Why the study?
It was unknown whether eccentric exercise was effective, safe, and feasible for increasing function and quality of life in people with heart failure compared to usual care and a waitlist control.
Does an eccentrically biased rehabilitation program improve walking capacity and quality of life in patients with mild to moderate chronic heart failure compared to concentric exercise or a waitlist control?
Does an eccentrically biased rehabilitation program improve walking capacity and quality of life in patients with mild to moderate chronic heart failure compared to concentric exercise or a waitlist control?
In patients with mild to moderate heart failure, an 8-week eccentric exercise program was safe and feasible but did not demonstrate superior improvements in walking capacity or quality of life compared to traditional concentric exercise or a waitlist control.
Eccentric exercise is not superior to concentric training or control for walking capacity in mild-moderate HF; challenges superiority assumptions and supports no practice change.
PURPOSE: To determine if eccentric exercise was effective, safe and feasible in increasing function and quality of life in people with heart failure compared to usual care and a waitlist control group. METHODS: A prospective, three-armed, parallel-design, assessor-blind, pilot randomised controlled trial with 1:1:1 allocation. Forty-seven participants (16 female; mean age 66 years) with mild to moderate heart failure were randomly allocated to either eccentric exercise, concentric exercise or a waitlist control group. Participants in the exercise groups completed twice-weekly exercise for eight weeks. Primary outcome was walking capacity. Secondary outcomes were quality of life, leg strength and fatigue. Outcomes were assessed at baseline, post intervention and three-month follow-up. Attendance, tolerability and adverse events were used to determine safety and feasibility. RESULTS: Intention-to-treat analysis showed no differences between eccentric exercise and either concentric exercise or waitlist for any outcome. Per-protocol analysis found improvements identified by the Minnesota living with heart failure questionnaire were significantly greater post-intervention for eccentric exercise compared to concentric exercise (-17.99 units, 95% confidence interval -35.96 to -0.01). No major adverse events were reported. CONCLUSION: In this small trial, eccentric exercise did not demonstrate superior outcomes to concentric exercise or a waitlist control group. CLINICAL TRIAL REGISTRATION: The protocol for this trial was registered at clinicaltrials.gov, registration number: NCT02223624, registration date: 22 August 2014.IMPLICATIONS FOR REHABILITATIONRegular physical activity and referral to rehabilitation is recommended for people with chronic heart failure, however exercise can be challenging for this group.Eccentric exercise was safe and tolerable for participants with heart failure.Documentation of exercise progression is important to demonstrate a dose-response relationship.In this study there were no differences between groups who received eccentric exercise, concentric exercise or no exercise.
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Ellis et al. (2020) studied this question.
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