Home-based exercise improves the quality of life and physical function but not the psychological status of people with chronic heart failure: a randomised trial. Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. Effect of exercise training on quality of life in patients with chronic heart failure. Predictors of a sustained response to exercise training in patients with chronic heart failure: a telemonitoring study. Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure. A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study. Physical Exercise Improves The Functional Capacity and Quality of Life in Patients With Heart Failure Long-term effects of a group-based high-intensity aerobic interval-training program in patients with chronic heart failure. Effects of group-based high-intensity aerobic interval training in patients with chronic heart failure. Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters Quality of life, psychological and physiological changes following exercise training in patients with chronic heart failure. Rationale and design of a randomised controlled trial evaluating the effectiveness of an exercise program to improve the quality of life of patients with heart failure in primary care: The EFICAR study protocol Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and quality of life in both women and men with chronic heart failure. Improved quality of life in chronic heart failure patients following local endurance training with leg muscles. Ground-based walking training improves quality of life and exercise capacity in COPD Home-based exercise improves functional performance and quality of life in women with diastolic heart failure. Exercise: a “new drug” for elderly patients with chronic heart failure Skeletal muscle endurance training improves peripheral oxidative capacity, exercise tolerance, and health-related quality of life in women with chronic congestive heart failure secondary to either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy. Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial Impact of the Dash Diet on Endothelial Function, Exercise Capacity, and Quality of Life in Patients with Heart Failure Comparison of hospital-supervised exercise versus home-based exercise in patients after orthotopic heart transplantation: effects on functional capacity, quality of life, and psychological symptoms. Effects of home-based exercise training on neurovascular control in patients with heart failure. Factors associated with the level of movement-related everyday activity and quality of life in people with chronic heart failure. Effects of short-term exercise training in patients with heart failure. Comparison of supervised exercise training and home-based exercise training in chronic heart failure. Resistance training for chronic heart failure patients on beta blocker medications. Effects of a home-based exercise program on clinical outcomes in heart failure. Exercise in Elderly Patients with Chronic Heart Failure in Primary Care: Effects on Physical Capacity and Health-Related Quality of Life Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial
QUESTIONS Are anxiety and depression correlated with physical function , disability , and quality of life in people with chronic heart failure ? Does 8 weeks of home-based exercise improve anxiety , depression , physical function , disability , and quality of life in these patients ? Do the changes in these outcomes correlate ? DESIGN R and omised trial . PARTICIPANTS 51 people with clinical ly stable chronic heart failure were r and omised into an experimental group ( n=24 ) or a control group ( n=27 ) . INTERVENTION The experimental group undertook an individualised home-based exercise program , 30 minutes per session , 3 sessions per week for 8 weeks , with regular telephone follow-up and consultations . The control group maintained their usual activity during this period . OUTCOME MEASURES The Hospital Anxiety and Depression Scale , six-minute walk test , Groningen Activity Restriction Scale , and Minnesota Living with Heart Failure Question naire were administered at baseline and 8 weeks . RESULTS At baseline , anxiety and depression were inversely moderately correlated with walking distance , activity , and quality of life . Compared with controls , the experimental group improved significantly more in their walking distance ( by 21 m , 95 % CI 7 to 36 ) and their quality of life ( by 7 points on the 105-point Minnesota score , 95 % CI 1 to 12 ) . In the experimental group , the changes in quality of life correlated moderately strongly with changes in anxiety ( r=0.539 , p=0.01 ) . CONCLUSIONS Anxiety and depression were associated with physical function , disability , and quality of life in people with chronic heart failure .  Home-based exercise improved quality of life and physical function significantly but not psychological status in these patients Patients with heart failure ( HF ) often have profound activity limitations and diminished quality of life ( QOL ) due to symptoms of dyspnea and fatigue . Although recent studies demonstrate positive physiologic and psychological benefits of low to moderate intensity , supervised , aerobic exercise training performed 3 to 5 days/ week for 20 to 40 minutes ' duration , in a monitored setting , the efficacy of a home-based exercise program combining endurance and resistance exercise on symptoms and QOL , are unknown . This r and omized controlled study examined the efficacy , safety , and adherence rates of a 3-month home-based combined walking and resistance exercise program on symptoms and QOL in 40 women and men aged 30 to 76 years with New York Heart Association class II to III HF . Baseline and 3-month evaluations consisted of a chronic HF question naire to assess symptoms and QOL and exercise capacity by symptom-limited treadmill exercise test with respiratory gas analysis . The exercise intervention improved fatigue ( p = 0.02 ) , emotional function ( p = 0.01 ) , and mastery ( p = 0.04 ) . Overall exercise adherence was excellent ( 90 % ) and there were no reported adverse events . A moderate intensity home-based combined walking and resistance program for patients with class II to III HF is safe and effective in reducing symptoms and improving QOL The effect of exercise training on quality of life and exercise capacity was studied in 67 patients with mild to moderate chronic heart failure ( CHF ; age : 65.6+/-8.3 years ; left