Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure

Belardinelli, Romualdo; Georgiou, Demetrios; Cianci, G.; Purcaro, A

doi:10.1161/01.cir.99.9.1173

Cited by 906 publications

(202 citation statements)

References 25 publications

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“…Although voluntary exercise had no effect on the functional parameters measured by echocardiography, these data are consistent with a clinical trial in which 100 chronic HF patients were enlisted. Although moderate long-term exercise did result in improvements in both quality of life and cardiac function, the parameters determined by echocardiography showed no differences between the exercised and nonexercised groups (33). It is unclear what the outcome of more intensive, forced exercise regimens such as swimming or running on a motorized, incline treadmill would be.…”

Section: Discussionmentioning

confidence: 99%

Exercise reverses preamyloid oligomer and prolongs survival in αB-crystallin-based desmin-related cardiomyopathy

Maloyan

Gulick

Glabe

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

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The R120G mutation in the small heat shock-like protein ␣B-crystallin (CryAB R120G ) causes desmin-related myopathy (DRM), which is characterized by the formation of desmin-and CryABcontaining aggregates within muscle fibers. Mice with cardiacspecific overexpression of CryAB R120G develop cardiomyopathy at 3 months and die at 6 -7 months from heart failure (HF). Previous studies showed that overexpression of CryAB R120G results in accumulation of preamyloid oligomer (PAO). PAO is considered to be the cytotoxic entity in many of the protein misfolding-based neurodegenerative diseases. On the basis of data from mouse models of neurodegenerative diseases showing that exercise or environmental enrichment reduces the amyloid oligomer level and improves cognitive ability, we hypothesized that CryAB R120G -induced DRM would also respond favorably to prolonged voluntary exercise, reducing HF symptoms and rescuing the mice from premature death. Six months of voluntary exercise in CryAB R120G animals resulted in 100% survival at a time when all unexercised mice had died. After 22 weeks of exercise, PAO levels were decreased by 47% compared with the unexercised CryAB R120G control mice (P ‫؍‬ 0.00001). Although CryAB R120G expression led to decreased levels of the metallomembrane endopeptidase neprilysin, normal levels were maintained in the exercised CryAB R120G mice, and in vitro loss-of-function and gain-of-function experiments using adenovirus-infected cardiomyocytes confirmed the importance of neprilysin in ameliorating PAO accumulation. The data demonstrate that voluntary exercise slows the progression to HF in the CryAB R120G DRM model and that PAO accumulation is mediated, at least in part, by decreased neprilysin activity.cardiac ͉ disease ͉ heart ͉ transgenic

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Section: Discussionmentioning

confidence: 99%

Exercise reverses preamyloid oligomer and prolongs survival in αB-crystallin-based desmin-related cardiomyopathy

Maloyan

Gulick

Glabe

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

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“…Exercise training in patients with CHF is increasing in popularity and has been shown to increase exercise capacity, reduce mortality and improve quality of life [31]. Whether a trained heart failure patient can perform enough work during exercise to develop diaphragmatic fatigue remains to be determined.…”

Section: Diaphragmatic Fatigue and Exercisementioning

confidence: 99%

Diaphragmatic function after intense exercise in congestive heart failure patients

