title: Long-term versus intermediate-term supervised exercise training in advanced heart failure: effects on exercise tolerance and mortality.
abstract: OBJECTIVE
  To date there have been no studies exploring the effects of long-term versus intermediate-term and short-term supervised exercise training program in patients with severe chronic heart failure (CHF) on optimal medical therapy. We assessed exercise tolerance and mortality in CHF patients undergoing long- versus intermediate-term exercise training (ET).
  
  
  METHODS
  Forty-two consecutive severe CHF patients (New York Heart Association functional class III) were referred for a supervised exercise and cardiac rehabilitation program and were followed-up for 3 years: 20/42 (48%) patients discontinued ET after intermediate-term period of 1.6+/-0.8 years (Group A, intermediate-term ET), and 22/42 (52%) remained on the ET program for 3.0+/-0.3 years (Group B, long-term ET). Exercise duration, 6-min walked distance and metabolic equivalents (METs) assessed by modified Bruce protocol were recorded before, 4.5 months after, and 3 years after initiation of ET.
  
  
  RESULTS
  Both groups were comparable regarding age, gender, prevalence of ischemic etiology, mean ejection fraction and medications. Risk factors for ischemic heart disease were similar, except for the prevalence of diabetes, which was higher in Group A compared to Group B (11/20 versus 5/22, p=0.03). Significantly more Group A patients died after ET discontinuation (4/20 versus 0/22, p=0.01). At the end of follow-up a significant improvement could be seen in Group B patients compared to A in exercise duration, 6-min walked distance and metabolic equivalents (p<0.01 for all).
  
  
  CONCLUSIONS
  Higher survival rate was observed in severe CHF patients undergoing long-term versus intermediate-term exercise training. Long-term supervised exercise training is safe and improves exercise tolerance in these patients.
authors.affiliation: Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.forename: Dov
authors.initials: D
authors.lastname: Freimark
authors.forename: Ella
authors.initials: E
authors.lastname: Ahron
authors.forename: Nira
authors.initials: N
authors.lastname: Koren-Morag
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwamenthal
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.forename: Michael
authors.initials: M
authors.lastname: Shechter
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Dvora
authors.initials: D
authors.lastname: Kachlon
authors.forename: Michael
authors.initials: M
authors.lastname: Motro
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Adler
mesh_terms: D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors