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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BackgroundMethodResultInfluential
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Background
Lifestyle Modification with Diet and Exercise in Obese Patients with Heart Failure – A Pilot Study
Pritchett, A. M., Deswal, A. M., & Aguilar, D. A. (2012) · Journal of Obesity & Weight loss Therapy · doi:10.4172/2165-7904.1000118 · Cited by 42
“Benefits of regular exercise in HF include reduced hospitalization / death, improved functional capacity and quality of life, as well as attenuation of LV remodeling and improved ejection fraction [45,46].”
Background
Comparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes
Hawwa, N., Vest, A. R., Kumar, R., Lahoud, R. N., Young, J. B., Wu, Y., Gorodeski, E. Z., & Cho, L. (2016) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2016.12.002 · Cited by 42
Brain-Derived Neurotrophic Factor Improves Limited Exercise Capacity in Mice With Heart Failure
Matsumoto, J., Takada, S., Kinugawa, S., Furihata, T., Nambu, H., Kakutani, N., Tsuda, M., Fukushima, A., Yokota, T., Tanaka, S., et al. (2018) · Circulation · doi:10.1161/circulationaha.118.035212 · Cited by 42
Acute and Chronic Endothelial Dysfunction: Implications for the Development of Heart Failure
Linke, A., Recchia, F. A., Zhang, X., & Hintze, T. H. (2003) · Heart Failure Reviews · doi:10.1023/a:1022151106019 · Cited by 41
Maximum Oxygen Uptake Corrected for Skeletal Muscle Mass Accurately Predicts Functional Improvements Following Exercise Training in Chronic Heart Failure
LeMaitre, J. P., Harris, S. J., Hannan, J., Fox, K. A. A., & Denvir, M. A. (2005) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2005.07.011 · Cited by 42
“There has been only one previous study suggesting that exercise training can improve prognosis [25] although a more recent meta-analysis of 9 studies has also supported this possibility [26].”
Result
Programas de rehabilitación cardiaca y calidad de vida relacionada con la salud. Situación actual
Cano‐de‐la‐Cuerda, R., Diego, I. M. A., Martín, J. J. A., Sánchez, A. M., & Page, J. C. M. (2011) · Revista Española de Cardiología · doi:10.1016/j.recesp.2011.07.016 · Cited by 50
Review of the Role of Exercise in Improving Quality of Life in Healthy Individuals and in Those With Chronic Diseases
Mitchell, T. L., & Barlow, C. E. (2011) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e318223cc9e · Cited by 41
Surgical Intensive Care Unit Mobility is Increased after Institution of a Computerized Mobility Order Set and Intensive Care Unit Mobility Protocol: A Prospective Cohort Analysis
Hildreth, A. N., Enniss, T. M., Martin, R., Miller, P. R., Mitten-Long, D., Gasaway, J., Ebert, F., Butcher, W., Browder, K., Chang, M., et al. (2010) · The American Surgeon · doi:10.1177/000313481007600824 · Cited by 41
A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure
Celano, C. M., Freedman, M. E., Beale, E. E., Gomez-Bernal, F., & Huffman, J. C. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000883 · Cited by 47
“The PP-based health behavior intervention paired the use of PP exercises with education and systematic goal-setting related to physical activity, low sodium diet, and medication adherence, three key health behaviors in patients with HF (Belardinelli et al., 1999; O'Connor et al., 2009; Pina et al., 2003; Wright et al.…”
BackgroundMethodInfluential
Einsatz von Kraftausdauertraining und Muskelaufbautraining in der kardiologischen Rehabilitation
Bjarnason‐Wehrens, B., Hambrecht, R., Gielen, S., Mayer-Berger, W., Meister, E. R., & Baum, K. (2004) · Zeitschrift für Kardiologie · doi:10.1007/s00392-004-0063-7 · Cited by 42
Avoidance coping styles predict mortality among patients with congestive heart failure: a 6-year follow-up study
Murberg, T. A., Furze, G., & Bru, E. (2003) · Personality and Individual Differences · doi:10.1016/s0191-8869(03)00130-2 · Cited by 41
Cardiac rehabilitation: a comprehensive review
Lear, S. A., & Ignaszewski, A. P. (2001) · Trials · doi:10.1186/cvm-2-5-221 · Cited by 42
“The second study randomized 99 men and women with CHF to a supervised intervention of twice-weekly exercise sessions or to control (usual care, no intervention) for 14 months [51].”
Background
Lessons Learned From Blue Zones, Lifestyle Medicine Pillars and Beyond: An Update on the Contributions of Behavior and Genetics to Wellbeing and Longevity
Kreouzi, M., Theodorakis, N., & Constantinou, C. (2024) · American Journal of Lifestyle Medicine · doi:10.1177/15598276221118494 · Cited by 48
Effect of a Home-Based Mobile Health App Intervention on Physical Activity Levels in Patients With Heart Failure
Saleh, Z. T., Elshatarat, R. A., Elhefnawy, K. A., Elneblawi, N. H., Raddaha, A. H. A., Al-Za'areer, M. S., Almarwani, A. M., Alzahrani, N. S., Aqel, A. A., Shawashi, T. O., et al. (2022) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000911 · Cited by 42
Exercise induces renin–angiotensin system unbalance and high collagen expression in the heart of Mas-deficient mice
Guimarães, G. G., Santos, S. H. S., Oliveira, M. L., Velloso, E. P. P., Motta‐Santos, D., Martins, A. S., Alenina, N. V., Bäder, M., Santos, R. A. S., & Campagnole‐Santos, M. J. (2012) · Peptides · doi:10.1016/j.peptides.2012.05.024 · Cited by 40
Rehabilitation in Cardiac Patients
Hansen, D., Dendale, P., Berger, J. E., & MEEUSEN, R. R. (2005) · Sports Medicine · doi:10.2165/00007256-200535120-00005 · Cited by 42
Peak oxygen uptake
Meyer, T., Scharhag, J., & Kindermann, W. (2005) · Zeitschrift für Kardiologie · doi:10.1007/s00392-005-0207-4 · Cited by 40
“Whereas in healthy individuals VO2peak is mainly considered as an indicator of (aerobic) endurance capacity [16] it is often – partly in concert with other variables – regarded as a descriptor of “functional capacity” in cardiac patients [10, 11, 106].”
