title: Effects of a 14-month low-cost maintenance training program in patients with chronic systolic heart failure: a randomized study.
abstract: BACKGROUND
  Exercise training is known to be beneficial in chronic heart failure (CHF) patients but there is a lack of studies following patient groups for longer duration with maintenance training programs to defer deconditioning.
  
  
  METHODS
  Study base consisted of all patients diagnosed with CHF in a 3-year period. Sixty-six patients with systolic CHF (ejection fraction <45, New York Heart Association II-III) were randomized to 12 months of either usual care orhome-based maintenance exercise with group training sessions every 2 weeks after an initial 8-week training program. The primary endpoint was maximum workload; secondary endpoints were 6-min walk test, incremental shuttle walk test, sit-to-stand test, quality of life, and serological markers.
  
  
  RESULTS
  Six patients died and 43 completed the study. The initial 8-week training was associated with small but significant improvement in all of the functional tests. In both groups there was a significant decline in the maximum workload the next 12 months (P=0.03 and P<0.001, respectively) but after an adjustment for difference between groups in baseline characteristics, maintenance intervention reduced the decline in the maximum workload by 8.0 W (95% CI: 3.0-13.0, P=0.002). No effect of maintenance intervention was observed for 6-min walk test, incremental shuttle walk test, sit-to-stand test, or quality of life. After 14 months changes in most markers of inflammation, endothelial damage, and glycemic control were more beneficial in the intervention group.
  
  
  CONCLUSIONS
  A low-cost maintenance intervention in CHF patients reduced the decline in the maximum workload compared with usual care but not in other measures of physical function. Results suggest beneficial effects of long-term maintenance training on glycemic control, inflammation, and endothelial function.
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. eva@prescott.dk
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hjardem-Hansen
authors.forename: Flemming
authors.initials: F
authors.lastname: Dela
authors.forename: Bodil
authors.initials: B
authors.lastname: Ørkild
authors.forename: Ane S
authors.initials: AS
authors.lastname: Teisner
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D011788:Quality of Life; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers