The effect of endurance training on exercise capacity following cardiac resynchronization therapy in chronic heart failure patients: a pilot trial.
BACKGROUND
Both endurance training (ET) and cardiac resynchronization therapy (CRT) improve quality of life (QOL) and exercise tolerance in patients with advanced chronic heart failure (CHF).


METHODS
A randomized intervention trial to study the effect on exercise capacity of ET in addition to CRT in patients with CHF and dyssynchrony.


METHODS
Seventeen patients (eight men, aged 59+/-9 years) with CHF and dyssynchrony were randomized to CRT with (n=8) or without (n=9) ET and compared with two matched control CHF groups (standard care with ET: n=9, standard care only: n=10). At baseline and after 5 months, exercise tolerance, left ventricular (LV) remodelling, QOL and NT-pro brain natriuretic peptide (NT-proBNP) levels were assessed.


RESULTS
Peak oxygen consumption (VO2peak), maximal workload (Wattmax), circulatory power, LV ejection fraction, dyssynchrony and QOL improved in both CRT groups. However, the increase in VO2peak (+40% versus +16%, P=0.005), Wattmax (+43% versus +13%, P=0.0005), and circulatory power (+74% versus +32%, P=0.01), was significantly greater in the trained versus the untrained CRT patients. Comparison of the four patient groups confirmed the cumulative effects of CRT plus ET.


CONCLUSIONS
ET in resynchronized CHF patients is feasible and further enhances exercise tolerance. Patients with severe CHF should be prescribed an exercise training programme after implantation in order to maximize the expected benefit.
Conraads
Viviane M A
VM
Department of Cardiology, University Hospital Antwerp, Wilrijkstraat, Belgium. Viviane.Conraads@uza.be
Vanderheyden
Marc
M
Paelinck
Bernard
B
Verstreken
Sofie
S
Blankoff
Ivan
I
Miljoen
Hielko
H
De Sutter
Johan
J
Beckers
Paul
P
D000368:Aged; D002037:Bundle-Branch Block / Q000628:therapy*; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002908:Chronic Disease; D004554:Electric Countershock; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010807:Physical Endurance; D010865:Pilot Projects; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000628:therapy*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain