For many years cardiac failure was considered to be the main contraindication to physical training, and even to exercise testing. However, several studies have now shown a functional improvement after training. These effects are studied in a new programme of rehabilitation, which is less demanding on cardiac output than standard programmes. Twenty five patients with chronic heart failure (ejection fraction (EF) 0.26 +/- 0.10) were randomized into two groups: a control group (C) with 13 patients and a rehabilitation group (R) with 12 patients. In the control group two patients did not complete the study (cancer, cardiac transplantation). For the eleven others, the different parameters studied were comparable at day 0 with group R and did not significantly change over 3 months, apart from a spontaneous 22% improvement in endurance performance. In the rehabilitation group (40 sessions over 90 days, using specialized equipment) there were no incidents. Tolerance was excellent (heart rate during sessions < 115 bpm) and all functional parameters improved. Performance was significantly improved whether under increasing load (from 8.2 +/- 3 min (mean +/- SEM) to 11 +/- 3.4 min; 34%) or endurance (constant load) (9.8 +/- 13 to 19.2 +/- 14 min; 94%). Training did not modify the isotopic ejection fraction. The improvement in the quality of life was estimated by the patients to be 63%, whilst the spontaneous variation in the control group was only 4%. Eighty percent of the patients requested that training be prolonged. The functional improvement obtained by purely peripheral effect had no adverse effect on the heart.

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