Muscle dysfunction is not limited to the lower limbs, but generalized and comparable between patients with CHF and patients with COPD with similar exercise capacity. FFM is a strong predictor of peripheral muscle strength, to a lesser extent of O(2)peak, and not at all of peripheral muscle endurance.

Background: increasing evidence supports the existence of left ventricular diastolic dysfunction as an important cause of congestive heart failure, present in up to 40% of heart failure patients. Aim: to review the pathophysiology of LV diastolic dysfunction and diastolic heart failure and the currently available methods to diagnose these disorders. Results: for diagnosing LV diastolic dysfunction, invasive hemodynamic measurements are the gold standard. Additional exercise testing with assessment of LV volumes and pressures may be of help in detecting exercise-induced elevation of filling pressures because of diastolic dysfunction. However, echocardiography is obtained more easily, and will remain the most often used method for diagnosing diastolic heart failure in the coming years. MRI may provide noninvasive determination of LV three-dimensional motion during diastole, but data on correlation of MRI data with clinical findings are scant, and possibilities for widespread application are limited at this moment. Conclusions: in the forthcoming years, optimal diagnostic and therapeutic strategies for patients with primary diastolic heart failure have to be developed. Therefore, future heart failure trials should incorporate patients with diastolic heart failure, describing precise details of LV systolic and diastolic function in their study populations.

Although the 6 MWRT is a reproducible test in CR, its responsiveness is not superior to that of the 6 MWT. We therefore prefer the conventional 6 MWT as an evaluative measurement in CR and advise against using the 6 MWRT as (evaluative) measurement in CR for this purpose.

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instruments namely 12 generic, seven disease-specific and 13 domain-specific Hr-QoL questionnaires. Barely half of the analysed studies conceptualised Hr-QoL, and extensive differences in the conceptions of Hr-QoL also existed. Three main objectives in the used Hr-QoL instruments were found; to assess and describe Hr-QoL in CHF, to describe the impact of interventions on Hr-QoL in CHF, and to examine relationsypredictors of Hr-QoL in CHF. In approximately half of the analysed studies a single generic instrument was used to evaluate the main outcome. In studies evaluating the impact of interventions, the foremost disease-specific questionnaires were used both as a single instrument as well as together with a generic instrument. Both generic and disease-specific instruments were used to examine relations and predictors of Hr-QoL in CHF. Another option consists of a battery of mixed Hr-QoL domainspecific instruments to cover the different domains of Hr-QoL. Studies using this approach were spread among the three main objectives. In some of the articles using a battery approach, disease-specific instruments were mixed together with both generic andyor disease-specific instruments. The many instruments available, the different aspects of how to implement them, the absence of and the divergent conceptions about Hr-QoL may cause difficulties in the interpretation and understanding of the results. Implications: The focus for future nursing research in patients with CHF should be on developing guidelines on how to measure Hr-QoL and the refinement of existing instruments, instead of developing new ones.