ventricular ejection fraction : 26.5+/-9.6 % ) . Patients were r and omly allocated to either a training group or to a control group . After intervention a significantly larger decrease in Feelings of Being Disabled ( a subscale of the Heart Patients Psychological Question naire ) and a significantly larger increase in the Self- Assessment of General Well-Being ( SAGWB ) were observed in the training group . Exercise time and anaerobic threshold were increased in the training group only . The increase in exercise time was related to both Feelings of Being Disabled and SAGWB . We conclude that supervised exercise training improves both quality of life and exercise capacity and can be safely performed by chronic heart failure patients BACKGROUND Exercise training ( ExT ) improves exercise capacity in chronic heart failure , but the results of home-based training have been variable . We sought the predictors of favorable outcome using a telemonitoring approach . METHODS Exercise capacity and quality of life ( QOL ) were assessed in 30 patients ( 28 men , age 64 + /- 8 years ) with symptomatic chronic heart failure and left ventricular ejection fraction < or = 35 % ( 28 % + /- 9 % ) undergoing 8 months of home ExT.  Patients were provided with heart rate monitors and exercise diaries after undergoing 4 months of hospital-based ExT. Weekly telephone contact was established and heart rate data were downloaded bimonthly . Changes in peak oxygen consumption per unit time ( V*O2 ) and QOL were compared between the 15 most and 15 least adherent patients defined by the number of hours per week at > 60 % maximum heart rate , observed during heart-rate monitoring . RESULTS Peak V*O2 increased by 26 % ( P < .001 ) after 4 months of hospital ExT , but this increase had fallen to 8 % ( P = .07 ) at 12 months ; only adherent patients ( n = 15 ) showed persistent improvement of peak V*O2 at 12 months ( P = .02 ) . Improvement in peak V*O2 at 12 months was associated with baseline peak V*O2 ( r = -0.61 , P < .001 ) and hours logged on the heart rate monitor ( r = 0.47 , P = .01 ) . Quality of life improvements were sustained at 12 months for the Minnesota Living with Heart Failure Question naire and Hare-Davis Depression Question naire . Nevertheless , QOL improvements achieved during the outpatient program were lost or attenuated at 12 months in nonadherent patients but were maintained in adherent patients . CONCLUSIONS Telemonitoring is feasible for following adherence to home ExT. Ongoing adherence is critical in obtaining sustained benefit from ExT in heart failure BACKGROUND Chronic heart failure is characterized by increased peripheral vascular resistance and reduced peripheral perfusion due to adrenergic and renin angiotensin activation and impaired endothelial function . Recent studies have shown that nonpharmacological peripheral vasodilation with thermal therapy by means of warm-water baths and sauna has beneficial effects in chronic heart failure . European hydrotherapy ( according to Kneipp ) additionally uses short cold water stimuli , which lead to prolonged vasodilation and adaptive responses . Studies on the efficacy of hydrotherapy in chronic heart failure are lacking . METHODS We studied 15 patients ( 5 men , 10 women , mean ( + /- SD ) age 64.3 + /- 1.8 years ) with mild chronic heart failure ( NYHA functional class II to III , ejection fraction 30%-40 % ) . Patients were r and omly assigned to 6 weeks of intensive home-based hydrotherapy or 6 weeks restriction in a crossover intervention trial . Quality of life and heart-failure -- related symptoms were assessed by means of a vali date d question naire ( PLC ) . Grade d bicycle exercise test with incremental workloads ( 0 , 50 , 75 , 100 watts ) was performed at the end of each treatment period . The hydrotherapeutic program consisted of a structured combination of daily home-based external warm- and cold-water applications . RESULTS Baseline characteristics were balanced between the groups . With hydrotherapy , a significant ( P < or = .05 ) improvement in 3 of 6 dimensions of quality of life ( mood , physical capacity , enjoyment ) and a significant reduction in heart-failure-related symptoms was found . Heart rates at rest and at 50-Watt workload were significantly reduced by hydrotherapy ;  blood pressure decreased nonsignificantly at rest and during exercise . The hydrotherapeutic treatment was well accepted and no relevant adverse effects were observed . CONCLUSIONS A home-based hydrotherapeutic thermal treatment program improves quality of life , heart-failure-related symptoms and heart rate response to exercise in patients with mild chronic heart failure . The results of this investigation suggest a beneficial adaptive response to repeated brief cold stimuli in addition to enhanced peripheral perfusion due to thermal hydrotherapy in patients with chronic heart failure AIMS Supervised exercise can benefit selected patients with heart failure , however the effectiveness of home-based exercise remains uncertain . We aim ed to assess the effectiveness of a home-based exercise programme in addition to specialist heart failure nurse care . METHODS AND RESULTS This was a r and omized controlled trial of a home-based walking and resistance exercise programme plus specialist nurse care ( n=84 ) compared with  specialist nurse care alone ( n=85 ) in a heart failure population in the West Midl and s , UK . PRIMARY OUTCOME Minnesota Living with Heart Failure Question naire ( MLwHFQ ) at 6 and 12 months . SECONDARY OUTCOMES composite of death , hospital admission with heart failure or myocardial infa rct ion ; psychological well-being ; generic quality of life ( EQ-5D ) ; exercise capacity . There was no statistically significant difference between groups in the MLwHFQ at 6 month ( mean , 95 % CI ) ( -2.53 , -7.87 to 2.80 ) and 12 month ( -0.55 , -5.87 to 4.76 ) follow-up or secondary outcomes with the exception of a higher EQ-5D score ( 0.11 , 0.04 to 0.18 ) at 6 months and lower Hospital Anxiety and Depression Scale score ( -1.07 , -2.00 to -0.14 ) at 12 months , in favour of the exercise group . At 6 months , the control group showed deterioration in physical activity , exercise capacity , and generic quality of life . CONCLUSION Home-based exercise training programmes may not be appropriate for community-based heart failure patients OBJECTIVE The purpose of this study was to investigate the effects of physical exercise on the functional