Online Figure 1. Consort Statement
Identification
Supplementary Figure 2. High Intensity Training: Funnel plot of standard error by mean difference in peak VO2
Records identified through database
searching
(n = 222)
Eligibility
Screening
Records after duplicates removed
(n = 114)
Records screened
(n = 114)
Full-text articles assessed
for eligibility
(n = 77)
Records excluded (n =37)
based on title and abstract
Full-text articles excluded,
with reasons (n = 3)
Included
Studies included in
quantitative synthesis
Supplementary Figure 3. Vigorous Intensity(meta-analysis)
Training: Funnel plot of standard error by mean difference in peak VO2.
(n = 74)
Supplementary Figure 4. Moderate Intensity Training: Funnel plot of standard error by mean difference in peak VO2.
Supplementary Figure 5. Low Intensity Training: Funnel Plot of standard error by mean difference in peak VO2.
Sensitivity Analysis
Sub-Analysis 1. Change in peak VO2 in high intensity studies that used interval (and not continuous) exercise.
Study or Subgroup
Myers 2012
Patwala 2009
Wisloff 2007
Exercise
Control
Mean
SD Total Mean
SD Total Weight
4.67 8.1368
24 0.73 1.8073
26
1.37 3.3032
25 -0.01 0.0242
25 57.0%
6 5.3537
9
0.2 0.1611
5 43.0%
Total (95% CI)
34
30 100.0%
Heterogeneity: Tau² = 7.96; Chi² = 5.39, df = 1 (P = 0.02); I² = 81%
Test for overall effect: Z = 1.50 (P = 0.13)
Mean Difference
IV, Random, 95% CI
Not estimable
1.38 [0.09, 2.67]
5.80 [2.30, 9.30]
Mean Difference
IV, Random, 95% CI
3.28 [-1.01, 7.57]
-10
-5
0
5
10
Favours Control Favours Exercise
Sub-Analysis 2. Change in peak VO2 in high intensity studies that used continuous (and not interval) exercise.
Study or Subgroup
Myers 2012
Patwala 2009
Wisloff 2007
Exercise
Control
Mean
SD Total Mean
SD Total Weight
4.67 8.1368
24 0.73 1.8073
26 100.0%
1.37 3.3032
25 -0.01 0.0242
25
0.0%
6 5.3537
9
0.2 0.1611
5
0.0%
Total (95% CI)
24
Heterogeneity: Not applicable
Test for overall effect: Z = 2.32 (P = 0.02)
26 100.0%
Mean Difference
IV, Random, 95% CI
3.94 [0.61, 7.27]
1.38 [0.09, 2.67]
5.80 [2.30, 9.30]
Mean Difference
IV, Random, 95% CI
3.94 [0.61, 7.27]
-10
-5
0
5
10
Favours Control Favours Exercise
Sub-Analysis 3. Sensitivity analysis of change in peak VO2 after the removal of HF-ACTION (O’Connor, 2009) from our
vigorous intensity analysis.
Study or Subgroup
Belardinelli 2008
Braith 1999
Brubaker 2009
Delagardelle 2008a
Delagardelle 2008b
Franco 2005
Fu 2011
Giannuzi 2003
Hambrecht 2000
Jette 1991a
Jette 1991b
Keteyian 1999
Klecha 2007
Klocek 2004a
Klocek 2004b
Kulcu 2007
Linke 2005
Maiorana 2011
Mueller 2007
Myers 2001
O'Connor 2009
Oka 2000
Passino 2008
Roveda 2003
Sarullo 2006
Senden 2005
Van Den Berg-Emons 2003
Willenheimer 1998
Wisloff 2007b
Exercise
Control
Mean
SD Total Mean
SD Total Weight
3.1 10.1497
44
-0.3 0.6591
21
2.7%
3.3 4.6131
10
-0.8 1.0408
9
2.7%
-0.2 0.5356
30
-0.1 0.2629
29
5.8%
1.8 8.4661
22
-0.7 5.257
9
1.4%
2.3 5.3188
23
-0.2 0.1906
6
3.6%
2.2 4.2577
17
-0.2 0.3148
12
3.8%
3.6 6.2033
14
-1.4 1.5138
7
2.3%
2.4 5.9713
45
-0.1 0.1901
44
4.2%
4.8 8.0117
31
0.3 0.5089
33
2.9%
3.52
3.783
7 -0.82 0.9808
8
2.8%
1.73 2.5751
11 1.43 1.999
10
3.9%
2.3 4.2009
21
0.7 1.6958
22
3.9%
4.6 8.2106
25
-0.7 1.2494
25
2.4%
1.1 1.8955
14
-1.5 0.5406
7
5.1%
4 4.9599
14
-1.5 0.5406
7
3.1%
3.5 4.9013
23
2 6.9544
21
2.2%
4.7 7.3586
12
0.3 0.4466
11
1.8%
2.7 2.1051
12
-1 1.1133
12
4.7%
3.9 6.2925
25
1.3 3.1494
25
2.9%
5.7 8.9243
12
0.4 0.6296
12
1.3%
0.7 6.1865 1159
0.1 2.0737 1172
0.0%
0.52 0.8184
12 0.001 0.0016
12
5.7%
2 4.9015
71
-0.6 1.2449
19
4.8%
5.8 6.2334
7
0.9 1.1709
9
1.5%
3.2
3.887
30
0.3 0.8034
30
4.6%
0.7 1.6958
25
-0.7 2.0689
36
5.3%
1.2 2.4012
18
-0.3 0.7507
16
5.0%
0.9 2.0299
22
-0.1 3.539
27
4.4%
1.9 1.6953
9
0.2 0.1257
4
5.1%
Total (95% CI)
606
483 100.0%
Heterogeneity: Tau² = 1.96; Chi² = 177.64, df = 27 (P < 0.00001); I² = 85%
Test for overall effect: Z = 7.26 (P < 0.00001)
Mean Difference
IV, Random, 95% CI
3.40 [0.39, 6.41]
4.10 [1.16, 7.04]
-0.10 [-0.31, 0.11]
2.50 [-2.43, 7.43]
2.50 [0.32, 4.68]
2.40 [0.37, 4.43]
5.00 [1.56, 8.44]
2.50 [0.75, 4.25]
4.50 [1.67, 7.33]
4.34 [1.46, 7.22]
0.30 [-1.66, 2.26]
1.60 [-0.33, 3.53]
5.30 [2.04, 8.56]
2.60 [1.53, 3.67]
5.50 [2.87, 8.13]
1.50 [-2.09, 5.09]
4.40 [0.23, 8.57]
3.70 [2.35, 5.05]
2.60 [-0.16, 5.36]
5.30 [0.24, 10.36]
0.60 [0.22, 0.98]
0.52 [0.06, 0.98]
2.60 [1.33, 3.87]
4.90 [0.22, 9.58]
2.90 [1.48, 4.32]
1.40 [0.45, 2.35]
1.50 [0.33, 2.67]
1.00 [-0.58, 2.58]
1.70 [0.59, 2.81]
Mean Difference
IV, Random, 95% CI
2.46 [1.80, 3.13]
-100
-50
0
50
100
Favours Control Favours Exercise
Online Table 1.
