Discussion
HEART, SCHMIDT
To our knowledge, this is the first randomized clinical trial aimed at evaluating the effects of functional training in individuals with HF. We compared functional training to strength training due to similarities between both physical modalities and because the latter is traditionally recommended by the American College of Cardiology Foundation and the American Heart Association as a non-pharmacological therapeutic approach in HF [Even though adherence to both physical trainings was slightly below the recommended rate of 80%, our study demonstrated an improvement on peak VOSperlich et al. [In a cross-sectional study, Schmidt et al. [Considering the functionality, the intention-to-treat analysis showed a meaningful improvement on DASI in both study groups after 12 weeks of training, but not in the per-protocol analysis. The moderate effect size within groups shows that functional and strength training are effective in improving functional status. We believe that the smaller sample size in the per-protocol analysis was the reason why we failed to detect differences in functional status between groups in this part of the analyses, since it includes only those individuals who have completed the treatment as planned. Gary et al. [The present study also demonstrated interesting results in functionality related to gait speed. Aartolahti et al. [In our study, the functional training was performed with a strength component and did not change muscular strength. The systematic review performed by Liu et al. [Our study has limitations. First, the absence of a control group makes it difficult to identify changes in outcomes resulting from the intervention. However, including a usual care group without any exercise intervention is discouraged by the Research Ethics Committee, since it is notorious that physical exercise has positive effects in patients with HF. Second, our sample size was incomplete, because the study had to be finished earlier due to the COVID-19 pandemic. Finally, we believe that the measurement of lower-extremity muscle strength should also be done, since we prioritized lower-body exercises.