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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Background
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Background
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Self-citation
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Background
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BackgroundInfluential
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“With respect to prognosis, 1 observational study and 2 small randomized controlled trials (RCTs) demonstrated a reduction in mortality, cardiovascular events, and rehospitalization in patients with CHF.(51,52,56) However, in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION)…”
Result
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A Randomized Controlled Trial of High-Dose Vitamin D 3 in Patients With Heart Failure
Boxer, R. S., Kenny, R. A., Schmotzer, B. J., Vest, M., Fiutem, J. J., & Piña, I. L. (2013) · JACC Heart Failure · doi:10.1016/j.jchf.2012.11.003 · Cited by 99
Exercise performance following cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay
Auricchio, A., Kloss, M., Trautmann, S. I., Rodner, S., & Klein, H. (2002) · The American Journal of Cardiology · doi:10.1016/s0002-9149(01)02200-7 · Cited by 99
New aspects for the role of physical training in the management of patients with chronic heart failure
Adamopoulos, S. N., Parissis, J., & Kremastinos, D. T. (2003) · International Journal of Cardiology · doi:10.1016/s0167-5273(02)00504-1 · Cited by 99
Resistance Exercise Training in Patients with Heart Failure
Volaklis, K. A., & Tokmakidis, S. P. (2005) · Sports Medicine · doi:10.2165/00007256-200535120-00006 · Cited by 99
“[6-12] The majority of these studies were based function, morphology and metabolism.”
Background
Reduction in Circulating Testosterone Relates to Exercise Capacity in Men With Chronic Heart Failure
Jankowska, E. A., Filippatos, G. S., Ponikowska, B., Borodulin-Nadzieja, L., Anker, S. D., Banasiak, W., Poole-Wilson, P. A., & Ponikowski, P. P. (2009) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2008.12.011 · Cited by 98
Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS)
Levett, D. Z. H., & Grocott, M. P. W. (2015) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-014-0307-6 · Cited by 97
Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery
Rosenfeldt, F., Braun, L. A., Spitzer, O., Bradley, S. J., Shepherd, J., Bailey, M., van der Merwe, J., Leong, J. Y., & Esmore, D. (2011) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-11-20 · Cited by 95
“For instance, patients with chronic heart failure who perform regular moderate exercise have increased functional capacity, greater muscle strength, lower mortality and greater quality of life compared to nonexercising controls [33-35].”
Background
Does Aerobic Training Lead to a More Active Lifestyle and Improved Quality of Life In Patients with Chronic Heart Failure?
van den Berg-Emons, R. J. G., Balk, A. H. M. M., Bussmann, H., & Stam, H. J. (2004) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2003.10.005 · Cited by 97
Does the Collaborative Model Improve Care for Chronic Heart Failure?
Asch, S. M., Baker, D. W., KEESEY, J. W., Broder, M. S., Schonlau, M., Rosen, M., Wallace, P., & Keeler, E. B. (2005) · Medical Care · doi:10.1097/01.mlr.0000167182.72251.a1 · Cited by 95
“In addition, patient education—particularly with regard to the close monitoring of diet, weight, and exercise—can reduce hospitalizations.(8) Despite the prevalence of CHF and the promise of treatment, there are significant gaps in the quality of care that CHF patients receive.”
Background
Exercise training and heart failure: a systematic review of current evidence.
Lloyd‐Williams, F., Mair, F. S., & Leitner, M. (2002) · Europe PMC (PubMed Central) · Cited by 97
Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters
Karapolat, H., Demir, E., Bozkaya, Y. T., Eyigör, S., Nalbantgil, S., Durmaz, B., & Zoghi, M. (2009) · Clinical Research in Cardiology · doi:10.1007/s00392-009-0049-6 · Cited by 95
“muscle strength and mass, New York Heart Association functional class, and quality of life [3, 4].”