capacity and quality of life in heart failure patients . METHODS Forty-two patients of both sexes with heart failure of NYHA class II and III with different etiologies were r and omly divided into  untrained or trained groups . The six-month exercise program consisted of aerobic training , muscle strength training , agility and joint flexibility activities . Physical fitness was evaluated by testing the performance on these trained components . Quality of life was evaluated by scored answers to a st and ardized question naire involving multiple domains . RESULTS Baseline values did not differ between groups . Improvement in the trained group was identified in all components of functional capacity when compared to the untrained group ( p < 0.001 ) . Quality of life improved in the trained patients concerning physical , psychological , social and environmental domains ( p < 0.001 ) , whereas no significant change was found in the untrained patients . CONCLUSIONS Guided and monitored physical exercise is safe and has the potential to improve functional capacity and quality of life in heart failure patients with multiple etiologies Studies on the long-term effects of exercise training programs on functional capacity and the quality of life in patients with chronic heart failure ( CHF ) are sparse . The aim of this study was to evaluate the long-term effects of group-based , high-intensity interval training on functional capacity and the quality of life in 80 patients with stable CHF ( mean age 70.1 + /- 7.9 years ) in New York Heart Association classes II to IIIB . Patients were r and omized to either an  exercise group ( n = 40 ) or a control group  ( n = 40 ) . The  mean ejection fractions  at baseline were 31 + /- 8 % in the exercise group and 31 + /- 1 % in the control group . The exercise group exercised twice a week for 4 months in addition to 4 consultations with a CHF nurse .  Six-minute walking distance , workload and exercise time on a cycle ergometer test , and the quality of life were measured at baseline and 4 and 12 months after enrollment . After 4 months , functional capacity ( 6-minute walking distance + 58 vs -15 m , p < 0.001 ) and the quality of life ( Minnesota Living With Heart Failure Question naire score + 10 vs -1 point , p < 0.005 ) improved significantly in the exercise group compared with the control group . After 12 months , the improvements were still significant in the exercise group compared with the control group for all parameters ( 6-minute walking distance + 41 vs -20 m , p < 0.001 ; workload + 10 vs -1 W , p = 0.001 ; exercise time + 53 vs -6 seconds , p = 0.003 ; quality of life + 10 vs -6 points , p = 0.003 ) . In conclusion , the results support the implementation of a group-based aerobic interval training program to improve long-term effects on functional capacity and the quality of life in patients with CHF The aim of this study was to evaluate the effectiveness of a novel group-based aerobic interval training of high intensity on functional capacity and quality of life in patients with chronic heart failure ( CHF ) and examine the relation between changes in functional capacity and quality of life .  Eighty patients with stable CHF ( 63 men , 17 women ; mean age 70.1 + /- 7.9 [ SD ] years ; left ventricular ejection fraction 30 + /- 8.5 % ) on optimal medical treatment were r and omly assigned to either a 16-week group-based aerobic high-intensity interval training model twice weekly for 65 to 80 minutes/day ( n = 40 ) or a control group ( n = 40 ) that received st and ard care .  Functional capacity was measured using the 6-minute walk test and cycle ergometer test . Quality of life was measured using the Minnesota Living with Heart Failure Question naire . After 16 weeks , functional capacity improved significantly in the exercise group compared with the control group measured using the 6-minute walk test ( + 58 vs -15 meters ; p < 0.001 ) and for both workload and time measured using the bicycle ergometer test ( + 10 vs -1 W ; p < 0.001 ; + 57 vs -8 seconds ; p < 0.001 ) . Quality of life improved significantly in the exercise group compared with the control group ( p = 0.03 ) , and a significant inverse correlation was found between quality of life and functional capacity ( r = -0.49 , p < 0.05 ) . In conclusion , our exercise model significantly improved functional capacity and quality of life compared with the control group in patients with CHF . Improvements in quality of life were significantly related to functional capacity Purpose To compare the effects of home-based and hospital-based exercise programs on exercise capacity , quality of life , psychological symptoms , and hemodynamic parameters in heart failure ( HF ) patients . Methods Seventy-four patients were r and omized into either a hospital-based exercise  ( Group 1 ) or a  home-based exercise ( Group 2 ) group . Prior to and after the 8-week rehabilitation program , the two groups were compared with respect to their functional capacity [ maximal oxygen uptake ( pVO2 ) and 6-min walk test ( 6MWT ) ] , quality of life ( Medical Outcomes Study and the 36-item Short Form Survey , SF-36 ) , psychological symptoms [ Beck Depression Inventory ( BDI ) and State-Trait Anxiety Inventory ] , and hemodynamic parameters [ ( left ventricular diastolic diameter in diastole , left ventricular diameter in systole , Mitral Early diastolic peak flow velocity (E)/late diastolic peak flow velocity ( A ) , Mitral E/Mitral early peak velocity ( Em ) , Tei index , right ventricular systolic peak velocity ( Sm ) , tricuspid annular plane systolic excursion , systolic pulmonary arterial pressure ( SPAP ) , and left and right ventricular ejection fraction ( LVEF and RVEF ) ] . Results After the exercise programs , significant improvement was observed in pVO2 , 6MWT and subscales of physical function , general health , and vitality of SF 36 , as well as BDI and LVEF in both groups ( P < 0.05 ) . A comparison of the two exercise groups revealed no significant differences between them regarding the analyzed variables ( P > 0.05 ) . Conclusion Both the hospital-based and home-based exercise groups improved significantly in functional capacity , quality of life , depression symptoms , and LVEF . Based on these results , we believe that physicians can recommend home-based exercise under strict supervision for stable HF patients . However , additional research should be conducted in this area OBJECTIVE