Kufel¹,

Pineda²,

Junega³

et al. 2002

Eur Respir J

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Respiratory muscle strength and endurance is reduced in patients with congestive heart failure, making these patients susceptible to diaphragmatic fatigue during exercise.In order to determine whether or not contractile fatigue of the diaphragm occurs in patients with congestive heart failure following intense exercise, twitch transdiaphragmatic pressures (twitch Ptdi) were measured during unpotentiated and potentiated cervical magnetic stimulation (CMS) of the phrenic nerves before and at intervals after cycle endurance exercise.Ten patients aged 65.7 ¡ 6.0 yrs (mean ¡ SD) with an ejection fraction of 31.2 ¡ 9.8% performed a constant-load symptom-limited exercise test at 60% of their peak work capacity. Twitch Ptdi at baseline were 15.9¡6.3 cmH 2 O (unpotentiated CMS) and 28.8¡ 10.7 cmH 2 O (potentiated CMS) and at 10 min postexercise were 16.4¡4.7 cmH 2 O (unpotentiated CMS) and 27.6¡10.1 cmH 2 O (potentiated CMS). One patient demonstrated a sustained fall in twitch Ptdi of o15%, considered potentially indicative of diaphragmatic fatigue.Contractile diaphragmatic fatigue is uncommon in untrained patients with congestive heart failure following high-intensity constant-workload cycle exercise. Therefore, diaphragmatic fatigue is an unlikely cause of exercise-limitation during activities of daily living in heart failure patients.

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“…Two-way ANOVA for repeated measures was adopted, followed by Tukey's test for comparisons between CR and CG, considering the following factors: exercise train ing program (CR versus CG) and time (beginning, 30 days, 60 days, 6, 12 and 18 months follow-up). Mortality was evaluated according to the Kaplan-Meier method [5]. Analyses were made by Sig maStat3.5 (www.Systat.com).…”

Section: Discussionmentioning

confidence: 99%

“…In general, supervised CR programs are successful in increasing physical fitness, cardiovascular performance, quality of life and reducing mortality [5][6][7][8][9][10][11][12][13][19][20][21][22][23][24].However, there are indicat ions that only 11% to 30% of those who need CR have access to specialized centers [6,22,23,25].Taking these facts into consideration, there has been an increase in the number of programs, whether supervised or not. The effectiveness of these programs has been well documented, revealing broad benefits [19,23,[26][27][28],although other studies have failed to observe positive effects, especially those regarding quality of life [29].In the present study, patients with HF in both groups demonstrated improvement in cardio respiratory fitness and in functional capacity during the 60 intervention days, as verified by other authors [19][20][21]23,[26][27][28].Nevertheless, only the supervised CR group showed quality of life imp rovement along the 60 CR days.…”

Section: Supervised Program Effectsmentioning

confidence: 99%

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Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

Pôrto¹,

Kümpel²,

Leite³

et al. 2012

AJMMS

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The aim of this study was to evaluate the effects of a supervised cardiac rehabilitation (CR) program on longterm quality of life (Qo L) of patients with heart failure (HF).Methods: A sample of 21 HF patients, previously sedentary, NYHA II, was randomly divided into two g roups: the CR group (N = 13) and the control group (CG = 8). The CR consisted of sessions of 120 minutes/day, 3 times/week,for 60 days. CR g roup performed their activ ities under supervision at a rehabilitation clinic, and CG received standard care and was instructed to exercise at ho me. All patients underwent a ma xima l sympto m-limited test at the beginning and after 30 and 60 days of CR. Qo L was monitored after 60-days, 6, 12 and 18 months of CR. Results:Two-way A NOVA for repeated measures, follo wed by Tukey's test for statistical analysis showed significantimp rovement in peak VO 2 at 30 and 60-days of CR (p<0.05). Qo L imp roved after 60-days of CR and remained improved throughout the 18following months in the supervised CR group. The use of hospital emergency services became less frequent (p=0.023) and there was a trend for better survival after 18 months of follow-up (p=0.092).Conclusion: CR was effect ive upon cardiopulmonary and Qo L aspects.

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Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure

Abstract: 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.

Cited by 906 publications

References 25 publications

Exercise reverses preamyloid oligomer and prolongs survival in αB-crystallin-based desmin-related cardiomyopathy

Exercise reverses preamyloid oligomer and prolongs survival in αB-crystallin-based desmin-related cardiomyopathy

Diaphragmatic function after intense exercise in congestive heart failure patients

Quality of Life after Cardiac Rehabilitation for Patients with Heart Failure: 18 months follow-up

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