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Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome
Belardinelli R, Georgiou D, Cianci G, Purcaro A
Circulation 1999 Mar 9;99(9):1173-1182
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: It is still a matter of debate whether exercise training (ET) is a beneficial treatment in chronic heart failure (CHF). METHODS AND RESULTS: 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 VO2, 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 peakVO2 and thallium activity score improved at 2 months (18% and 24%, respectively; p < 0.001 for both) and did not change further after 1 year. Quality of life also improved and paralleled peak VO2. 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; p = 0.01) and hospital readmission for heart failure (5 versus 14; RR 0.29; 95% CI 0.11 to 0.88; p = 0.02). Independent predictors of events were ventilatory threshold at baseline (beta-coefficient = 0.378) and posttraining thallium activity score (beta-coefficient -0.165). CONCLUSIONS: 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.
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