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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“…peak _VO2 and exercise tolerance, reverses skeletal muscle histochemical abnormalities, enhances nutritive blood flow, improves quality of life and probably clinical outcomes for patients with CHF (Sullivan et al., 1988; Coats et al., 1992; Tyni-Lenne et al., 1998; Belardinelli et al., 1999).”
Background
No effect of group-based aerobic interval training on N-terminal pro- B-type natriuretic peptide levels in patients with chronic heart failure
Nilsson, B. B., Westheim, A. S., Risberg, M. A., Arnesen, H., & Seljeflot, I. (2010) · Scandinavian Cardiovascular Journal · doi:10.3109/14017431.2010.496869 · Cited by 27
Exercise training in advanced heart failure patients: Discordance between improved exercise tolerance and unchanged NT-proBNP levels
Arad, M., Adler, Y., Koren‐Morag, N., Natanzon, S., Sela, B., Dov, I. B., Shechter, M., Schwammenthal, E., & Freimark, D. (2007) · International Journal of Cardiology · doi:10.1016/j.ijcard.2007.05.005 · Cited by 27
TAI CHI CHIH AS AN INTERVENTION FOR HEART FAILURE
Fontana, J. A., Colella, C. M., Baas, L. S., & Ghazi, F. (2000) · Nursing Clinics of North America · doi:10.1016/s0029-6465(22)02656-1 · Cited by 27
Improved exercise tolerance and cardiac function in severe chronic heart failure patients undergoing a supervised exercise program
Freimark, D., Shechter, M., Schwammenthal, E., Tanné, D., Elmaleh, E., Shemesh, Y., Motro, M., & Adler, Y. (2007) · International Journal of Cardiology · doi:10.1016/j.ijcard.2006.03.021 · Cited by 26
Effects of exercise training on SFO-mediated sympathoexcitation during chronic heart failure
Llewellyn, T. L., Sharma, N. M., Zheng, H., & Patel, K. P. (2013) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00534.2013 · Cited by 26
“Exercise training (ExT) is an established therapy for HF that improves the health, quality of life, and clinical outcome of patients with this disease (3).”
Background
Muscular Changes in Animal Models of Heart Failure with Preserved Ejection Fraction: What Comes Closest to the Patient?
Goto, K., Schauer, A., Augstein, A., Methawasin, M., Granzier, H. L. M., Halle, M., Craenenbroeck, E. M. V., Rolim, N. P. L., Gielen, S., Pieske, B. M., et al. (2020) · ESC Heart Failure · doi:10.1002/ehf2.13142 · Cited by 25
Just how special are the physical activity cognitions in diseased populations? Preliminary evidence for integrated content in chronic disease prevention and rehabilitation
Rhodes, R. E., & Blanchard, C. M. (2007) · Annals of Behavioral Medicine · doi:10.1007/bf02879912 · Cited by 26
Developing the model of pulmonary rehabilitation for chronic heart failure
Evans, R. A. (2011) · Chronic Respiratory Disease · doi:10.1177/1479972311423111 · Cited by 26
“The first randomized controlled trial involving long-term training (over 1 year) confirmed these improvements in peak exercise capacity and health status with exercise training and also showed a reduction in hospitalisation and mortality.(35) There is now a body of evidence demonstrating that a period of exercise trai…”
Background
Impact of the Preoperative Risk and the Type of Surgery on Exercise Capacity and Training After Valvular Surgery
Pardaens, S., Moerman, V., Willems, A., Calders, P., Bartúnek, J., Vanderheyden, M., & SUTTER, J. D. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.01.413 · Cited by 26
Sedentary behavior & health-related quality of life among congestive heart failure patients
Edwards, M. K., & Loprinzi, P. D. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.06.256 · Cited by 26
Feasibility of a group-based self-management program among congestive heart failure patients
Smeulders, E. S. T. F., van Haastregt, J. C. M., Boyne, J. J., Stoffers, J., van Eijk, J. T. M., & Kempen, G. I. J. M. (2009) · Heart & Lung · doi:10.1016/j.hrtlng.2009.01.007 · Cited by 26
