title: Combined endurance and muscle strength training in female and male patients with chronic heart failure Effect of aerobic and resistance exercise on central hemodynamic responses in severe chronic heart failure. Circuit resistance training in chronic heart failure improves skeletal muscle mitochondrial ATP production rate--a randomized controlled trial. Resistance training for chronic heart failure patients on beta blocker medications. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure The effect of resistance training on left ventricular function and structure of patients with chronic heart failure. Strength/endurance training versus endurance training in congestive heart failure. Combined aerobic and resistance exercise training improves functional capacity and strength in CHF. Skeletal muscle atrophy and peak oxygen consumption in heart failure. Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: a randomized controlled pilot trial Hemodynamic responses during leg press exercise in patients with chronic congestive heart failure. Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow. Is strength training the more efficient training modality in chronic heart failure? Supervised exercise training improves aerobic capacity and muscle strength in older women with heart failure. Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. Reliability of the PEDro scale for rating quality of randomized controlled trials. Peripheral muscle training in patients with clinical signs of heart failure. Effect of resistance exercise on skeletal muscle myopathy in heart transplant recipients. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. High intensity knee extensor training, in patients with chronic heart failure. Major skeletal muscle improvement. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.
abstract: Background Exercise training has now become established practice in patients with chronic heart failure . Women are often under-represented in intervention studies compared to men . For this reason it was our aim to conduct a combined endurance and muscle strength training program to evaluate its effect on clinical performance data and health-related psychosocial factors in women and men . Methods One hundred and sixteen women , mean age 69 ± 9 years , body mass index ( BMI ) 25.8 ± 4.9 , and 169 men , mean age 66 ± 9 years , BMI 26.6 ± 3.6 underwent combined endurance/resistance training .  The training program lasted 29 ± 7 days and comprised bicycle ergometer training , a 6-min walk test as a training unit and muscle strength training for the lower and upper extremities . Results Differences between women and men were found in clinical parameters . In particular , statistically significant differences were revealed between the women and men with regard to cardiopulmonary performance . Quality of life was significantly improved on discharge with regard to both physical and mental health , whereas anxiety and depression showed no significant alteration . Conclusion A specialized in-hospital program for women and men combining endurance/resistance training and education is feasible . But our program revealed a very low level of cardiopulmonary performance in women . Women need to be encouraged and motivated to participate in such programs Exercise is now considered an important component of management in chronic heart failure ( CHF ) , but little is known about central hemodynamic changes that occur during different exercise modalities in these patients . Seventeen patients ( ejection fraction 25 + /- 2 % ) undertook brachial artery and right heart catheterization and oxygen consumption assessment at rest , during submaximal and peak cycling ( Cyc ) , and during submaximal upper and lower limb resistance exercise .  Cardiac output ( CO ) increased relative to baseline during peak Cyc ( P < 0.05 ) but did not change during submaximal Cyc or upper or lower limb exercise .  Heart rate ( HR ) was lowest during upper limb exercise and progressively increased during lower limb exercise , submaximal Cyc , and peak Cyc , with significant differences between each of these ( P < 0.01 ) . Conversely , stroke volume ( SV ) decreased during submaximal Cyc and lower limb exercise and was lower during peak and submaximal Cyc and lower limb exercise than during upper limb exercise ( P < 0.05 ) . CHF patients are dependent on increases in HR to increase CO during exercise when SV may decline . Resistance exercise , performed at appropriate intensity , induces a similar hemodynamic burden to aerobic exercise in patients with CHF BACKGROUND We aim ed to determine the role of skeletal muscle mitochondrial ATP production rate ( MAPR ) in relation to exercise tolerance after resistance training ( RT ) in chronic heart failure ( CHF ) . METHODS AND RESULTS Thirteen CHF patients ( New York Heart Association functional class 2.3 + /- 0.5 ; Left ventricular ejection fraction 26 + /- 8 % ; age 70 + /- 8 years ) underwent testing for peak total body oxygen consumption ( VO(2peak ) ) , and resting vastus lateralis muscle biopsy . Patients were then r and omly allocated to 11 weeks of RT ( n = 7 ) , or continuance of usual care ( C ; n = 6 ) , after which testing was repeated . Muscle sample s were analyzed for MAPR , metabolic enzyme activity , and capillary density . VO(2peak ) and MAPR in the presence of the pyruvate and malate ( P+M ) substrate combination , representing carbohydrate metabolism , increased in RT ( P < .05 ) and decreased in C ( P < .05 ) , with a significant difference between groups ( VO(2peak ) , P = .005 ; MAPR , P = .03 ) . There was a strong correlation between the change in MAPR and the change in peak total body oxygen consumption ( VO(2peak ) ) over the study ( r = 0.875 ; P < .0001 ) , the change in MAPR accounting for 70 % of the change in VO(2peak ) . CONCLUSIONS These findings suggest that mitochondrial ATP production is a major determinant of aerobic capacity in CHF patients and can be favorably altered by muscle strengthening exercise BACKGROUND Resistance training increases the skeletal muscle strength and functional ability of chronic heart failure patients . However , there is limited data regarding the effect of resistance training on the hemodynamic responses and peak oxygen consumption ( peak VO(2 ) ) of chronic heart failure patients treated with beta-blocker . This study examined the effect of resistance training on hemodynamics , peak aerobic capacity , muscle strength and quality of life of chronic heart failure patients on beta-blockers medication . METHODS Fifteen men diagnosed with chronic heart failure were matched to either a resistance training program or non-training control group . At baseline and after 8 weeks of resistance training patients performed both Balke incremental and maximal strength tests and completed quality of life question naires . RESULTS The resistance training group demonstrated a significant increase of walking time and peak VO(2 ) by 11.7 % ( p=0.002 ) and approximately 19 % ( p<0.05 ) , respectively . Peak VO(2 ) was significantly correlated with both walking time ( r=0.54 , p=0.038 ) and change in total weight lifted ( r=0.55 , p=0.034 ) . Quality of life significantly increased by 87 % ( p=0.030 ) . The improvement in quality of life was correlated with post training peak VO(2 ) ( r=0.58 , p=0.025 ) and total weight lifted during the post maximal strength test ( r=-0.52 , p=0.047 ) . CONCLUSIONS The benefits from resistance training for chronic heart failure patients on beta-blocker medication included an increased aerobic and exercise capacity , skeletal muscle strength and most importantly , an improvement in the quality of life , which is the main goal of cardiac rehabilitation programs . Furthermore , with appropriate supervision , it is recommended that resistance exercise be added to the exercise rehabilitation program of these patients when possible CONTEXT Guidelines recommend that exercise training be considered for medically stable out patients with heart failure . Previous studies have not had adequate statistical power to measure the effects of exercise training on clinical outcomes . OBJECTIVE To test the efficacy and safety of exercise training among patients with heart failure . DESIGN , SETTING , AND PATIENTS Multicenter , r and omized controlled trial of 2331 medically stable out patients with heart failure and reduced ejection fraction . Participants in Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training ( HF-ACTION ) were r and omized from April 2003 through February 2007 at 82 centers within the United States , Canada , and France ; median follow-up was 30 months . INTERVENTIONS Usual care plus aerobic exercise training , consisting of 36 supervised sessions followed by home-based training , or usual care alone . MAIN OUTCOME MEASURES Composite primary end point of all-cause mortality or hospitalization and prespecified secondary end points of all-cause mortality , cardiovascular mortality or cardiovascular hospitalization , and cardiovascular mortality or heart failure hospitalization . RESULTS The median age was 59 years , 28 % were women , and 37 % had New York Heart Association class III or IV symptoms . Heart failure etiology was ischemic in 51 % , and median left ventricular ejection fraction was 25 % . Exercise adherence decreased from a median of 95 minutes per week during months 4 through 6 of follow-up to 74 minutes per week during months 10 through 12 . A total of 759 patients ( 65 % ) in the exercise training group died or were hospitalized compared