Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise. Sixteen older women with CHF were compared with 80 age-matched peers without CHF and randomized to progressive resistance training or control stretching exercises for 10 wk. Women with CHF had significantly lower muscle strength (p < 0.0001) but comparable aerobic capacity to women without CHF. Exercise training was well tolerated and resulted in no changes in resting cardiac indexes in CHF patients. Strength improved by an average of 43.4 +/- 8.8% in resistance trainers versus -1.7 +/- 2.8% in controls (p = 0.001), muscle endurance by 299 +/- 66% versus 1 +/- 3% (p = 0.001), and 6-min walk distance by 49 +/- 14 m (13%) versus -3 +/- 19 m (-3%) (p = 0.03). Increases in type I fiber area (9.5 +/- 16%) and citrate synthase activity (35 +/- 21%) in skeletal muscle were independently predictive of improved 6-min walk distance (r2 = 0.78; p = 0.0024). High-intensity progressive resistance training improves impaired skeletal muscle characteristics and overall exercise performance in older women with CHF. These gains are largely explained by skeletal muscle and not resting cardiac adaptations.

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