Home-based exercise rehabilitation in addition to specialist heart failure nurse care: design, rationale and recruitment to the Birmingham Rehabilitation Uptake Maximisation study for patients with congestive heart failure (BRUM-CHF): a randomised controlled trial
Jolly, K. B., Tayor, R. S., Lip, G. Y. H., Greenfield, S., Davies, M. K., Davis, R., Mant, J., Singh, S., Ingram, J. T., Stubley, J., et al. (2007) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-7-9 · Cited by 27
Long-term versus intermediate-term supervised exercise training in advanced heart failure: Effects on exercise tolerance and mortality
Tenenbaum, A., Freimark, D., Ahron, E., Koren‐Morag, N., Schwammenthal, E., Fisman, E. Z., Shechter, M., Tanné, D., Kachlon, D., Motro, M., et al. (2006) · International Journal of Cardiology · doi:10.1016/j.ijcard.2005.11.098 · Cited by 26
Muscle reflex in heart failure: the role of exercise training
Wang, H., Zucker, I. H., & Wang, W. (2012) · Frontiers in Physiology · doi:10.3389/fphys.2012.00398 · Cited by 26
“…clinical trials and small randomized studies have demonstrated that long-term regular exercise is safe in stable CHF patients and increases the quality of life as well as survival (Belardinelli et al., 1999; Khan and Sinoway, 2000; Jankowska et al., 2007; Mueller, 2007a; Wisloff et al., 2007).”
Background
Relationship Between the Minnesota Living With Heart Failure Questionnaire and Key Ventilatory Expired Gas Measures During Exercise Testing in Patients With Heart Failure
Arena, R. A., Humphrey, R. H., & Peberdy, M. A. (2002) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200207000-00010 · Cited by 25
Diaphragmatic function after intense exercise in congestive heart failure patients
Kufel, T. J., Pineda, L., Junega, R. G., Hathwar, R., & Mador, M. J. (2002) · European Respiratory Journal · doi:10.1183/09031936.02.00016702 · Cited by 25
Exercise, Aging, and Alzheimer Disease
Larson, E. B., & Wang, L. (2004) · Alzheimer Disease & Associated Disorders · doi:10.1097/01.wad.0000126615.70030.70 · Cited by 25
Exercise training in heart failure
Coats, A. J. S. (2000) · Trials · doi:10.1186/cvm-1-3-155 · Cited by 25
Efficacy and safety of exercise rehabilitation in patients with hypertrophic cardiomyopathy
Wasserstrum, Y., Barbarova, I., Lotan, D., Kuperstein, R., Shechter, M., Freimark, D., Segal, G., Klempfner, R., & Arad, M. (2019) · Journal of Cardiology · doi:10.1016/j.jjcc.2019.04.013 · Cited by 23
Association of Exercise Intolerance With Emotional Distress, Attainment of Social Roles, and Health-Related Quality of Life Among Adult Survivors of Childhood Cancer
Hayek, S., Brinkman, T. M., Plana, J. C., Joshi, V. M., Leupker, R. V., Durand, J., Green, D. M., Partin, R. E., Santucci, A. K., Howell, R. M., et al. (2020) · JAMA Oncology · doi:10.1001/jamaoncol.2020.2054 · Cited by 24
Optimal effectiveness of heart failure management — an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure
Hafkamp, F. J., Tio, R. A., Otterspoor, L., Greef, T. V.-D., van Steenbergen, G. J., van de Ven, A. R. T., Smits, G., Post, H., & van Veghel, D. (2022) · Heart Failure Reviews · doi:10.1007/s10741-021-10212-8 · Cited by 24
Exercise training attenuates chemoreflex-mediated reductions of renal blood flow in heart failure
Marcus, N. J., Pügge, C., Mediratta, J. K., Schiller, A. M., Río, R. D., Zucker, I. H., & Schultz, H. D. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00268.2015 · Cited by 24
Heart Failure in the Elderly
Forman, D. E., & Rich, M. W. (2003) · Congestive Heart Failure · doi:10.1111/j.1527-5299.2003.00798.x · Cited by 25
Endurance Exercise Training in Young Adults with Barth Syndrome: A Pilot Study
Cade, W. T., Reeds, D. N., Peterson, L. R., Bohnert, K. L., Tinius, R. A., Benni, P. B., Byrne, B. J., & Taylor, C. L. (2016) · JIMD Reports · doi:10.1007/8904_2016_553 · Cited by 24
Improvement in aerobic capacity during cardiac rehabilitation in coronary artery disease patients: Is there a role for autonomic adaptations?
