., Menzies, D. G., PATTERSON, J., Geerling, R. H., Williams, A. D., Bamroongsuk, V., Toia, D., Krum, H., & Hare, D. L. (2004) · Journal of Cardiac Failure · doi:10.1016/s1071-9164(03)00583-9 · Cited by 248 · see citing works
Saberi, S., Wheeler, M. T., Bragg‐Gresham, J. L., Hornsby, W., Agarwal, P., Attili, A. K., Concannon, M., Dries, A. M., Shmargad, Y., Salisbury, H., et al. (2017) · JAMA · doi:10.1001/jama.2017.2503 · Cited by 246 · see citing works
Promoting and prescribing exercise for the elderly.
Nied, R. J., & Franklin, B. A. (2002) · PubMed · Cited by 244 · see citing works
Piotrowicz, E., Baranowski, R., Bilinska, M., Stepnowska, M., Piotrowska, M., Wójcik, A., Korewicki, J., Chojnowska, L., Malek, L. A., Klopotowski, M., et al. (2010) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp181 · Cited by 231 · see citing works
Exercise Training in Obese Children and Adolescents
Watts, K., Jones, T. W., Davis, E. A., & GREEN, D. J. (2005) · Sports Medicine · doi:10.2165/00007256-200535050-00002 · Cited by 237 · see citing works
Billman, G. E. (2009) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00534.2009 · Cited by 234 · see citing works
Whellan, D. J., O’Connor, C. M., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., Leifer, E., Kraus, W. E., Kitzman, D. W., Blumenthal, J. A., et al. (2007) · American Heart Journal · doi:10.1016/j.ahj.2006.11.007 · Cited by 234 · see citing works
The Role of Exercise Training in Heart Failure
Downing, J., & Balady, G. J. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.04.020 · Cited by 233 · see citing works
Thompson, P. D. (2003) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000087143.33998.f2 · Cited by 232 · see citing works
Recommendations for exercise training in chronic heart failure patients
(2001) · European Heart Journal · doi:10.1053/euhj.2000.2440 · Cited by 228 · see citing works
“expert groups in the field, the effect of exercise training on morbidity and mortality in this patient population is limited([28]).”
BackgroundTai Chi Exercise in Patients With Chronic Heart Failure
Yeh, G. Y., McCarthy, E. P., Wayne, P. M., Stevenson, L. W., Wood, M. J., Forman, D. E., Davis, R. B., & Phillips, R. S. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.150 · Cited by 226 · see citing works
“org) included (1) taking control of your HF, (2) how to follow a low-sodium diet, (3) HF medicines, (4) self-care and dealing with HF symptoms, (5) exercise and activity, (6) managing feelings about HF, (7) tips for family and friends, (8) lifestyle changes, (9) advanced directives, (10) heart rhythm problems, (11) ne…”
BackgroundInfluentialNuhr, M. J. (2004) · European Heart Journal · doi:10.1016/j.ehj.2003.09.027 · Cited by 226 · see citing works
Kiyuna, L. A., Albuquerque, R. P. E., Chen, C., Mochly‐Rosen, D., & Ferreira, J. C. B. (2018) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2018.09.019 · Cited by 225 · see citing works
Duppen, N., Takken, T., Hopman, M. T. E., ten Harkel, A. D. J., Dulfer, K., Utens, E. M. W. J., & Helbing, W. A. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.05.086 · Cited by 217 · see citing works
Wisløff, U. (2001) · Cardiovascular Research · doi:10.1016/s0008-6363(01)00210-3 · Cited by 215 · see citing works
Clinical evidence for a health benefit from cardiac rehabilitation: An update
Williams, M. A., Ades, P. A., Hamm, L. F., Keteyian, S. J., LaFontaine, T. P., Roitman, J. L., & Squires, R. W. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.05.015 · Cited by 207 · see citing works
“Improvements in shortness of breath, ability to perform activities of daily living, anxiety, depression, and general well-being have been observed using both generic and disease-specific instruments.(34,61,62) The magnitude of the improvement in each variable ranged between 15% and 50%.”
