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European Heart Journal 1999 20(12):872-879; doi:10.1053/euhj.1999.1485
Copyright © 1999 by the European Society of Cardiology.
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Safety and effects of physical training in chronic heart failure. Results of the Chronic Heart Failure and Graded Exercise study (CHANGE)

(CHANGE)

R.P. Wielengaa,f1, I.A. Huisveldb, E. Bolb, P.H.J.M. Dunselmana, R.A.M. Erdmanc, M.R.P. Baseliera and W.L. Mosterdb

a Department of Cardiology, Ignatius Hospital, Breda, The Netherlands
b Department of Medical Physiology and Sports Medicine, Utrecht University, Utrecht, The Netherlands
c Department of Cardiology, Thorax Centre, University Hospital Rotterdam Dijkzigt, Department of Medical Psychology and Psychotherapy, Erasmus University, Rotterdam, The Netherlands

Received October 20, 1998; accepted November 28, 1998

Abstract

Aims Physical training is considered to be safe and beneficial as part of the treatment in heart failure patients. Prospective, sufficiently large studies are still needed to confirm this hypothesis.

Methods In a prospective study, 80 patients with chronic heart failure class II and III (age, 56·6±8·3 years; left ventricular ejection fraction, 26·5±9·6%) were randomized to an endurance training group or to a control group with continuation of optimal pharmacological treatment.

Results No training-related adverse event was reported, implying that the training programme was safe for these groups of chronic heart failure patients. Between-group comparison of changes revealed that training increased exercise time (from 608±35 to 738±40s, P<0·0001), anaerobic threshold (from 10·5±0·4 to 11·8±0·3ml.kg–1min–1, P<0·05), and decreased the ventilatory equivalent for carbon dioxide at submaximal exercise level (from 2·8±0·1 to 2·7±0·1, P<0·05). Training did not increase peak oxygen consumption (15·2±0·5 to 16·6±0·5ml.kg–1min–1, ns). An improvement in patients’ assessment of quality of life was observed. There was a significant correlation between physiological and psychological improvements. Training was not effective in patients whose exercise test at entry had a duration of less than 7min. None of the other baseline data could predict an effective training response.

Conclusion Physical training in chronic heart failure patients class II and III is safe and results in significant improvements in exercise time, anaerobic threshold, ventilatory equivalent for carbon dioxide at submaximal exercise level and quality of life.

Key Words: Congestive heart failure • exercise testing • physical training

f1 Correspondence : R. P. Wielenga, Department of Medical Physiology and Sports Medicine, P.O. Box 80043, 3508 TA Utrecht, The Netherlands.

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