Lazzeroni, D., Castiglioni, P., Bini, M., Faini, A., Camaiora, U., Ugolotti, P. T., Centorbi, C. S., Brambilla, L., Brambilla, V., Piepoli, M. F., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316681341 · Cited by 24
Interval training early after heart failure decompensation is safe and improves exercise tolerance and quality of life in selected patients
Doletsky, A., Andreev, D. A., Giverts, I., Svet, A. V., Brand, A., Kuklina, M., Парисович, С. В., Dikur, O., Al, S., & Saner, H. E. (2017) · European Journal of Preventive Cardiology · doi:10.1177/2047487317724575 · Cited by 24
Heart failure with preserved vs reduced ejection fraction following cardiac rehabilitation: impact of endothelial function
Tanaka, S., Sanuki, Y., Ozumi, K., Harada, T., & Tasaki, H. (2018) · Heart and Vessels · doi:10.1007/s00380-018-1128-2 · Cited by 24
“Exercise has proven beneficial for HF patients including improvements in physical capacity [23], quality of life [24], endothelial dysfunction [25], circulating catecholamine levels [26], morbidity, and hospital admissions [27].”
Background
Rehabilitation of patients with congestive heart failure with or without β-blockade therapy
Curnier, D. Y., Galinier, M., Pathak, A., Fourcade, J., Bousquet, M., Sénard, J., Jm, F., Bounhoure, J., & Montastruc, J. (2001) · Journal of Cardiac Failure · doi:10.1054/jcaf.2001.26565 · Cited by 24
Personality as predictor of mortality among patients with congestive heart failure: a two-year follow-up study
Murberg, T. A., Bru, E., & Aarsland, T. (2001) · Personality and Individual Differences · doi:10.1016/s0191-8869(00)00067-2 · Cited by 23
Exercise-Based Rehabilitation for Heart Failure: Clinical Evidence
Ding, R. (2017) · Advances in experimental medicine and biology · doi:10.1007/978-981-10-4304-8_3 · Cited by 23
Low muscle mass assessed by psoas muscle area is associated with clinical adverse events in elderly patients with heart failure
Funamizu, T., Nagatomo, Y., Saji, M., Iguchi, N., Daida, H., & Yoshikawa, T. (2021) · PLoS ONE · doi:10.1371/journal.pone.0247140 · Cited by 23
Correlation between changes in diastolic dysfunction and health-related quality of life after cardiac rehabilitation program in dilated cardiomyopathy
Mehani, S. H. M. (2012) · Journal of Advanced Research · doi:10.1016/j.jare.2012.06.002 · Cited by 23
“[35,36] showed improvement in diastolic dysfunction represented in early and late diastolic filling after 2-month exercise training study of heart failure patients with moderate to severe systolic dysfunction.”
Background
Chronic heart failure: promoting quality of life
While, A., & Kiek, F. (2009) · British Journal of Community Nursing · doi:10.12968/bjcn.2009.14.2.38760 · Cited by 23

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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