Background
Prolonged Electrical Muscle Stimulation Exercise Improves Strength, Peak VO2, and Exercise Capacity in Patients With Stable Chronic Heart Failure
Banerjee, P., Caulfield, B., Crowe, L., & Clark, A. L. (2009) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2008.11.005 · Cited by 97
Physical Exercise Improves The Functional Capacity and Quality of Life in Patients With Heart Failure
Bocalini, D. S., dos SANTOS, L., & Serra, A. J. (2008) · Clinics · doi:10.1590/s1807-59322008000400005 · Cited by 96
Benefits of exercise training in chronic heart failure
Tabet, J., Meurin, P., Driss, A. B., Weber, H., Renaud, N., Grosdemouge, A., Beauvais, F., & Solal, A. C. (2009) · Archives of cardiovascular diseases · doi:10.1016/j.acvd.2009.05.011 · Cited by 93
Accelerometer-Based Quantification of 6-Minute Walk Test Performance in Patients With Chronic Heart Failure: Applicability in Telemedicine
Jehn, M., Schmidt‐Trucksäss, A., Schuster, T., Hanssen, H., Weis, M., Halle, M., & Koehler, F. (2009) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2008.11.011 · Cited by 95
Home-based versus centre-based cardiac rehabilitation
Taylor, R. S., Dalal, H., Jolly, K., Moxham, T., & Zawada, A. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007130.pub2 · Cited by 623
The 12-week progressive quadriceps resistance training improves muscle strength, exercise capacity and quality of life in patients with stable chronic heart failure
Jankowska, E. A., Węgrzynowska‐Teodorczyk, K., Superlak, M., Nowakowska, K., Lazorczyk, M., Biel, B., Kustrzycka−Kratochwil, D., Piotrowska, K., Banasiak, W., Woźniewski, M., et al. (2007) · International Journal of Cardiology · doi:10.1016/j.ijcard.2007.07.158 · Cited by 94
The Impact of Exercise Training on Conduit Artery Wall Thickness and Remodeling in Chronic Heart Failure Patients
Maiorana, A., Naylor, L. H., Exterkate, A., Swart, A., Thijssen, D. H. J., Lam, K. M.-T., O’Driscoll, G., & GREEN, D. J. (2010) · Hypertension · doi:10.1161/hypertensionaha.110.163022 · Cited by 94
Adherence to exercise training in heart failure: a review
Barbour, K. A., & Miller, N. H. (2007) · Heart Failure Reviews · doi:10.1007/s10741-007-9054-x · Cited by 97
“[18] 1999 14 months; supervised bicycle ergometer No methodology information provided”
Method
Nurses's knowledge of heart failure education principles
Albert, N. M., Collier, S., Sumodi, V., Wilkinson, S., Hammel, J., Vopat, L., Willis, C., & Bittel, B. (2002) · Heart & Lung · doi:10.1067/mhl.2002.122837 · Cited by 94
Regulation of central angiotensin type 1 receptors and sympathetic outflow in heart failure
Zucker, I. H., Schultz, H. D., Patel, K. P., Wang, W., & Gao, L. (2009) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00073.2009 · Cited by 94
Exercise-Based Cardiac Rehabilitation for Adults with Heart Failure – 2023 Cochrane Systematic Review and Meta-Analysis
Molloy, C., Long, L., Mordi, I. R., Bridges, C., Sagar, V. A., Davies, E. J., Coats, A. J. S., Dalal, H. M., Rees, K., Singh, S. J., et al. (2023) · European Journal of Heart Failure · doi:10.1002/ejhf.3046 · Cited by 103
Effects of Exercise Training on Left Ventricular Function and Peripheral Resistance in Patients with Chronic Heart Failure
Hambrecht, R., Gielen, S., Linke, A., Fiehn, E., Yu, J., Walther, C., Schoene, N., & Schuler, G. C. (2000) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200011000-00015 · Cited by 93
The Regulation of Sympathetic Outflow in Heart Failure
Zucker, I. H., Wei, W., Pliquett, R. U., LIU, J., & Patel, K. P. (2001) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2001.tb03696.x · Cited by 90
Low-intensity exercise training delays onset of decompensated heart failure in spontaneously hypertensive heart failure rats
Emter, C. A., McCune, S. A., Sparagna, G. C., Radin, M. J., & Moore, R. L. (2005) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00526.2005 · Cited by 92
“Emerging evidence suggests that carefully applied programs of exercise in patients with CHF are generally safe and may improve exercise tolerance, vascular endothelial function, central cardiac function, and overall quality of life (4, 28, 47, 59).”
Effects of short-term moderate exercise training on sexual function in male patients with chronic stable heart failure
Belardinelli, R., Lacalaprice, F., Faccenda, E., Purcaro, A., & Perna, G. (2004) · International Journal of Cardiology · doi:10.1016/j.ijcard.2004.05.020 · Cited by 90
Self-citation
Effect of continuous aerobic vs. interval training on selected anthropometrical, physiological and functional parameters of adults with Down syndrome
Boer, P., & Moss, S. J. (2016) · Journal of Intellectual Disability Research · doi:10.1111/jir.12251 · Cited by 95
Comparison of low-frequency electrical myostimulation and conventional aerobic exercise training in patients with chronic heart failure
Deley, G., Kervio, G., Verges, B., Hannequin, A., Petitdant, M.-F., Salmi-Belmihoub, S., Grassi, B., & Casillas, J.-M. (2005) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000166455.23346.a5 · Cited by 89
Cardiac Rehabilitation Following Percutaneous Revascularization, Heart Transplant, Heart Valve Surgery, and for Chronic Heart Failurea
Stewart, K. J., Badenhop, D. T., Brubaker, P. H., Keteyian, S. J., & King, M. L. (2003) · CHEST Journal · doi:10.1378/chest.123.6.2104 · Cited by 88
Effects of aerobic exercise training in children after the Fontan operation
Opocher, F., Varnier, M., Sanders, S. P., Tosoni, A., Zaccaria, M., Stellin, G., & Milanesi, O. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.08.085 · Cited by 87
Intrinsic skeletal muscle alterations in chronic heart failure patients: a disease-specific myopathy or a result of deconditioning?
Rehn, T. A., Munkvik, M., Lunde, P., Sjaastad, I., & Sejersted, O. M. (2011) · Heart Failure Reviews · doi:10.1007/s10741-011-9289-4 · Cited by 86
“Subsequent studies demonstrate that exercise intervention increases VO2peak [131–134], improves quality of life [131–135] and reduces mortality [131, 136, 137] in these patients.”
Background
A comparison of the shuttle and 6 minute walking tests with measured peak oxygen consumption in patients with heart failure
GREEN, D. J., Watts, K., Rankin, S. L., Wong, P., & O'Driscoll, J. (2001) · Journal of science and medicine in sport · doi:10.1016/s1440-2440(01)80038-4 · Cited by 85
The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy
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Change in circulating cytokines after 2 forms of exercise training in chronic stable heart failure
LeMaitre, J. P., Harris, S., Fox, K. A. A., & Denvir, M. A. (2003) · American Heart Journal · doi:10.1016/j.ahj.2003.07.001 · Cited by 84
Absence of Exercise Capacity Improvement After Exercise Training Program
Tabet, J., Meurin, P., Beauvais, F., Weber, H., Renaud, N., Thabut, G., Solal, A. C., Logeart, D., & Driss, A. B. (2008) · Circulation Heart Failure · doi:10.1161/circheartfailure.108.775460 · Cited by 84
“25,26 Thus, patients with CHF could well benefit from an ETP: (1) it improves exercise capacity and quality of life; (2) it promotes, as Belardinelli et al20 suggested, a favorable outcome for patients who undertake such a training program (the large U.”
Exercise improves cardiac function and glucose metabolism in mice with experimental myocardial infarction through inhibiting HDAC4 and upregulating GLUT1 expression
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Mousa, T. M., Liu, D., Cornish, K. G., & Zucker, I. H. (2007) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00601.2007 · Cited by 82
“EX in patients with CHF increases endurance, quality of life (35, 55), and, of most importance, survival (2, 40, 41).”
Background
Controlled study of myocardial recovery after interval training in heart failure: SMARTEX-HF – rationale and design
Støylen, A., Conraads, V. M., Halle, M., Linke, A., Prescott, E., & Ellingsen, Ø. (2011) · European Journal of Preventive Cardiology · doi:10.1177/1741826711403252 · Cited by 81
Exercise Training in Congestive Heart Failure: Risks and Benefits
Keteyian, S. J. (2011) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2011.02.005 · Cited by 80
Exercise training in patients with severe chronic heart failure: impact on left ventricular performance and cardiac size. A retrospective analysis of the Leipzig Heart Failure Training Trial
Erbs, S., Linke, A., Gielen, S., Fiehn, E., Walther, C., Yu, J., Adams, V., Schuler, G. C., & Hambrecht, R. (2003) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000099031.38268.27 · Cited by 81
Effects of Home-Based Exercise Training on Neurovascular Control in Patients with Heart Failure
Franco, F. G. D. M., dos Santos, A. C., Rondon, M. U. P. B., Trombetta, I. C., Strunz, C. M. C., Braga, A. M. W., Middlekauff, H. R., Negrão, C. E., & Barretto, A. C. P. (2006) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2006.02.009 · Cited by 79

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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