Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure

<jats:p> <jats:italic>Background</jats:italic> —It is still a matter of debate whether exercise training (ET) is a beneficial treatment in chronic heart failure (CHF). </jats:p> <jats:p> <jats:italic>Methods and Results</jats:italic> —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 V̇ <jats:sc>o</jats:sc> <jats:sub>2</jats:sub> , 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 V̇ <jats:sc>o</jats:sc> <jats:sub>2</jats:sub> and thallium activity score improved at 2 months (18% and 24%, respectively; <jats:italic>P</jats:italic> <0.001 for both) and did not change further after 1 year. Quality of life also improved and paralleled peak V̇ <jats:sc>o</jats:sc> <jats:sub>2</jats:sub> . 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; <jats:italic>P</jats:italic> =0.01) and hospital readmission for heart failure (5 versus 14; RR=0.29; 95% CI, 0.11 to 0.88; <jats:italic>P</jats:italic> =0.02). Independent predictors of events were ventilatory threshold at baseline (β-coefficient=0.378) and posttraining thallium activity score (β-coefficient −0.165). </jats:p> <jats:p> <jats:italic>Conclusions</jats:italic> —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. </jats:p>