title: Effects of an eccentric training personalized by a low rate of perceived exertion on the maximal capacities in chronic heart failure: a randomized controlled trial.
abstract: BACKGROUND
  The eccentric (ECC) training, in spite of its potential interest (slightest request of the cardiorespiratory system) compared with the concentric (CON) training, is not applied during the rehabilitation of the chronic heart failure (CHF). The main reasons are the difficulty personalizing the ECC exercises by avoiding the muscle complications and the lack of information concerning the specific effects on the maximal capacities in CHF patients.
  
  
  OBJECTIVE
  To compare - following a prior study on the feasibility and on the functional impacts - the effects on maximal capacities and tolerance in CHF of ECC training tailored by a low rate of perceived exertion (RPE) and those of conventionally tailored CON training.
  
  
  METHODS
  Prospective randomized comparative study.
  
  
  METHODS
  A Rehabilitation Department in a University Hospital.
  
  
  METHODS
  CHF outpatients with reduced ejection fraction randomized to either ECC (N.=21) or CON training (N.=21).
  
  
  METHODS
  ECC and CON training were respectively tailored by a low RPE (RPE between 9 and 11 on the Borg scale) and a heart rate (HR) corresponding to the first ventilatory threshold. Cardiopulmonary exercise test, maximal muscle strength tests (quadriceps, triceps surae) and 6-minute walk test were performed before and after training. Tolerance to training was assessed by RPE, muscle soreness, increase of HR, blood pressure and plasma NT-proBNP.
  
  
  RESULTS
  Improvement in peak work rate was similar for both groups (+20%, P<0.01), but VO2 peak and VO2 at the first ventilatory threshold were only increased in the CON group (+13.5%, P<0.01). Maximal strength of the triceps surae was increased in the ECC group only (+23%, P<0.01). Improvement in the walk test distance was similar in both groups, but the corresponding VO2 was only increased after CON training. Tolerance to training was good in both groups, except higher increment of training HR in the CON group (P<0.05).
  
  
  CONCLUSIONS
  ECC training tailored by a low RPE is well tolerated in CHF patients and induces an improvement in maximal capacities similar to that with conventional CON training despite lower demands on the cardiorespiratory system, showing a better energetic efficiency, potentially interesting for these patients with reduced energetic reserve.
authors.affiliation: Plateforme d'Investigation Technologique Inserm CIC 1432, University Hospital of Dijon, Dijon, France - jean-marie.casillas@chu-dijon.fr.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Casillas
authors.forename: Delphine
authors.initials: D
authors.lastname: Besson
authors.forename: Armelle
authors.initials: A
authors.lastname: Hannequin
authors.forename: Vincent
authors.initials: V
authors.lastname: Gremeaux
authors.forename: Claire
authors.initials: C
authors.lastname: Morisset
authors.forename: Nicolas
authors.initials: N
authors.lastname: Tordi
authors.forename: Yves
authors.initials: Y
authors.lastname: Laurent
authors.forename: Davy
authors.initials: D
authors.lastname: Laroche
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation / Q000379:methods*; D002908:Chronic Disease; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D005082:Physical Exertion; D011446:Prospective Studies; D012649:Self Concept