Safety and effects of physical training in chronic heart failure - Resultsof the Chronic Heart Failure and Graded Exercise study (CHANGE)

Aims Physical training is considered to be safe and beneficial as part of t he treatment in heart failure patients. Prospective, sufficiently large stu dies are still needed to confirm this hypothesis. Methods In a prospective study, 80 patients with chronic heart failure clas s II and III (age, 56+/-18.3 years; left ventricular ejection fraction, 26. 5+/-9.6%) were randomized to an endurance training group or to a control gr oup with continuation of optimal pharmacological treatment. Results No training-related adverse event was reported, implying that the t raining programme was safe for these groups of chronic heart failure patien ts. Between-group comparison of changes revealed that training increased ex ercise time (from 608+/-35 to 738+/-40 s. P<0.0001), anaerobic threshold (f rom 10.5+/-0.4 to 11.8+/-0.3 ml.kg(-1) min(-1), P<0.05). and decreased the ventilatory equivalent for carbon dioxide at submaximal exercise level (fro m 2.8+/-0.1 to 2.7+/-0.1, P<0.05). Training did not increase peak oxygen co nsumption (15.2+/-0.5 to 16.6+/-0.5 ml.kg(-1) min(-1), ns). An improvement in patients' assessment of quality of life was observed. There was a signif icant correlation between physiological and psychological improvements. Tra ining was not effective in patients whose exercise test at entry had a dura tion of less than 7 min. None of the other baseline data could predict an e ffective training response. Conclusion Physical training in chronic heart failure patients class II and III is safe and results in significant improvements in exercise time, anae robic threshold, ventilatory equivalent for carbon dioxide at submaximal ex ercise level and quality of life.