To assess the physiological and psychosocial effects of exercise training in chronic heart failure . SUBJECTS/ PATIENTS Twenty-six men with heart failure ( New York Heart Association functional classes II and III ) aged 52.5 ( SD 9.8 ) years , were studied . METHODS The subjects were r and omized either to rehabilitation group ( Group A : 16 patients ) , participating in a 6-month exercise training program , or to control group ( Group B : 10 patients ) . A psychosocial assessment , which included affective ( Beck Depression Inventory and Hospital Anxiety and Depression Scale ) , quality of life ( Quality of Life Index , Minnesota Living with Heart Failure Question naire and the Scale of Life Satisfaction ) and personality ( Eysenck Personality Question naire ) parameters , was performed at the beginning and the end of the study . RESULTS After training VO2 peak increased by 36 % and exercise time by 35 % , p < 0.05 . A significant decrease in anxiety and depression was also observed . Moreover , trained patients demonstrated a significant improvement in quality of life . No significant correlations were found between deltaVO2 peak and all psychosocial parameter gains . However , the more depressed patients showed the largest physiological responses . CONCLUSION An exercise rehabilitation program in patients with chronic heart failure is useful for improving their work capacity and psychosocial status . Improvements in psychological status seem to be independent of the aerobic gains Background Quality of life ( QoL ) decreases as heart failure worsens , which is one of the greatest worries of these patients . Physical exercise has been shown to be safe for people with heart failure . Previous studies have tested heterogeneous exercise programs using different QoL instruments and reported inconsistent effects on QoL. The aim of this study is to evaluate the effectiveness of a new exercise program for people with heart failure ( EFICAR ) , additional to the recommended optimal treatment in primary care , to improve QoL , functional capacity and control of cardiovascular risk factors . Methods / Design Multicenter clinical trial in which 600 patients with heart failure in NYHA class II-IV will be r and omized to two parallel groups : EFICAR and control . After being recruited , through the reference cardiology services , in six health centres from the Spanish Primary Care Prevention and Health Promotion Research Network ( redIAPP ) , patients are followed for 1 year after the beginning of the intervention . Both groups receive the optimized treatment according to the European Society of Cardiology guidelines . In addition , the EFICAR group performs a 3 month supervised progressive exercise program with an aerobic ( high-intensity intervals ) and a strength component ; and the programme continues linked with community re sources for 9 months . The main outcome measure is the change in health-related QoL measured by the SF-36 and the Minnesota Living with Heart Failure Question naires at baseline , 3 , 6 and 12 months . Secondary outcomes considered are changes in functional capacity measured by the 6-Minute Walking Test , cardiac structure ( B-type natriuretic peptides ) , muscle strength and body composition . Both groups will be compared on an intention to treat basis , using multi-level longitudinal mixed models . Sex , age , social class , co-morbidity and cardiovascular risk factors will be considered as potential confounding and predictor variables . Discussion A key challenges of this study is to guarantee the safety of the patients ; however , the current scientific evidence supports the notion of there being no increase in the risk of decompensation , cardiac events , hospitalizations and deaths associated with exercise , but rather the opposite . Safety assurance will be based on an optimized st and ardised pharmacological therapy and health education for all the participants .Trial Registration Clinical Trials.gov Identifier : BACKGROUND Data of training effects in chronic heart failure patients are based on findings in men . The purpose of this study was to compare the effects of skeletal muscle endurance training between men and women with chronic heart failure . METHODS AND RESULTS Twelve consecutive men ( mean [ + /- SD ] age 58 + /- 9 years , left ventricular ejection fraction 29 + /- 9 % ) and 12 women ( 60 + /- 10 years , left ventricular ejection fraction 28 + /- 7 % ) with moderate , chronic heart failure stratified according to age and inclusion criteria were investigated at baseline and after 8 weeks of knee extensor endurance training . The activity of skeletal muscle citrate synthase and resting heart rate were similar in men and women at baseline and with training improved ( P < .0001 ) similarly in both genders . Peak work rate ( P < .0001 ) , peak oxygen uptake ( P < .001 ) and muscle strength ( P < .05 ) at baseline were higher in men than in women . Training improved peak work rate ( P < .0001 ) and muscle strength ( P < .0001 ) similarly in both genders , while improvement in peak oxygen uptake was better in women ( P < .001 ) . The distance ambulated during 6 minutes was similar in both genders at baseline and increased after training more in men ( P < .004 ) . The overall and physical Sickness Impact Profile indicated similarly reduced health-related quality of life in men and women , while worse psychosocial quality of life was observed in men ( P < .05 ) . Both genders improved after exercise training in the overall , physical , and psychosocial Sickness Impact Profile ( P < .01 ) . CONCLUSIONS Exercise-based rehabilitation improves skeletal muscle capacity , exercise tolerance , and the health-related quality of life in women as well as in men with moderate , chronic heart failure BACKGROUND Despite reported benefits of exercising for chronic heart failure patients , limited data are available on quality of life and the effects of different modes of training . This study assessed the effects of local endurance training with knee extensor muscles on exercise tolerance and health-related quality of life in male patients with moderate , chronic heart failure . METHODS AND RESULTS Twenty-one patients ( mean age , 60 years ; range , 43 - 73 years ) in New York Heart Association functional classes II-III ( ejection fraction , 28 + /- 11 % ) were r and omized to two training groups and one control group . Both training groups performed the same relative quantity of dynamic work with knee extensor muscles 3 days a week for 8 weeks . However , the quantity of muscle mass trained at one time and , consequently , the load on the integrated circulation differed between the groups ( two- and one-leg training ) . Exercise capacity and perceived quality of life were assessed before and after the training or control period . Exercise tolerance increased ( P < .01 ) in both training groups with significantly ( P < .01 ) better improvement in submaximal exercise capacity in the two-leg group . There was no improvement in the control group . Coping capacity did not differ from the reference range and did not change during the study . Global health-related quality of life was depressed at baseline . Training improved ( P < .05 ) health-related quality of life . Compared with the control group , the improvement of health-related quality of life subscales was more pronounced in the two-leg training group ( P < .02-.005 ) as compared to the one-leg training group ( not significant to P < .05 ) . CONCLUSIONS Local muscle endurance training has beneficial effects on exercise tolerance and health-related quality of life in patients with moderate , chronic heart failure . As two-leg training showed a tendency toward better improvement in submaximal exercise capacity and in quality of life than one-leg training , the effects on quality of life appear to be exercise-related in addition to a possible placebo-related effect . Also , the effect appears to be related to the extent of muscle trained at one time This study was design ed to determine the effect of ground-based walking training on health-related quality of life and exercise capacity in people with chronic obstructive pulmonary disease ( COPD ) . People with COPD were r and omised to either a walking group that received supervised , ground-based walking training two to three times a week for 8–10 weeks , or a control group that received usual medical care and did not participate in exercise training .  130 out of 143 participants ( mean±sd age 69±8 years , forced expiratory volume in 1 s 43±15 % predicted ) completed the study . Compared to the control group , the walking group demonstrated greater improvements in the St George ’s Respiratory Question naire total score ( mean difference -6 points ( 95 % CI -10– -2 ) , p<0.003 ) , Chronic Respiratory Disease Question naire total score ( mean difference 7 points ( 95 % CI 2–11 ) , p<0.01 ) and endurance shuttle walk test time ( mean difference 208 s ( 95 % CI 104–313 ) , p<0.001 ) . This study shows that ground-based walking training  is an effective training modality that improves quality of life and endurance exercise capacity in people with COPD  . Walking training  improves quality of life and endurance exercise capacity compared to usual medical care in COPD BACKGROUND Diastolic heart failure ( DHF ) is common in older women . There have been no clinical trials that have identified therapies to improve symptoms in these patients . A total of 32 women with New York Heart Association class II and III DHF ( left ventricular ejection fraction > 45 % and symptoms of dyspnea or fatigue ) were r and omized into a 12-week home-based , low-to-moderate intensity ( 40 % and 60 % , respectively ) exercise and education program ( intervention ) or education only program ( control ) . Methods and results The intervention group improved in the 6-minute walk test from 840 + /- 366 ft to 1043 + /- 317 ft versus 824 + /- 367 ft to 732 + /- 408 ft in the control group ( P = .002 ) . Quality of life also improved in the intervention group compared with the control group as measured by the Living with Heart Failure Question naire ( 41 + /- 26 to 24 + /- 18 vs 27 + /- 18 to 28 + /- 22 at 12 weeks , P = .002 ; 24 + /- 18 to 19 + /- 18 vs 28 + /- 22 to 32 + /- 27 at the 3-month follow-up , P = .014 ) and the Geriatric Depression Scale ( 6 + /- 4 to 4 + /- 4 vs 5 + /- 3 to 7 + /- 5 at 12 weeks , P = .012 ; 4 + /- 4 to 4 + /- 4 vs 7 + /- 5 to 7 + /- 5 at the 3-month follow-up , P = .009 ) . CONCLUSIONS Women with DHF exhibit significant comorbidities and physical limitations . Home-based , low-to-moderate intensity exercise , in addition to education , is an effective strategy for improving the functional capacity and quality of life in women with DHF . Further study is needed to assess the long-term effect of exercise on clinical outcomes Patients with chronic heart failure ( CHF ) experience progressive deterioration of functional capacity and quality of life ( QoL ) . This prospect i ve , r and omized , controlled trial assesses the effect of exercise training ( ET ) protocol on functional capacity , rehospitalization , and QoL in CHF patients older than 70 years compared with a control group . A total of 343 elderly patients with stable CHF ( age , 76.90±5.67 , men , 195 , 56.9 % ) were r and omized to ET ( TCG , n=170 ) or usual care ( UCG , n=173 ) . The ET protocol involved supervised training sessions for 3 months in the hospital followed by home-telemonitored sessions for 3 months . Assessment s , performed at baseline and at 3 and 6 months , included : ECG , resting echocardiography , NT-proBNP , 6-minute walk test ( 6MWT ) , Minnesota Living with Heart Failure Question naire , and comprehensive geriatric assessment with the InterRAI-HC instrument . As compared to UCG , ET patients at 6 months showed : i ) significantly increased 6MWT distance ( 450±83 vs. 290±97 m , p<0.001 ) ; ii ) increased ADL scores ( 5.00±2.49 vs. 6.94±5.66 , p=0.037 ) ; iii ) 40 % reduced risk of rehospitalisation ( hazard ratio=0.558 , 95%CI , 0.326 - 0.954 , p=0.033 ) ; and iv ) significantly improved perceived QoL ( 28.6±12.3 vs. 44.5±12.3 , p<0.001 ) . In hospital and home-based telemonitored exercise confer significant benefits on the oldest CHF patients , improving functional capacity and subjective QoL and reducing risk of rehospitalisation Despite reported benefits of exercise training in men with chronic congestive heart failure ( CHF ) and in both men and women with coronary artery disease , the effects of training in women with CHF have not been throughly investigated . Therefore , 16 women ( 62 + /- 10 years [ mean + /- SD ] ) with stable , moderate , chronic CHF ( left ventricular ejection fraction 28 + /- 8 % ) were studied in a r and omized crossover trial with 8 weeks of knee extensor endurance training and 8 weeks of nontraining . The effects of the exercise-based rehabilitation were assessed in skeletal muscle metabolic capacity , exercise tolerance , and quality of life . The compliance rate in training was 98 % and no adverse events occurred during the study period . Training increased the activity of citrate synthase ( 44 % , p < 0.0001 ) and lactate dehydrogenase ( 23 % , p < 0.002 ) in the trained muscles , and an improved oxidative capacity in relation to the glycolytic capacity ( 23 % , p < 0.002 ) was found . Peak oxygen uptake ( 14 % , p < 0.0005 ) and peak work rate ( 43 % , p < 0.0001 ) during incremental exercise increased , and blood lactate concentration during st and ardized submaximal exercise and during the recovery phase decreased ( 17 % , p < 0.05 ) . The distance ambulated during 6 minutes ( p < 0.03 ) , and the overall ( p < 0.01 ) , physical ( p < 0.05 ) , and psychosocial ( p < 0.03 ) health-related quality of life improved . Because the skeletal muscle endurance training improved peripheral oxidative capacity , exercise tolerance , and the health-related quality of life without any adverse events , this mode of training can be recommended for women with chronic heart failure Background Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease ( COPD ) to improve exercise capacity , symptoms and quality of life , however only a minority of individuals with COPD are able to participate . Travel and transport are frequently cited as barriers to uptake of centre-based programs . Other models of pulmonary rehabilitation , including home-based programs , have been proposed in order to improve access to this important treatment . Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life , but not all elements of the program were conducted in the home environment . It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity , symptoms and quality of life as a hospital-based program . The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD . Methods / Design This r and omised , controlled , equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD . Participants will be r and omly allocated to hospital-based or home-based pulmonary rehabilitation . Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks . Home-based programs will involve one home visit followed by seven weekly telephone calls , using a motivational interviewing approach to enhance exercise participation and facilitate self management . The primary outcome is change in 6-minute walk distance immediately following intervention . Measurements of exercise capacity , physical activity , symptoms and quality of life will be taken at baseline , immediately following the intervention and at 12 months , by a blinded assessor . Completion rates will be compared between programs . Direct healthcare costs and indirect ( patient-related ) costs will be measured to compare the cost-effectiveness of each program . Discussion This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner . The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD .Trial registration Clinical Trials.gov : NCT01423227 Endothelial dysfunction has been recognized as a pathophysiologic mechanism in the progression of heart failure ( HF ) . However , little attention has been given to the ability of dietary approaches to improve endothelial function . This study examined the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on endothelial function , exercise capacity , and quality of life in patients with chronic symptomatic ( stage C ) HF . Forty-eight patients were r and omized to follow the DASH diet ( n = 24 ) or the general HF dietary recommendations ( n = 24 ) . Endothelial function was assessed by measuring large and small arterial elasticity ( LAE and SAE ) at rest . Exercise capacity ( measured with the 6-minute walk test ) and quality of life ( measured with the Minnesota Living with Heart Failure Question naire ) at baseline and 3 months were also evaluated . Patients were older adults with an average HF duration of 5 years .  LAE at 1 month improved significantly in the DASH diet group ( P < 0.01 ) . Overall LAE and SAE scores at 3 months also improved ; however , the net changes were not statistically significant . The DASH group had better exercise capacity ( 292 m vs 197 m ; P = 0.018 ) and quality of life scores ( 21 vs 39 ; P = 0.006 ) over time , while sodium intake levels at 1 , 2 , and 3 months were comparable between the groups . Adhering to the DASH diet improved arterial compliance initially and improved exercise capacity and quality of life scores at 3 months . The DASH diet may be an important adjunctive therapy for patients with symptomatic H UNLABELLED In heart transplant patients it is common to observe a reduced exercise capacity and diminished quality of life . The objective of this study was to compare the effectiveness of a hospital-based exercise program versus that of a home-based exercise program on the functional capacity , quality of life , and psychological symptoms among heart transplant patients . METHODS Thirty-eight heart transplant patients were r and omly placed into two groups : a hospital-based exercise program ( group 1 , n = 15 ) or a home-based exercise program ( group 2 , n = 13 ) . All patients performed flexibility , stretching , aerobic , strengthening , breathing , and relaxation exercise programs for 8 weeks . We performed estimates of functional capacity ( maximal oxygen consumption-pVO2 ) , quality of life ( Short Form-36-SF36 ) , and psychological symptoms ( Beck Depression Inventory-BDI , the State-Trait Anxiety Inventory-STAI ) . RESULTS In group 1 , significant increases were observed in pVO2 and all SF36 subgroups , with the exception of vitality and social function subgroups ( P < .05 ) . Significant increases were not observed on the BDI or STAI ( P > .05 ) . Group 2 failed to show significant improvements in any variable , with the exception of the score on the bodily pain subgroup of the SF36 ( P > .05 ) . CONCLUSION Based on our clinical results , we recommend a well-organized exercise program performed in a rehabilitation unit to improve postoperative exercise capacity and quality of life among heart transplant patients BACKGROUND The effect of home-based exercise training on neurovascular control in heart failure patients is unknown . AIMS To test the hypothesis that home-based training would maintain the reduction in muscle sympathetic nerve activity ( MSNA ) and forearm vascular resistance ( FVR ) acquired after supervised training . METHODS AND RESULTS Twenty-nine patients ( 54+/-1.9 years , EF<40 % ) were r and omised into two groups : untrained control ( n=12 ) and exercise trained  ( n=17 ) . Both groups underwent assessment of Quality of Life ( QoL ) , MSNA , and forearm blood flow . The exercise group underwent a 4-month supervised training program followed by 4 months of home-based training . After the initial 4 months of training , patients in the exercise group showed a significant increase in peak VO(2 ) and reduction in MSNA , compared to the untrained group , but this was not maintained during 4 months of home-based training . In contrast , the decrease in FVR ( 56+/-3 vs. 46+/-4 vs. 40+/-2 U , p=0.008 ) and the improvement in QOL that were achieved during supervised training were maintained during home-based training . CONCLUSIONS Home-based training following supervised training is a safe strategy to maintain improvements in QoL and reduction in FVR in chronic heart failure patients , but is an inadequate strategy to maintain fitness as estimated by peak VO(2 ) or reduction in neurohumoral activation BACKGROUND AND PURPOSE Cardiac rehabilitation has been shown to be effective in people with chronic heart failure ( CHF ) , particularly in terms of exercise capacity . However , no effects have been found on the level of movement-related everyday activity . Therefore , rehabilitation programs also should focus on enhancing the level of movement-related everyday activity . The aim of this study was to explore factors associated with the level of  movement-related everyday activity  and with quality of life in people with CHF . SUBJECTS AND METHODS Measurements of  movement-related everyday activity ( using an accelerometry-based Activity Monitor )  , quality of life , and associated factors were performed in 36 people with stable CHF ( New York Heart Association classes II and III ) . RESULTS Knee flexion and extension torque , and particularly extension torque , were significantly associated with movement-related everyday activity ( r = .43-.49 , P < .05 ) , whereas nonphysiological factors such as feelings of being disabled were associated with quality of life ( r = .37-.77 , P < or = .01 , P < .05 ) . No relationship was found between  movement-related everyday activity and quality of life ( r = .20-.22 , P > .05 ) . DISCUSSION AND CONCLUSION The results indicate that knee torque is associated with the level of movement-related everyday activity in people with CHF and that quality of life is mediated by nonphysiological factors Heart failure is a debilitating disorder which limits exercise capacity and produces a poor quality of life . The present study was design ed to determine the effects of an exercise training program on patients with CHF NYHA functional class II-III , attributed to left ventricular systolic dysfunction and dilated left ventricle . Twenty-two ambulatory male patients with stable CHF were r and omised to a training ( n = 15 ) and a control group ( n = 7 ) . A symptom limited ramp cardiopulmonary exercise test with gas exchange analysis was performed at baseline after 4 and 8 weeks . The training group underwent an exercise training program at 50 % of peak oxygen uptake for eight weeks . The control group was not exercised . After 8 weeks , compared with baseline , there were statistically significant increase in peak oxygen uptake , peak workload , anaerobic threshold , oxygen pulse , RPP , ventilation and the duration of the test only in trained patients . The reduction in scores tested by the Minnesota Living with Heart Failure question naire ( p < 0.001 ) and Borg dyspnea rating score ( p < 0.001 ) reflect the reduction of symptoms and the improvement in health-related quality of life .  Carefully selected patients with moderate to severe CHF can achieve significant improvements of exercise capacity and quality of life with exercise training and can safely participate in a conditioning program OBJECTIVE This study was planned to compare the outcomes between supervised and home-based exercise training in patients with chronic heart failure . METHODS The study was conducted at the Department of Physical Therapy in Ankara University , Faculty of Medicine , Turkey between 2000 and 2001 . Twenty-two patients with stable chronic heart failure were r and omly assigned to the supervised exercise training group ( n=11 ) or the home-based exercise training group ( n=11 ) . Symptom-limited maximal exercise tests with gas exchange analysis were carried out before r and omization . Work load equivalent to 60 % of achieved peak heart rate at the tests was determined as exercise training work load for each subject . Both groups participated in a program of 3 exercise training sessions per week for 3 months . The exercise tests were repeated after 3 months . RESULTS After training , peak exercise duration increased significantly in the supervised exercise training group and the home-based exercise training group ( p<0.05 ) . There was substantial improvement in peak VO2 with exercise training in the supervised exercise training group ( p<0.05 ) but , peak VO2 did not change significantly in the home-based exercise training group ( p>0.05 ) . CONCLUSION Supervised and home-based exercise training enhanced exercise capacity in patients with chronic heart failure . The training program must be tailored to each patient 's specific limitations , individual needs and possibilities . Home-based exercise training may be a training alternative to stable chronic heart failure patients who prefer not to participate in an outpatient supervised training program BACKGROUND Resistance training increases the skeletal muscle strength and functional ability of chronic heart failure patients . However , there is limited data regarding the effect of resistance training on the hemodynamic responses and peak oxygen consumption ( peak VO(2 ) ) of chronic heart failure patients treated with beta-blocker . This study examined the effect of resistance training on hemodynamics , peak aerobic capacity , muscle strength and quality of life of chronic heart failure patients on beta-blockers medication . METHODS Fifteen men diagnosed with chronic heart failure were matched to either a resistance training program or non-training control group . At baseline and after 8 weeks of resistance training patients performed both Balke incremental and maximal strength tests and completed quality of life question naires . RESULTS The resistance training group demonstrated a significant increase of walking time and peak VO(2 ) by 11.7 % ( p=0.002 ) and approximately 19 % ( p<0.05 ) , respectively . Peak VO(2 ) was significantly correlated with both walking time ( r=0.54 , p=0.038 ) and change in total weight lifted ( r=0.55 , p=0.034 ) . Quality of life significantly increased by 87 % ( p=0.030 ) . The improvement in quality of life was correlated with post training peak VO(2 ) ( r=0.58 , p=0.025 ) and total weight lifted during the post maximal strength test ( r=-0.52 , p=0.047 ) . CONCLUSIONS The benefits from resistance training for chronic heart failure patients on beta-blocker medication included an increased aerobic and exercise capacity , skeletal muscle strength and most importantly , an improvement in the quality of life , which is the main goal of cardiac rehabilitation programs . Furthermore , with appropriate supervision , it is recommended that resistance exercise be added to the exercise rehabilitation program of these patients when possible BACKGROUND The aim of this study was to determine the effects of a home-based exercise program on clinical outcomes .  Exercise training improves exercise capacity in patients with heart failure ( HF ) but the long-term effects on clinical outcomes remain unknown . METHODS We r and omized 173 patients with systolic HF to control ( n = 87 ) or home-based exercise ( n = 86 ) . The primary end point was a composite of all-cause hospitalizations , emergency department admissions , urgent transplantation , and death at 12 months . Functional performance ( as assessed by cardiopulmonary exercise testing and the 6-minute walk test ) , quality of life , and psychological states were measured at baseline , 3 months , and 6 months . RESULTS There was no significant difference between experimental and control groups in the combined clinical end point at 12 months and in functional status , quality of life , or psychological states over 6 months . Patients in the exercise group had a lower incidence of multiple ( 2 or more ) hospitalizations compared with the control group : 12.8 % versus 26.6 % , respectively ( P = .018 ) . CONCLUSIONS A home-based walking program that incorporated aerobic and resistance exercise did not result in improved clinical outcomes at 1-year follow-up in this cohort of patients with systolic HF . However , the exercise program result ed in reduced rehospitalization rates Introduction : Chronic heart failure ( CHF ) limits exercise capacity which influences physical fitness and health-related quality of life ( HRQoL ) . Aim : The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care . Methods : An exercise intervention was conducted as a prospect i ve , longitudinal and controlled clinical study in primary care in elderly patients with CHF .  Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training . Follow-up on physical capacity and HRQoL was done at 3 , 6 and 12 months . Results : Exercise significantly improved muscle endurance in the intervention group ( n = 29 , mean age 76.2 years ) compared to the control group ( n = 31 , mean age 74.4 years ) at all follow-ups except for shoulder flexion right at 12 months ( shoulder abduction p = 0.006 , p = 0.048 , p = 0.029 ; shoulder flexion right p = 0.002 , p = 0.032 , p = 0.585 ; shoulder flexion left p = 0.000 , p = 0.046 , p = 0.004 ) . Six minute walk test improved in the intervention group at 3 months ( p = 0.013 ) compared to the control group . HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12 months ( p = 0.016 and p = 0.034 ) and SF-36 , general health ( p = 0.048 ) and physical component scale ( p = 0.026 ) significantly improved at 3 months compared to the control group . Conclusion : This study shows that exercise conducted in groups in primary care and in the patients ' homes could be used in elderly patients with CHF . The combination of endurance exercise and resistance training has positive effects on physical capacity . However , the minor effects in HRQoL need further verification in a study with a larger study population Introduction The Rehabilitation EnAblement in CHronic Heart Failure ( REACH-HF ) trial is part of a research programme design ed to develop and evaluate a health professional facilitated , home-based , self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers . The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers . Methods and analysis A parallel two group r and omised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care ( intervention group ) or usual care alone ( control group ) in 216 patients with systolic heart failure ( ejection fraction < 45 % ) and their caregivers . The intervention comprises a self-help manual delivered by specially trained facilitators over a 12-week period . The primary outcome measure is patients ’ disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure question naire at 12 months ’ follow-up . Secondary outcomes include survival and heart failure related hospitalisation , blood biomarkers , psychological well-being , exercise capacity , physical activity , other measures of quality of life , patient safety and the quality of life , psychological well-being and perceived burden of caregivers at 4 , 6 and 12 months ’ follow-up . A process evaluation will assess fidelity of intervention delivery and explore potential mediators and moderators of changes in health-related quality of life in intervention and control group patients . Qualitative studies will describe patient and caregiver experiences of the intervention . An economic evaluation will estimate the cost-effectiveness of the REACH-HF intervention plus usual care versus usual care alone in patients with systolic heart failure . Ethics and dissemination The study is approved by the North West — Lancaster Research Ethics Committee ( ref 14/NW/1351 ) . Findings will be disseminated via journals and presentations to publicise the research to clinicians , commissioners and service users . Trial registration number IS RCT N86234930 ; Pre- results
Home-based exercise increased exercise capacity safely but did not improve quality of life in patients with chronic heart failure .
It could therefore be used to improve the management of people with chronic heart failure who do not have access to hospital-based exercise
QUESTIONS Does home-based exercise improve exercise capacity and quality of life in people with chronic heart failure ?
Is it safe ?