Isolated Quadriceps Training Increases Maximal Exercise Capacity in Chronic Heart Failure

Objectives This study sought to elucidate the mechanisms responsible for the benefits of small muscle mass exercise training in patients with chronic heart failure (CHF). Background How central cardiorespiratory and/or peripheral skeletal muscle factors are altered with small muscle mass training in CHF is unknown. Methods We studied muscle structure and oxygen (O2) transport and metabolism at maximal cycle (whole body) and knee-extensor exercise (KE) (small muscle mass) in 6 healthy controls and 6 patients with CHF who then performed 8 weeks of KE training (both legs, separately) and repeated these assessments. Results Pre-training cycling and KE peak leg O2 uptake (VO2peak) were ~17% and ~15% lower, respectively, in the patients compared to controls. Structurally, KE training increased quadriceps muscle capillarity and mitochondrial density by ~21 and ~25%, respectively. Functionally, despite not altering maximal cardiac output, KE training increased maximal O2 delivery (~54%), arterial-venous O2 (a–v O2) difference (~10%), and muscle O2 diffusive conductance (DMO2) (~39%) (assessed during KE), thereby increasing single leg VO2peak by ~53%, to a level exceeding that of the untrained controls. Post-training, during maximal cycling, O2 delivery (~40%), a–v O2 difference (~15%), and DMO2 (~52%) all increased, yielding an increase in VO2peak of ~40%, matching the controls. Conclusions In the face of continued central limitations, clear improvements in muscle structure, peripheral convective and diffusive O2 transport, and subsequently O2 utilization support the efficacy of local skeletal muscle training as a powerful approach to combat exercise intolerance in CHF.