BACKGROUND: Exercise is currently recommended for patients after myocardial infarction; however, the effects of regular exercise on the remodeling process remain to be defined. The aim of this multicenter, randomized study was to investigate whether a long-term physical training program influences left ventricular size and function in postinfarction patients with systolic dysfunction. METHODS AND RESULTS: Consecutive patients with < 40% ejection fraction after a first Q-wave myocardial infarction were randomly assigned to a 6-month exercise training program (n = 39) or control group (n = 38). After 6 months, a significant increase in work capacity was observed only in the training group (from 4.462 +/- 1.095 to 5.752 +/- 1.749 kilopond-meters (Kp-m), p < 0.01), not in the control group (from 4.375 +/- 1.143 to 4.388 +/- 1.199 Kp-m), whereas left ventricular volumes had increased in the control group (end-diastolic volume, from 94 +/- 26 to 99 +/- 27 mL/m2, p < 0.01; end-systolic volume, from 62 +/- 20 to 67 +/- 23 mL/m2, p < 0.01) but not in the training group (end-diastolic volume, from 93 +/- 28 to 92 +/- 28 mL/m2, p = NS; end-systolic volume, from 61 +/- 22 to 57 +/- 23 mL/m2, p = NS). Conversely, ejection fraction had improved in the training group (from 34 +/- 5% to 38 +/- 8%, p < 0.01) but not in the control group (from 34 +/- 5% to 33 +/- 7%, p = NS). CONCLUSIONS: In postinfarction patients with systolic dysfunction, long-term exercise training may attenuate the unfavorable remodeling response and even improve ventricular function over time.
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