Exercise training in patients with heart failure: A randomized, controlled trial

Objective : To assess the benefit of exercise training in patients with heart failure caused by left ventricular systolic dysfunction and to further describe the physiologic changes associated with exercise training in these patients. Design : Randomized, controlled trial. Setting : Urban outpatient clinic. Patients : 40 men with compensated heart failure who were receiving standard medical therapy were randomly assigned to an exercise-training group or to a control group that did not exercise. Fifteen of the 21 patients assigned to exercise training and 14 of the 19 patients assigned to the control group completed the study. Intervention : Patients assigned to exercise training participated in a program of three exercise sessions per week for 24 weeks. Measurements : Symptom-limited exercise tests with gas exchange analysis done just before randomization, at week 12, and at week 24. Results : At week 24, the following changes (mean ± SE) were seen in patients in the exercise group and patients in the control group, respectively : exercise duration, 2.8 ± 0.6 minutes and 0.5 ± 0.5 minutes ; peak oxygen consumption (VO 2 ), 231 ± 54 Umin and 58 ± 38 Umin ; peak ventilation, 12 ± 3 Umin and -4 ± 3 Umin ; peak heart rate, 10 ± 4 beats/min and -2 ± 4 beats/min ; and peak power output, 20 ± 6 W and 2 ± 5 W. Differences between the increases occurring in the exercise group and the changes occurring in the control group were significant (P< 0.05). Among patients in the exercise group, 85% of the increase in peak VO 2 occurred by week 12, and 46% of the increase in peak VO 2 was caused by the increase in peak heart rate. Conclusions : Exercise training does not appear to be contraindicated in patients with compensated heart failure. Exercise training improved exercise tolerance, as measured by increases in peak VO 2 , exercise duration, and power output. This improved exercise tolerance was caused in part by an increase in peak heart rate.