Maintaining physical fitness of patients with chronic heart failure: a randomized controlled trial.
BACKGROUND
We aimed to compare the effects of three different training advices, after 1 year, following a 6 months supervised cardiac rehabilitation period in patients with chronic heart failure (CHF).


METHODS
Sixty-nine CHF patients were randomized, at the end of their rehabilitation period, either to usual care (UC) or to UC and controlled home training (HT), prolonged supervised training (ST) or preferred training (PT). Treadmill cardio-pulmonary exercise testing was performed before rehabilitation, postrehabilitation and thereafter at 3-month intervals during the 1-year follow-up. submaximal exercise capacity [Oxygen consumption and workload at the respiratory compensation point (VO2RCP, WattRCP) and submaximal workload (SMW) efficiency (SMW/HR) at 70% of the initial maximal workload] was chosen as a primary endpoint, because health status in CHF patients depends largely on their ability to perform activities at a submaximal level.


RESULTS
After 6 months of rehabilitation, the four groups (UC, HT, ST and PT) were comparable with regard to cardiac rehabilitation-derived benefit, both at the submaximal and maximal level. Although exercise capacity during follow-up declined in both UC and HT patients, ST and especially PT patients maintained and even improved VO2peak and VO2RCP. However, only PT patients managed to maintain or even increase submaximal (WattRCP and SMW/HR ratio) workload (P=0.045 and <0.0001 for interaction, respectively). Ventilatory-derived prognostic markers during treadmill cardio pulmonary exercise testing evolved similarly in the four subgroups.


CONCLUSIONS
This study suggests that engagement in physical training of their own choice (PT), might be the optimal training modality for maintaining physical capacity in CHF patients.
Beckers
Paul J
PJ
Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Denollet
Johan
J
Possemiers
Nadine M
NM
Wuyts
Kurt
K
Vrints
Christiaan J
CJ
Conraads
Viviane Marie
VM
D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010349:Patient Compliance; D057240:Patient Preference; D010809:Physical Fitness; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome