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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Gardner, R. S., & McDonagh, T. (2004) · Clinical Medicine · doi:10.7861/clinmedicine.4-1-18 · Cited by 9
Benefits of tai chi in chronic heart failure: Body or mind?
Ades, P. A., & Wu, G. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2004.08.001 · Cited by 9
Long-Term Exercise Training and Adherence
Whellan, D. J. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.07.018 · Cited by 9
Physical activity and cardiac rehabilitation for the primary and secondary prevention of heart failure
Komuro, K., Komuro, J., Ueno, K., Kaneko, H., & Komuro, I. (2024) · Cardiology Plus · doi:10.1097/cp9.0000000000000086 · Cited by 8
The Effect of Exercise Training in Systolic and Diastolic Function
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Physicians’ Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study
Aldhahir, A. M., Alhotye, M., Alqahtani, J. S., Alghamdi, S. M., Alsulayyim, A. S., Alqarni, A. A., Alzahrani, E. M., Siraj, R. A., & Alwafi, H. H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192215208 · Cited by 8
Physical capacity increase in patients with heart failure is associated with improvement in muscle sympathetic nerve activity.
Goes-Santos, B. R., Rondon, E., Fonseca, G., Sales, A. R. K., Santos, M. R., Antunes-Correa, L. M., Ueno-Pardi, L. M., Oliveira, P., Trevizan, P., Franco, F. G. M., et al. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.02.018 · Cited by 8
The Effects and Safety of Exercise Training in Subjects With Chronic Heart Failure—Do Elder Subjects Gain Similar Benefits?
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Körperliches Training bei Herzinsuffizienz
Edelmann, F., & Pieske, B. M. (2013) · Herz · doi:10.1007/s00059-013-3918-8 · Cited by 8
Effects of Ivabradine on Hemodynamic and Functional Parameters in Left Ventricular Systolic Dysfunction: a Systematic Review and Meta-analysis
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“Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases [1-5].”
Background
Telerehabilitation for patients with heart failure.
Tousignant, M., & Mampuya, W. M. (2015) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2223-3652.2015.01.12 · Cited by 8
“Furthermore, CR increases the patients’ sense of control over their disease and helps to better manage their symptoms, which in turn reduce hospital admissions and decrease health care costs (9-13).”
Background
Ca2+ sensitization of cardiac myofilament proteins contributes to exercise training-enhanced myocardial function in a porcine model of chronic occlusion
Sarin, V., Muthuchamy, M., & Heaps, C. L. (2011) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00294.2011 · Cited by 8
Effects of Daily Physical Activity Level on the Degree of Sympathetic Tone
Ino‐Oka, E., Sekino, H., Ohtaki, Y., & Inooka, H. (2009) · Internal Medicine · doi:10.2169/internalmedicine.48.0953 · Cited by 8
“Various measures, including exercise at 60% of the maximum oxygen consumption, aerobic exercise (16, 17), Borg’s scale for perceived exertion (18), or Karvonen’s heart rate reserve method (19) have been used as indices of effective and safe exercise intensity for patients with heart disease.”
Method
Exercise training in heart failure
Piepoli, M. F. (2005) · Current Cardiology Reports · doi:10.1007/s11886-005-0080-9 · Cited by 8
DIRETRIZ DE REABILITAÇÃO CARDIOPULMONAR E METABÓLICA: ASPECTOS PRÁTICOS E RESPONSABILIDADES
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Cardiac Rehabilitation Exercise Training for High-Risk Cardiac Patients
Choi, H. E., Kim, C., & Sohn, Y. (2017) · Annals of Rehabilitation Medicine · doi:10.5535/arm.2017.41.4.650 · Cited by 8
“In the last decade, several studies have demonstrated that HF patients in the New York Heart Association functional class II and III can benefit from moderate exercise training with significant improvements in exercise capacity, quality of life, and reduction in hospitalizations [3,4].”
Background
Exercise for Preventing Hospitalization and Readmission in Adults With Congestive Heart Failure
Aronow, W. S., & Shamliyan, T. (2018) · Cardiology in Review · doi:10.1097/crd.0000000000000210 · Cited by 8
Assessment for Exercise Prescription in Heart Failure
Guazzi, M. (2015) · Cardiac failure review · doi:10.15420/cfr.2015.01.01.46 · Cited by 8
The effectiveness of cardiac rehabilitation in non-ischemic dilated cardiomyopathy patients: A pilot study
Lin, M.-T., Chen, W.-C., Wu, C., Chen, S., & Lee, C.-M. (2019) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2019.08.018 · Cited by 8
Stellenwert von trainingsbedingten Rückwirkungen am arteriellen Gefäßsystem und der Skelettmuskulatur in der Therapie der Herzinsuffizienz NYHA II/III
Huonker, M., & Keul, J. (2001) · Zeitschrift für Kardiologie · doi:10.1007/s003920170080 · Cited by 8
Effect of physical exercise training on health-related quality of life and exercise tolerance in patients with left ventricular dysfunction.
Toda, G., Shibata, S., Nakamizo, R., Seto, S., & Yano, K. (2004) · PubMed · Cited by 8
Current Concepts in Cardiac Rehabilitation Medical Considerations and Outcomes Evaluations
Benzer, W., & Oldridge, N. (2001) · Journal für Kardiologie (Krause & Pachernegg GmbH) · Cited by 8
Exercise Training in Heart Failure: A Long Way to go Yet
Patel, H. C., & Kaye, D. M. (2018) · European Journal of Heart Failure · doi:10.1002/ejhf.1332 · Cited by 8
Improving effect of physical exercise on heart failure: Reducing oxidative stress-induced inflammation by restoring Ca2+ homeostasis
Yuan, S., Kuai, Z., Zhao, F., Xu, D., & Wu, W. (2024) · Molecular and Cellular Biochemistry · doi:10.1007/s11010-024-05124-8 · Cited by 7
Heart Failure Guidelines and Implications for Surgically Treating Heart Failure
Pierce, J. D., Dalton, K., Duke, K., & Spaniol, J. R. (2009) · AORN Journal · doi:10.1016/j.aorn.2009.06.020 · Cited by 7
Long-term physical training in cardiac transplant candidates: is it feasible?
Gal, T. B., Pinchas, A., Zafrir, N., Sahar, G., Berman, M., & Aravot, D. J. (2000) · Transplantation Proceedings · doi:10.1016/s0041-1345(00)00964-7 · Cited by 7
Cardiac Remodeling and Physical Exercise: A Brief Review about Concepts and Adaptations
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The Acute Impact of Different Types of Aerobic Exercise on Arterial Wave Reflections and Inflammation
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Exercise-Based, Comprehensive Cardiac Rehabilitation
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Association Between Physical Activity Intensity and Physical Capacity Among Individuals Awaiting Bariatric Surgery
Rioux, B., Sénéchal, M., Kwok, K., Fox, J., Gamey, D., Bharti, N., Vergis, A., Hardy, K., & Bouchard, D. (2017) · Obesity Surgery · doi:10.1007/s11695-016-2448-x · Cited by 6

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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