Background
Coping and mortality among patients with congestive heart failure
Murberg, T. A., & Bru, E. (2001) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm0801_05 · Cited by 40
The validity of patient and physician estimates of walking distance
Giantomaso, T., Makowsky, L., Ashworth, N. L., & Sankaran, R. (2003) · Clinical Rehabilitation · doi:10.1191/0269215503cr626oa · Cited by 40
Exercise Training as a Therapy for Chronic Heart Failure: Can Older People Benefit?
Witham, M. D., Struthers, A. D., Fesc, & McMurdo, M. E. T. (2003) · Journal of the American Geriatrics Society · doi:10.1034/j.1600-0579.2003.00217.x · Cited by 40
Central mechanisms for exercise training-induced reduction in sympatho-excitation in chronic heart failure
Haack, K. K. V., & Zucker, I. H. (2015) · Autonomic Neuroscience · doi:10.1016/j.autneu.2014.10.015 · Cited by 40
“These data support earlier work showing that mortality was reduced in CHF patients that underwent and exercise training program (Belardinelli et al., 1999; Hagerman et al., 2005; Keteyian et al., 2012; O'Connor et al., 2009; Rosenwinkel et al., 2001; Smart et al., 2004).”
BackgroundResult
Exercise training for patients with cardiovascular disease
Casillas, J.-M., Grémeaux, V., Damak, S., Feki, A., & Pérennou, D. A. (2007) · Annales de Réadaptation et de Médecine Physique · doi:10.1016/j.annrmp.2007.03.007 · Cited by 43
Prior exercise speeds pulmonary oxygen uptake kinetics and increases critical power during supine but not upright cycling
Goulding, R. P., Roche, D. M., & Marwood, S. (2017) · Experimental Physiology · doi:10.1113/ep086304 · Cited by 39
Inhibition of xanthine oxidase in the acute phase of myocardial infarction prevents skeletal muscle abnormalities and exercise intolerance
Nambu, H., Takada, S., Maekawa, S., Matsumoto, J., Kakutani, N., Furihata, T., Shirakawa, R., Katayama, T., Nakajima, T., Yamanashi, K., et al. (2020) · Cardiovascular Research · doi:10.1093/cvr/cvaa127 · Cited by 39
Cardiac adaptation to endurance exercise in rats
Fenning, A. S., Harrison, G., Dwyer, D., Rose’Meyer, R., & Brown, L. (2003) · Molecular and Cellular Biochemistry · doi:10.1023/a:1025465412329 · Cited by 39
Beneficial effects of physical training and methodology of exercise prescription in patients with heart failure.
Papathanasiou, G., Tsamis, N., Γεωργιάδου, Π., & Adamopoulos, S. N. (2008) · PubMed · Cited by 38
Design and Rationale of the EMPA-VISION Trial: Investigating the Metabolic Effects of Empagliflozin in Patients with Heart Failure
Hundertmark, M., Agbaje, O. F., Coleman, R. L., George, J. T., Grempler, R., Holman, R. R., Lamlum, H., Lee, J., Milton, J. E., Niessen, H. G., et al. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13406 · Cited by 37
“Patients with HF experience a significant symptom burden that frequently leads to substantial reductions in QoL and exercise capacity.(62) Modulating cardiac energy metabolism in HF has been shown to improve exercise capacity.”
Background
Do low-frequency electrical myostimulation and aerobic training similarly improve performance in chronic heart failure patients with different exercise capacities?
Deley, G., Eicher, J., Vergès, B. L., Wolf, J., & Casillas, J.-M. (2008) · Acta Dermato Venereologica · doi:10.2340/16501977-0153 · Cited by 38
Exercise as a Nonpharmacologic Intervention in Patients with Heart Failure
Chung, C. J., & Schulze, P. C. (2011) · The Physician and Sportsmedicine · doi:10.3810/psm.2011.11.1937 · Cited by 38
Differential effects of exercise training in men and women with chronic heart failure
Keteyian, S. J., Duscha, B. D., Brawner, C. A., Green, H. J., MARKS, C. R. C., Schachat, F. H., Annex, B. H., & Kraus, W. E. (2003) · American Heart Journal · doi:10.1016/s0002-8703(03)00075-9 · Cited by 38
CARDIAC REHABILITATION: FROM HELLERSTEIN TO THE MILLENNIUM
Bethell, H. J. N. (2000) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2000.tb11856.x · Cited by 38
Exercise prescription for the prevention and treatment of cardiovascular diseases: part I
Giada, F., Biffi, A., Agostoni, P., Anedda, A., Belardinelli, R., Carlon, R., Carù, B., D’Andrea, L., Delise, P., Francesco, A. D., et al. (2008) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e3282f7ca77 · Cited by 39
Self-citation
Nutritional status of outpatients with chronic stable heart failure based on serum amino acid concentration
Tsuji, S., Koyama, S., Taniguchi, R., Fujiwara, T., Fujiwara, H., & Sato, Y. (2018) · Journal of Cardiology · doi:10.1016/j.jjcc.2018.05.007 · Cited by 37
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“In patients with heart failure, exercise contributes to enhanced quality of life, improved functional capacity [2] and lower morbidity and mortality [3].”
Background

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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