AIM: The aim of this study is to evaluate the effect of a combined program of two or three modalities: aerobic interval training (AIT), inspiratory muscle training (IMT), and resistance training (RT), on cardiac function, exercise capacity and dyspnoea in heart failure (HF). Moreover, this study aims to find the best training exercise that could have additional benefits on measured parameters, thus providing a novel application in cardiac rehabilitation programs. METHODS: 60 patients with HF, left ventricle ejection fraction <= 45% and inspiratory muscle weakness were randomly assigned to one of the six following groups (n = 10, for each group): Control, AIT, IMT, RT, AIT plus IMT and AIT plus IMT plus RT (combined group: CT). AIT was performed at 60% of maximum heart rate, IMT at 60% of maximal inspiratory pressure and RT at 60% of 1 repetition maximum. The control group patients had no training at all. The training regimens were performed 3 times per week for 12 weeks. RESULTS: All groups showed significant positive effects on almost all the measured parameters. However, the combination of IMT to AIT and the addition of RT to IMT and AIT (CT group) were the most powerful modalities and resulted in additional benefits over all training modalities. For example, the improvements (post-training versus pre-training) on ejection fraction was 29% (p < 0.001) and on exercise time 68.5% (p = 0.001) in CT group. However, the improvements for the same parameters were lower in AIT plus IMT group (ejection fraction 18% (p < 0.001) and exercise time 62% (p < 0.001)). CONCLUSIONS: The addition of RT to AIT and IMT (CT group) resulted in additional benefits in some of the measured parameters over the double combined group: AIT plus IMT and all training modalities, which make the combination of three exercise training the most recommended protocol in cardiac rehabilitation programs and prevention protocols.

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