with 796 patients ( 68 % ) in the usual care group ( hazard ratio [ HR ] , 0.93 [ 95 % confidence interval { CI } , 0.84 - 1.02 ] ; P = .13 ) . There were nonsignificant reductions in the exercise training group for mortality ( 189 patients [ 16 % ] in the exercise training group vs 198 patients [ 17 % ] in the usual care group ; HR , 0.96 [ 95 % CI , 0.79 - 1.17 ] ; P = .70 ) , cardiovascular mortality or cardiovascular hospitalization ( 632 [ 55 % ] in the exercise training group vs 677 [ 58 % ] in the usual care group ; HR , 0.92 [ 95 % CI , 0.83 - 1.03 ] ; P = .14 ) , and cardiovascular mortality or heart failure hospitalization ( 344 [ 30 % ] in the exercise training group vs 393 [ 34 % ] in the usual care group ; HR , 0.87 [ 95 % CI , 0.75 - 1.00 ] ; P = .06 ) . In prespecified supplementary analyses adjusting for highly prognostic baseline characteristics , the HRs were 0.89 ( 95 % CI , 0.81 - 0.99 ; P = .03 ) for all-cause mortality or hospitalization , 0.91 ( 95 % CI , 0.82 - 1.01 ; P = .09 ) for cardiovascular mortality or cardiovascular hospitalization , and 0.85 ( 95 % CI , 0.74 - 0.99 ; P = .03 ) for cardiovascular mortality or heart failure hospitalization . Other adverse events were similar between the groups . CONCLUSIONS In the protocol -specified primary analysis , exercise training result ed in nonsignificant reductions in the primary end point of all-cause mortality or hospitalization and in key secondary clinical end points . After adjustment for highly prognostic predictors of the primary end point , exercise training was associated with modest significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00047437 Objective : To determine the short- and long-term effects of an intensive , concentrated rehabilitation programme in patients with chronic heart failure . Design : R and omized controlled trial , with one-month and six-year evaluations . Setting : Residential rehabilitation centre in Switzerl and . Subjects : Fifty patients with chronic heart failure , r and omized to exercise or control groups . Interventions : A rehabilitation programme lasting one month , including educational sessions , a low-fat diet , and 2 hours of individually prescribed exercise daily . Main measures : Exercise test responses , health outcomes and physical activity patterns . Results : Peak Vo2 increased 21.4 % in the exercise group during the rehabilitation programme ( P<0.05 ) , whereas peak Vo2 did not change among controls . After the six-year follow-up period , peak Vo2 was only slightly higher than that at baseline in the trained group ( 7 % , NS ) , while peak Vo2 among controls was unchanged . During long-term follow-up , 9 and 12 patients died in the exercise and control groups , respectively ( P = 0.63 ) . At six years , physical activity patterns tended to be higher in the exercise group ; the mean energy expenditure values over the last year were 2704 ± 1970 and 2085 ± 1522 kcal/week during recreational activities for the exercise and control groups , respectively . However , both groups were more active compared to energy expenditure prior to their cardiac event ( P<0.001 ) . Conclusions : Six years after participation in a residential rehabilitation programme , patients with chronic heart failure had slightly better outcomes than control subjects , maintained exercise capacity and engaged in activities that exceed the minimal amount recommended by guidelines for cardiovascular health INTRODUCTION Resistance training ( RT ) has been shown to improve chronic heart failure ( CHF ) patients '  functional ability and quality of life . Despite these benefits RT has not always been recommend as a form of exercise principally because of a concern for acceleration of the left ventricular ( LV ) remodeling process . This study investigated the effects of 8 weeks RT on the LV structure and function of patients with CHF . METHOD Fifteen men who suffered from CHF were divided into either a RT program or non-training control group . Before and after 8 weeks of training patients underwent resting echocardiography to assess their end-diastolic and end-systolic dimensions ( EDD and ESD , respectively ) , ejection fraction ( EF ) , fractional shortening ( FS ) and stroke volume ( SV ) . RESULTS A repeated measured ANOVA showed that 8 weeks of RT had no significant effect on the LV measurements ( group x time , p>0.05 ) . Post training comparison , however , revealed that the EF and FS of the training group was significantly higher than in the control group ( 40.9+/-10.5 % vs. 30.3+/-4.6 % , p=0.029 and 25.0+/-7.0 % vs. 17.4+/-3.1 % , p=0.020 respectively ) . CONCLUSION RT is a suitable method of training for CHF patients since it does not cause a reduction of LV contractility function or enhance myocardial deterioration as measured by EF and FS PURPOSE The aim of this study was to compare the effects of endurance training alone ( ET ) with combined endurance and strength training ( CT ) on hemodynamic and strength parameters in patients with congestive heart failure ( CHF ) . METHODS Twenty male patients with CHF were r and omized into one of two training regimens consisting of endurance training or a combination of endurance and resistance training . Group ET had 40-min interval cycle ergometer endurance training three times per week . Group CT combined endurance and strength training with the same interval endurance training for 20 min , followed by 20 min of strength training .  Left ventricular function was assessed at baseline and after 40 training sessions by echocardiography and radionuclide ventriculography .  Work capacity was measured with cardiopulmonary exercise test ( CPX ) and lactate determination . Strength was measured with an isokinetic dynamometer . RESULTS After 40 sessions , the ET group improved functional class , work capacity , peak torque , and muscular endurance . However , peak O2 remained unchanged . Left ventricular ejection fraction ( LVEF ) and fractional shortening ( FS ) decreased , whereas left ventricular end-diastolic diameter ( LVED ) increased . The CT group improved NYHA score , working capacity , peak O2 , and peak lactate ; peak torque and muscular endurance , LVEF , and FS increased , whereas LVED decreased . Compared with ET , CT was significantly ( P < 0.05 ) better in improving LV function . CONCLUSION Combined endurance/strength training was superior to endurance training alone concerning improvement of LV function , peak VO2 , and strength parameters . It appears that for stable CHF patients , a greater benefit can be derived from this training modality This study examined the effect of a novel circuit weight training ( CWT ) program on cardiorespiratory fitness , muscular strength , and body composition in 13 patients with chronic heart failure ( CHF ) , using a prospect i ve r and omized crossover protocol . Peak exercise oxygen uptake ( VO(2 peak ) ) increased after the 8-wk CWT program ( 19 . 5 + /- 1.2 vs. 22.0 + /- 1.5 ml . kg(-1 ) . min(-1 ) , P < 0.01 ) , as did exercise test duration ( 15.2 + /- 0.9 vs. 18.0 + /- 1.1 min , P < 0 . 001 ) . Submaximal exercise heart rate was lower after training at 60 and 80 W ( 121 + /- 3 vs. 134 + /- 5 beats/min , P < 0.01 ) as was rate pressure product , whereas ventilatory threshold increased , from 52 + /- 3 to 58 + /- 3 % of VO(2 peak ) ( P < 0.05 ) . CWT also increased maximal isotonic voluntary contractile strength for seven different muscle groups , from 392 to 462 kg ( P = 0.001 ) . CWT , an exercise prescription specifically targeting peripheral abnormalities in CHF , improves functional capacity and muscular strength in these patients We measured skeletal muscle mass and peak oxygen consumption ( VO2 ) in 13 cachectic heart failure patients , 14 noncachectic patients , and in 52 healthy controls to examine skeletal muscle atrophy and its relation to low peak VO2 in heart failure patients . Our results show that skeletal muscle atrophy is associated with prior weight loss and is related to low peak VO2 in heart failure patients Chronic heart failure ( CHF ) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise . Sixteen older women with CHF were compared with 80 age-matched peers without CHF and r and omized to progressive resistance training or control stretching exercises for 10 wk . Women with CHF had significantly lower muscle strength ( P < 0.0001 ) but comparable aerobic capacity to women without CHF . Exercise training was well tolerated and result ed in no changes in resting cardiac indexes in CHF patients . Strength improved by an average of 43.4 + /- 8.8 % in resistance trainers vs. -1.7 + /- 2.8 % in controls ( P = 0.001 ) , muscle endurance by 299 + /- 66 % vs. 1 + /- 3 % ( P = 0.001 ) , and 6-min walk distance by 49 + /- 14 m ( 13 % ) vs. -3 + /- 19 m ( -3 % ) ( P = 0.03 ) . Increases in type I fiber area ( 9.5 + /- 16 % ) and citrate synthase activity ( 35 + /- 21 % ) in skeletal muscle were independently predictive of improved 6-min walk distance ( r2 = 0.78 ; P = 0.0024 ) . High-intensity progressive resistance training improves impaired skeletal muscle characteristics and overall exercise performance in older women with CHF . These gains are largely explained by skeletal muscle and not resting cardiac adaptations Objective : To examined the effects of different training modalities on exercise capacity ( Vo 2peak ) , systolic function , muscular strength and endurance and quality of life in heart failure patients . Design : R and omized controlled trial . Setting : Cardiac rehabilitation centre in Canada . Subjects : Forty-two individuals with heart failure ( 62 ± 12 years ; New York Heart Association ( NYHA ) classes I — III ) . Interventions : Aerobic training ( n = 14 ) , combined aerobic and resistance training ( n = 15 ) or usual care ( n = 13 ) three times per week for 12 weeks . Main measures : ( 1 ) Vo 2peak measured by symptom-limited grade d exercise test on cycle ergometer ; ( 2 ) systolic function assessed by two-dimensional echocardiography ; ( 3 ) muscular strength and muscular endurance measured by one-repetition maximum procedure ; and ( 4 ) quality of life assessed by question naires . Results : In the intention-to-treat analysis , neither aerobic nor combined aerobic and resistance training significantly improved Vo2peak , systolic function or quality of life compared with usual care . However , combined aerobic and resistance training significantly improved upper extremity strength ( 40.7 (14.0)—48.5 ( 16.0 ) kg , P<0.05 ) and muscular endurance ( 5.7 (2.7)—11.6 ( 7.6 ) reps , P<0.05 ) compared with aerobic training or usual care . In compliant participants ( exercise adherence 80 % ) , Vo2peak increased in the aerobic group ( 16.9 (6.0)—19.0 ( 6.8 ) , P= 0.026 ) and tended to increase in the combined training group ( 15.9 (5.0)—17.6 ( 5.6 ) , P= 0.058 ) compared with usual care . Quality of life was improved in the aerobic group only . Conclusions : Both aerobic and combined aerobic and resistance training are effective interventions to improve Vo2peak in compliant heart failure patients . Combined training may be more effective in improving muscle strength and endurance To increase muscle mass and strength in patients with chronic congestive heart failure ( CHF ) , there is a need for implementing resistance exercises in exercise training programs . This study sought to assess the safety of rhythmic strength exercise with respect to left ventricular function in 9 patients with stable CHF , compared with 6 stable coronary patients with mild left ventricular dysfunction ( control group ) . With use of right-sided catheterization , changes in left ventricular function were assessed during double leg press exercise at loads of 60 % and 80 % of maximum voluntary contraction . The exercise sessions lasted 14 minutes each , divided into work and recovery phases of 60/120 seconds . In CHF , during exercise at a 60 % load , there was a significant increase in heart rate ( mean + /- SEM 90 + /- 4 beats/min ; p < 0.05 ) , mean arterial blood pressure ( 95 + /- 3 mm Hg ; p < 0.01 ) , diastolic pulmonary artery pressure ( 20.2 + /- 2.7 mm Hg ; p < 0.01 ) , and cardiac index ( 3 + /- 0.3 L/m2/min ; p < 0.05 ) . Additionally , during leg press exercise at an 80 % load , there was a significant decrease in systemic vascular resistance ( 1,086 + /- 80 dynes x s x cm(-5 ) ; p < 0.001 ) , an increased cardiac index ( 3.4 + /- 0.1 ; p < 0.001 ) , and left ventricular stroke work index ( 75 + /- 5 g x m/m2 ; p < 0.01 ) , suggesting enhanced left ventricular function . Compared with controls , in CHF the magnitude of changes in hemodynamic parameters during exercise , demonstrated at a 60 % load , was significantly smaller ( systemic vascular resistance : [ mean ] 1,613 -- > 1000 vs 1472 -- > 1,247 dynes x s x cm(-5 ) ; cardiac index : 2.4 -- > 3 vs 2.8 -- > 4.4 L/m2/min , and stroke work index : 60 -- > 69 vs 114 -- > 155 g x m/m2 ; p < 0.05 each ) . Nevertheless , changes indicated an enhanced contractile function of the left ventricle in CHF . This study demonstrates stability of left ventricular function during resistance exercise in well-compensated CHF patients with optimal drug therapy , as well as the appropriateness of the chosen mode and intensity applied as these factors relate to cardiovascular stress . This conclusion can not be extrapolated to patients with less well-compensated heart failure , or to more protracted resistance training BACKGROUND Resistance exercise training was applied to patients with chronic heart failure ( CHF ) on the basis that it may partly reverse deficiencies in skeletal muscle strength and endurance , aerobic power ( VO(2peak ) ) , heart rate variability ( HRV ) , and forearm blood flow ( FBF ) that are all putative factors in the syndrome . METHODS AND RESULTS Thirty-nine CHF patients ( New York Heart Association Functional Class=2.3+/-0.5 ; left ventricular ejection fraction 28%+/-7 % ; age 65+/-11 years ; 33:6 male : female ) underwent 2 identical series of tests , 1 week apart , for strength and endurance of the knee and elbow extensors and flexors , VO(2peak ) , HRV , FBF at rest , and FBF activated by forearm exercise or limb ischemia . Patients were then r and omized to 3 months of resistance training ( EX , n=19 ) , consisting of mainly isokinetic ( hydraulic ) ergometry , interspersed with rest intervals , or