MethodCombined aerobic and resistance exercise training improves functional capacity and strength in CHF
Maiorana, A., O’Driscoll, G., Cheetham, C., Collis, J. J., Goodman, C., Rankin, S. L., Taylor, R. R., & GREEN, D. J. (2000) · Journal of Applied Physiology · doi:10.1152/jappl.2000.88.5.1565 · Cited by 211 · see citing works
Colombo, P. C., Ganda, A., Lin, J., Onat, D., Harxhi, A., Iyasere, J., Uriel, N. Y., & Cotter, G. (2011) · Heart Failure Reviews · doi:10.1007/s10741-011-9261-3 · Cited by 210 · see citing works
Passino, C., Severino, S., Poletti, R., Piepoli, M. F., Mammini, C., Clerico, A., Gabutti, A., Nassi, G., & Emdin, M. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.12.050 · Cited by 195 · see citing works
Garín, O., Ferrer, M., Pont, À., Rué, M., Kotzeva, A., Wiklund, I. E., Ganse, E. H. V., & Alonso, J. (2008) · Quality of Life Research · doi:10.1007/s11136-008-9416-4 · Cited by 192 · see citing works
“Of these, 94 articles [2, 19-111] met the inclusion criteria and were considered eligible for data extraction.”
BackgroundA Structured Exercise Program for Patients with Advanced Non-small Cell Lung Cancer
Temel, J. S., Greer, J. A., Goldberg, S. B., Vogel, P. D., Sullivan, M., Pirl, W. F., Lynch, T. J., Christiani, D. C., & Smith, M. R. (2009) · Journal of Thoracic Oncology · doi:10.1097/jto.0b013e31819d18e5 · Cited by 190 · see citing works
Cardiac Rehabilitation Exercise and Self-Care for Chronic Heart Failure
Ades, P. A., Keteyian, S. J., Balady, G. J., Miller, N. H., Kitzman, D. W., MANCINI, D. M., & Rich, M. W. (2013) · JACC Heart Failure · doi:10.1016/j.jchf.2013.09.002 · Cited by 190 · see citing works
EXERCISE AND AUTONOMIC FUNCTION IN HEALTH AND CARDIOVASCULAR DISEASE
Rosenwinkel, E. T., Bloomfield, D. M., Arwady, M. A., & Goldsmith, R. L. (2001) · Cardiology Clinics · doi:10.1016/s0733-8651(05)70223-x · Cited by 189 · see citing works
Taylor, R. S., Walker, S., Smart, N. A., Piepoli, M. F., Warren, F. C., Ciani, O., O’Connor, C. M., Whellan, D. J., Keteyian, S. J., Coats, A. J. S., et al. (2018) · European Journal of Heart Failure · doi:10.1002/ejhf.1311 · Cited by 191 · see citing works
“Study characteristics Publication year 1990–1999 2 (11) 2000–2009 12 (67) 2010–2012 3 (17) Unpublished 1 (6) Main study location Europe 14 (78) North America* 4 (22) Study centre Single 12 (67) Multiple 5 (28) Not reported 1 (6) Sample size 0–99 10 (56) 100–999 7 (39) ≥1000 1 (6) Duration of follow-up in dataset (mont…”
Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention
Billman, G. E. (2002) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00874.2001 · Cited by 185 · see citing works
Exercise testing in clinical medicine
Ashley, E. A., MYERS, J. N., & Froelicher, V. F. (2000) · The Lancet · doi:10.1016/s0140-6736(00)03138-x · Cited by 184 · see citing works
Exercise-based rehabilitation for heart failure
Taylor, R. S., Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H., Lough, F., Rees, K., Singh, S. J., & Mordi, I. R. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003331.pub4 · Cited by 871 · see citing works
Gender Differences in Patients with Heart Failure
Strömberg, A., & Mårtensson, J. (2003) · European Journal of Cardiovascular Nursing · doi:10.1016/s1474-5151(03)00002-1 · Cited by 177 · see citing works
Freyssin, C., Verkindt, C., Prieur, F., Benaich, P., Maunier, S., & Blanc, P. (2012) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2012.03.007 · Cited by 173 · see citing works
Belardinelli, R., Capestro, F., Misiani, A., Scipione, P., & Georgiou, D. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000230104.93771.7d · Cited by 175 · see citing works
Self-citationExercise based rehabilitation for heart failure
Davies, E., Moxham, T., Rees, K., Singh, S. J., Coats, A. J. S., Ebrahim, S. B. J., Lough, F., & Taylor, R. S. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003331.pub3 · Cited by 173 · see citing works
Home-based versus centre-based cardiac rehabilitation
Taylor, R. S., Dalal, H. M., Jolly, K. B., Zawada, A., Dean, S. G., Cowie, A., & Norton, R. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007130.pub3 · Cited by 169 · see citing works
Bjarnason‐Wehrens, B., Mayer-Berger, W., Meister, E. R., Baum, K., Hambrecht, R., & Gielen, S. (2004) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000137692.36013.27 · Cited by 169 · see citing works
Chronic Exercise Reduces Sympathetic Nerve Activity in Rabbits With Pacing-Induced Heart Failure
Liu, J., Irvine, S. D., Reid, I. A., Patel, K. P., & Zucker, I. H. (2000) · Circulation · doi:10.1161/01.cir.102.15.1854 · Cited by 168 · see citing works
Effects of Exercise Training in Patients with Chronic Heart Failure and Sleep Apnea
Ueno, L. M., Drager, L. F., Rodrigues, A. C. T., Rondon, M. U. P. B., Braga, A., Mathias, W., Krieger, E. M., Barretto, A. C. P., Middlekauff, H. R., Lorenzi‐Filho, G., et al. (2009) · SLEEP · doi:10.1093/sleep/32.5.637 · Cited by 167 · see citing works
The Effect of Physical Training in Chronic Heart Failure
Jónsdóttir, S., Andersen, K. K., Sigurðsson, A. F., & Sigurðsson, S. B. (2005) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2005.05.002 · Cited by 173 · see citing works
Coenzyme Q10 and exercise training in chronic heart failure
Belardinelli, R., Muçaj, A., Lacalaprice, F., Solenghi, M., Seddaiu, G., Principi, F., Tiano, L., & Littarru, G. P. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl158 · Cited by 167 · see citing works
Self-citation
- Authors
- Belardinelli, R., Georgiou, D., Cianci, G., & Purcaro, A.
- Affiliations
- Columbia University (US)
- Venue
- Circulation
- Published
- 1999-03-09
- Volume
- 99
- Issue
- 9
- Pages
- 1173-1182
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2136315725
- Cited by
- 1,099
- References
- 25
- Citations by year
- 2026: 9 · 2025: 20 · 2024: 19 · 2023: 16 · 2022: 26 · 2021: 31 · 2020: 25 · 2019: 25 · 2018: 30 · 2017: 36 · 2016: 37 · 2015: 48 · 2014: 34 · 2013: 38 · 2012: 53
- FWCI
- 101.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- chronic heart failure, exercise training, moderate-intensity aerobic training, functional capacity, peak oxygen uptake, quality of life, myocardial perfusion, thallium scintigraphy, mortality, hospital readmission, ischemic heart disease, ventilatory threshold, prognostic factors
- MeSH terms
- Aged, Echocardiography, Exercise Therapy, Female, Heart Failure, Hemodynamics, Humans, Male, Middle Aged, Myocardium, Patient Readmission, Prospective Studies, Quality of Life, Radionuclide Imaging, Thallium Radioisotopes, Multivariate Analysis, Survival Analysis, Treatment Outcome
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