Cited by 1,099Cardiovascular and exercise physiologyHeart Failure Treatment and ManagementCardiac Health and Mental Health

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Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure: Effects on Functional Capacity, Quality of Life, and Clinical Outcome

Belardinelli, Romualdo, Georgiou, Demetrios, Cianci, Giovanni, Purcaro, Augusto·1999·Circulation

DOI 10.1161/01.cir.99.9.1173

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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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“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…”
Background
Impact 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
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., & Taylor, R. S. (2015) · Open Heart · doi:10.1136/openhrt-2014-000163 · Cited by 300
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
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 288
“, 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).”
BackgroundMethodInfluential
Effects of tai chi mind-body movement therapy on functional status and exercise capacity in patients with chronic heart failure: A randomized controlled trial
Yeh, 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
“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).”
Background
10-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 271
Self-citation
Exercise 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
Secondary Prevention Through Cardiac Rehabilitation Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology
Giannuzzi, P. (2003) · European Heart Journal · doi:10.1016/s0195-668x(03)00198-2 · Cited by 249
Aerobic exercise reduces cardiomyocyte hypertrophy and increases contractility, Ca2+ sensitivity and SERCA-2 in rat after myocardial infarction
Wisløff, U. (2002) · Cardiovascular Research · doi:10.1016/s0008-6363(01)00565-x · Cited by 248
Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow*1
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
Effect of Moderate-Intensity Exercise Training on Peak Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy: A Randomized Clinical Trial
Saberi, S., Wheeler, M., Bragg-Gresham, J., Hornsby, W., Agarwal, P. P., Attili, A., Concannon, M., Dries, A. M., Shmargad, Y., Salisbury, H., et al. (2017) · JAMA · doi:10.1001/jama.2017.2503 · Cited by 241
Promoting and prescribing exercise for the elderly.
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A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: Effectiveness, quality of life, and adherence
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
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
Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: effect of endurance exercise training
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Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION): Design and rationale
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 235
The Role of Exercise Training in Heart Failure
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Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease
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Recommendations for exercise training in chronic heart failure patients
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“expert groups in the field, the effect of exercise training on morbidity and mortality in this patient population is limited([28]).”
Background
Tai 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 231
“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…”
BackgroundInfluential
Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure
Nuhr, M. J. (2004) · European Heart Journal · doi:10.1016/j.ehj.2003.09.027 · Cited by 226
Targeting mitochondrial dysfunction and oxidative stress in heart failure: Challenges and opportunities
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 231
Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease
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
Increased contractility and calcium sensitivity in cardiac myocytes isolated from endurance trained rats
Wisløff, U. (2001) · Cardiovascular Research · doi:10.1016/s0008-6363(01)00210-3 · Cited by 215
Clinical evidence for a health benefit from cardiac rehabilitation: An update
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“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%.”
Method
Combined 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
Inflammatory activation: cardiac, renal, and cardio-renal interactions in patients with the cardiorenal syndrome
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
Aerobic Training Decreases B-Type Natriuretic Peptide Expression and Adrenergic Activation in Patients With Heart Failure
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
Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses
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
“Of these, 94 articles [2, 19-111] met the inclusion criteria and were considered eligible for data extraction.”
Background
A 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
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 196
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 194
Impact of Exercise-Based Cardiac Rehabilitation in Patients with Heart Failure (ExTraMATCH II) on Mortality and Hospitalisation: An Individual Patient Data Meta-Analysis of Randomised Trials
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
“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
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 181
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
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 184
Cardiac Rehabilitation in Chronic Heart Failure: Effect of an 8-Week, High-Intensity Interval Training Versus Continuous Training
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
Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy
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 176
Self-citation
Exercise based rehabilitation for heart failure
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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 178
Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation
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 168
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
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
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
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
Self-citation

Authors: Belardinelli, R., Georgiou, D., Cianci, G., & Purcaro, A.
Affiliations: Columbia University (US)
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1999-03-09
Volume: 99
Issue: 9
Pages: 1173-1182
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.99.9.1173
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 › Physiology (medical) › 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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Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure: Effects on Functional Capacity, Quality of Life, and Clinical Outcome

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