continuance with usual care ( CON , n=20 ) , after which they underwent repeat endpoint testing . Combining all 4 movement patterns , strength increased for EX by 21+/-30 % ( mean+/-SD , P<.01 ) after training , whereas endurance improved 21+/-21 % ( P<.01 ) . Corresponding data for CON remained almost unchanged ( strength P<.005 , endurance P<.003 EX versus CON ) . VO(2peak ) improved in EX by 11+/-15 % ( P<.01 ) , whereas it decreased by 10+/-18 % ( P<.05 ) in CON ( P<.001 EX versus CON ) . The ratio of low-frequency to high-frequency spectral power fell after resistance training in EX by 44+/-53 % ( P<.01 ) , but was unchanged in CON ( P<.05 EX versus CON ) . FBF increased at rest by 20+/-32 % ( P<.01 ) , and when stimulated by submaximal exercise ( 24+/-32 % , P<.01 ) or limb ischemia ( 26+/-45 % , P<.01 ) in EX , but not in CON ( P<.01 EX versus CON ) . CONCLUSIONS Moderate-intensity resistance exercise training in CHF patients produced favorable changes to skeletal muscle strength and endurance , VO(2peak ) , FBF , and HRV PURPOSE An open , r and omized , controlled study was design ed to study the effects of exclusive strength training ( ST ) in patients with severe chronic heart failure ( CHF ) in comparison with conventional endurance ( ET ) and combined ET-ST training ( CT ) . The hypothesis was that ST would at least be equal to ET or CT , because peripheral muscle atrophy and weakness play a key role in exercise limitation in CHF patients . METHODS Three groups of 15 patients underwent ST , ET , or CT during 40 sessions , three times a week , for 45 min . Fifteen patients served as control group . Before and after intervention , left ventricular ejection fraction ( LVEF ) , peak oxygen consumption ( VO2peak ) , peak workload , thigh muscle volume , knee extensor strength , endurance , and quality of life ( QoL ) were assessed . RESULTS All measured parameters improved significantly in the three training groups , except for knee extensor strength in ET . Training outcome was superior in all three training groups compared with the control group , but statistical significance was only reached for VO2peak and peak workload , thigh muscle volume , and knee extensor endurance . In contrast , knee extensor strength , LVEF , and QoL did not reach statistical significance . None of the training modalities proved to be superior to any other , although small differences between the three groups were observed . CONCLUSION Independently of the training modality , intensive exercise training is efficient in increasing cardiac function , exercise capacity , peripheral muscle function , and QoL in CHF patients BACKGROUND The effect that supervised or unsupervised exercise training has on aerobic capacity ( peak oxygen consumption [ VO2peak ] ) , muscle strength and quality of life in older women with heart failure remains unknown . OBJECTIVE To examine the effect of six months ( three months supervised followed by three months unsupervised ) of aerobic training ( AT ) or combined aerobic and strength training ( CAST ) on VO2peak , muscle strength and quality of life in older women with heart failure . METHODS Twenty older women ( mean age + /- SD , 72+/-8 years ) with clinical ly stable heart failure were r and omly assigned to AT ( n=10 ) or CAST ( n=10 ) . Supervised AT was performed two days per week at 60 % to 70 % heart rate reserve , whereas unsupervised training was performed two days per week at a rate of perceived exertion of 12 to 14 on the Borg scale . The CAST group also performed one to two sets of low-to-moderate intensity strength training two days per week . RESULTS Supervised AT or CAST result ed in an increase in VO2peak ( 12 % ; P<0.05 ) and leg press strength ( 13 % ; P<0.05 ) that returned to baseline after unsupervised training .  Vertical row strength was greater ( + 23 % ; P<0.05 ) after supervised CAST and remained unchanged after supervised or unsupervised AT . Supervised or unsupervised exercise training was not associated with a significant change in quality of life . CONCLUSIONS Supervised AT or CAST are effective modes of exercise to improve VO2peak and muscle strength in older women with heart failure . However , the improvements in VO2peak and muscle strength are not maintained with unsupervised exercise training BACKGROUND Beneficial training outcomes have been reported in patients with chronic heart failure ( CHF ) following leg exercise training .  