Objective effects of a 6 months' endurance and strength training program in outpatients with congestive heart failure

The aim of this study was to assess the feasibility and the effects of a long-term training program with endurance and strength elements for patients with advanced congestive heart failure (CHF).

We studied 14 patients, mean age 57 yr, mean NYHA class 2.7, mean LVEF 29%, and mean VO2max 17.2 mL x kg(-1) x min(-1). They underwent a 6 months' outpatient "in-hospital" training program (80 sessions). After an introduction period the program was subdivided into four cycles in which endurance and strength were revalued and progressively increased. Endurance was measured by spiro-ergometric exercise testing with concomitant lactate determination, while strength was measured on an isokinetic dynamometer.

The compliance ratio was 89% and there were no major problems during training. NYHA class improved from a mean of 2.7 to 1.5 (P = 0.0001), working capacity from 83 to 100 W (P = 0.001), VO2 from 16.7 to 18.4 mL x kg(-1) x min(-1) (P = 0.02), and maximal exercise lactate from 4.1 to 5.2 mmol x L(-1) (P = 0.01). At isokinetic testing we found a significant 18% increase in muscular endurance of knee flexors (P = 0.008) and 25% increase of knee extensors (P = 0.007). The increase of peak torque, total work, and average power reached statistical significance only for the knee extensors.

This pilot study showed that progressively adapted global strength training in association with traditional endurance training is feasible for selected patients with CHF. Additional larger studies should be done to test the effects, the safety, and the composition of such supervised "in-hospital" training programs.