However , data from more comprehensive training programs are limited . The aim of this study was to test the hypothesis that exercise training applying the concept of comprehensive local muscle training can improve aerobic and functional working capacity as well as quality of life in patients with CHF . METHODS Twenty-four men and women [ age 63+/-9 years ( mean+/-S.D. ) ] with stable , moderate chronic heart failure ( left ventricular ejection fraction 30+/-10 % ) , were investigated in a r and omized controlled study with a training group of 16 patients and a  control group of 8 patients . The training was performed as an aerobic resistance training by activating all the main muscle groups , one at a time . The patients exercised for 1 h , three times per week for 8 weeks . RESULTS Patient groups did not differ at baseline . Peak oxygen uptake ( 8 % , P<0.03 ) , the distance walked in a 6-min walking test ( 11 % , P<0.002 ) , the health-related quality of life ( P<0.001 ) and plasma norepinephrine levels at rest ( 32 % , P<0.003 ) and at submaximal intensities ( P<0.03 ) improved after training . No changes were found in the control group , except for decreased peak oxygen uptake ( P<0.02 ) and quality of life scores ( P<0.03 ) . CONCLUSIONS Since comprehensive physical training activating a minor muscle mass at a time markedly improves exercise capacity and quality of life and reduces catecholamine levels , it can be recommended for the rehabilitation of patients with CHF under supervision of a physical therapist BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . The aim of the study was to evaluate , in a controlled setting , the effects of a 5-month dynamic peripheral training programme in patients with clinical signs of congestive heart failure with special reference to their anaerobic threshold , muscle function , heart rate variability and quality of life . Twenty-four r and omized patients with clinical signs of heart failure in NYHA II-III entered the study . Training result ed in a significant ( p = 0.01 ) change in the anaerobic threshold , the patients ' ability to lift weights ( p = 0.01 ) and performance of heel-lift ( p = 0.01 ) . The heart rate recorded during the training exercises decreased significantly ( p = 0.04 ) . There were no significant differences in peak oxygen uptake , isokinetic and isometric strength , HRV and quality of life except for three items in the control group . The results of this study indicate that peripheral training is beneficial for patients with clinical signs of congestive heart failure The purpose of this study was to determine the efficacy of resistance exercise in reversing skeletal muscle myopathy in heart transplant recipients . Myopathy , engendered by both heart failure and immunosuppression with glucocorticoids , is a post-transplant complication . The sequelae of myopathic disease includes fiber-type shifts and deficits in aerobic metabolic capability . We r and omly assigned patients to either 6 months of  resistance exercise ( training group ; n = 8) or a control ( control group ;  n = 7 ) group . Exercise was initiated at 2 months after transplant . Biopsy of the right vastus lateralis was performed before and after the 6-month intervention . Myosin heavy chain ( MHC ) composition was assessed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Biochemical assays were performed to determine citrate synthase , 3-hydroxyacyl-CoA-dehydrogenase , and lactate dehydrogenase activity . There were no group differences ( p > or=0.05 ) in MHC composition and enzymatic reserve at baseline . Improvements in the training group for citrate cynthase ( + 40 % ) , 3-hydroxyacyl-CoA-dehydrogenase ( + 10 % ) , and lactate dehydrogenase activity ( + 48 % ) were significantly greater ( p < or=0.05 ) than in the control group ( + 10 % , -15 % , and + 20 % , respectively ) . Oxidative type 1 MHC isoform concentration increased significantly in the training group ( + 73 % , p < or=0.05 ) but decreased in the control group ( -28 % ; p < or=0.05 ) . Glycolytic type 2x MHC isoform increased significantly ( 17 % ; p < or=0.05 ) in the control group but decreased ( -33 % ; p < or=0.05 ) in the training group . This is the first study to demonstrate that resistance training elicits myofibrillar shifts from less oxidative type II fibers to more oxidative fatigue-resistant type I fibers in heart transplant recipients .  Resistance exercise initiated early in the post-transplant period is efficacious in changing skeletal muscle phenotype through increases in enzymatic reserve and shifts in fiber morphology AIMS To determine the prevalence , incidence rate , lifetime risk and prognosis of heart failure . METHODS AND RESULTS The Rotterdam Study is a prospect i ve population -based cohort study in 7983 participants aged > or = 55 .  Heart failure was defined according to criteria of the European Society of Cardiology . Prevalence was higher in men and increased with age from 0.9 % in subjects aged 55 - 64 to 17.4 % in those aged > or = 85 . Incidence rate of heart failure was 14.4/1000 person-years ( 95 % CI 13.4 - 15.5 ) and was higher in men ( 17.6/1000 man-years , 95 % CI 15.8 - 19.5 ) than in women ( 12.5/1000 woman-years , 95 % CI 11.3 - 13.8 ) . Incidence rate increased with age from 1.4/1000 person-years in those aged 55 - 59 to 47.4/1000 person-years in those aged > or = 90 . Lifetime risk was 33 % for men and 29 % for women at the age of 55 . Survival after incident heart failure was 86 % at 30 days , 63 % at 1 year , 51 % at 2 years and 35 % at 5 years of follow-up . CONCLUSION Prevalence and incidence rates of heart failure are high . In individuals aged 55 , almost 1 in 3 will develop heart failure during their remaining lifespan . Heart failure continues to be a fatal disease , with only 35 % surviving 5 years after the first diagnosis Skeletal muscle adaptations to high intensity knee extensor strength and /or endurance training in patients with chronic heart failure were investigated . Eleven patients with chronic heart failure were r and omized into two groups and exercised the m. quadriceps femoris 3 days/week for 8 weeks . After training , the maximal exercise intensity tolerated on the ergometer cycle was raised from 99 ( 32 ) to 114 ( 40 ) watts ( W , P < 0.05 ) for all 11 patients . Peak dynamic knee extensor work rate showed the greatest increase after endurance training ( 40 % , P < 0.01 ) . Maximal dynamic and isometric strength were elevated by 40 - 45 % ( P < 0.05 ) after strength training . The cross-sectional area of m. quadriceps femoris was increased in the strength-trained legs ( 9 % , P < 0.05 ) , and the capillary per fibre ratio of m. vastus lateralis was raised by 47 and 58 % in the endurance-trained legs ( P < 0.05 ) . The oxidative enzyme activity in m. vastus lateralis was significantly raised above 50 % after endurance training , whereas glycolytic enzyme activity was unaltered . The peripheral skeletal musculature in patients with chronic heart failure adapts fairly quickly to high intensity knee extensor training . This results in a marked rise in local , and a small rise in total work capacity , indicating maintained plasticity of skeletal muscle in chronic heart failure patients CONTEXT Findings from previous studies of the effects of exercise training on  patient-reported health status  have been inconsistent . OBJECTIVE To test the effects of exercise training on health status among patients with heart failure . DESIGN , SETTING , AND PATIENTS Multicenter , r and omized controlled trial among 2331 medically stable out patients with heart failure with left ventricular ejection fraction of 35 % or less . Patients were r and omized from April 2003 through February 2007 . INTERVENTIONS Usual care plus aerobic exercise training ( n = 1172 ) , consisting of 36 supervised sessions followed by home-based training , vs usual care alone ( n = 1159 ) . R and omization was stratified by heart failure etiology , which was a covariate in all models . MAIN OUTCOME MEASURES Kansas City Cardiomyopathy Question naire ( KCCQ ) overall summary scale and key subscales at baseline , every 3 months for 12 months , and annually thereafter for up to 4 years . The KCCQ is scored from 0 to 100 with higher scores corresponding to better health status . Treatment group effects were estimated using linear mixed models according to the intention-to-treat principle . RESULTS Median follow-up was 2.5 years . At 3 months , usual care plus exercise training led to greater improvement in the KCCQ overall summary score ( mean , 5.21 ; 95 % confidence interval , 4.42 to 6.00 ) compared with usual care alone ( 3.28 ; 95 % confidence interval , 2.48 to 4.09 ) . The additional 1.93-point increase ( 95 % confidence interval , 0.84 to 3.01 ) in the exercise training group was statistically significant ( P < .001 ) . After 3 months , there were no further significant changes in KCCQ score for either group ( P = .85 for the difference between slopes ) , result ing in a sustained , greater improvement overall for the exercise group ( P < .001 ) . Results were similar on the KCCQ subscales , and no subgroup interactions were detected . CONCLUSIONS Exercise training conferred modest but statistically significant improvements in self-reported health status compared with usual care without training . Improvements occurred early and persisted over time . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00047437
target: Resistance training increased 6-minute walk distance compared to no training , but had no other benefits on cardiac function , exercise capacity , or quality of life if used alone or as an adjunct to aerobic training in people with chronic heart failure .
background: QUESTION Does resistance training , either alone or as an adjunct to aerobic training , improve cardiac function , exercise capacity and quality of life in people with chronic heart failure ?