Categories of exercise intensity and the subjective and objective measures (absolute and relative) accompanying each category.
From : Norton, K. J. Sci. Med. Sports 13 (2010) 496-502.
Intensity Category
Sedentary
Objective Measures
< 1.6 METs
<40% Heart rate Maximum
<20% Heart Rate Reserve
<20% VO2 maximum
1.6 <3.0 METs
40<55% Heart rate
Maximum
20<40% Heart Rate Reserve
20<40% VO2 maximum
Subjective Measures
RPE <8 (Scale 6-20)
Modified RPE <1 (Scale 0-10)
Descriptive Measures
Activities that usually involve
sitting and lying and little
additional movement
RPE 8-10
Modified RPE 1-2
Moderate
3.0<6.0 METs
55<70% Heart rate
Maximum
40<60% Heart Rate Reserve
40<60% VO2 maximum
RPE 11-13
Modified RPE 3-4
Vigorous
6.0<9.0 METs
70<90% Heart rate
Maximum
60<85% Heart Rate Reserve
60<85% VO2 maximum
RPE 14-16
Modified RPE 5-6
An aerobic activity that does
not cause noticeable change
in breathing rate
An intensity that can be
sustained for at least 60
minutes
An aerobic activity that is
able to be conducted whilst
maintaining a conversation
uninterrupted
An intensity that may last
between 30 and 60 minutes
An aerobic activity in which a
conversation generally cannot
be maintained uninterrupted
An intensity that may last up
to about 30 minutes
High
>9 METs
>90% Heart rate Maximum
>85% Heart Rate Reserve
>85% VO2 maximum
RPE >16
Modified RPE >7
Low
Online Table 2.
MEDLINE search Strategy
An intensity that generally
cannot be sustained for
longer than about 10 minutes
#1 (chronic heart failure*):ti,ab,kw
#2 MeSH descriptor chronic heart failure, this term only
#3 MeSH descriptor heart failure, Chronic explode all trees
#4 MeSH descriptor heart Failure, this term only
#5 “chronic heart”:ti,ab,kw
#6 “chronic heart”:ti,ab,kw
#7 (CHF):ti,ab,kw
#8 MeSH descriptor Cardiomyopathy explode all trees
#9 cardiomyopathy:ti,ab,kw
#10 “exercise training”:ti,ab,kw
#11 (physical training):ti,ab,kw
#12 (physical exercise):ti,ab,kw
#13 (#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12)
Online Table 3: Randomized Control Trials Included in the Meta-Analysis:
High Intensity Training; patients and training characteristics.
Study
Country
Anagnostakou
(2011)[1]
GREECE
Sessions
Attended
(%)
Not reported
Participants include in the
final analysis
Training characteristics
Exercise Volume
Total Patient-Hours
Exercise Volume
Weekly Minutes
Total patients N=28. Exercise:
n=14, 12m/2f, mean age 52.
Exercise control: n=14,
11m/3f, mean age 54. NYHA
class I/II/III.
8 weeks of interval
exercise (first group) and
continuous (second group)
training, 3 sessions per
week, and 40 minutes at
50% of workload
performed during the
baseline steep ramp test
until fatigue.
8 weeks of interval (first
group) and continuous
(second group) exercise
training, 3 sessions per
week, 60 minutes at 90%
of MHR.
8 weeks of interval (first
group) and continuous
(second group) exercise
training. First group; 6
sessions per week, 71
minutes. Second group; 61
minutes, at 50-80% of the
maximal power reached
during a steep ramp test.
12 weeks. Interval
walking four 4-min
intervals by 2–4 times at
75–80% of HRR.
Cont walked continuously
at a moderate training
intensity, ~ 45–60% of
HRR for 30–45 min, 2-5
Ex Tra: 225 hours
120
Ex Cont: 277 hours
120
Ex Tra: 720
Ex Cont: 1454
180
180
Ex Tra: 680
Ex Cont: 555
426
366
Ex Tra; High 384
192
Ex Tra; Cont 450
225
Beckers
(2008)[2]
BELGIUM
100
Total patients N=58. Exercise:
n=30, 24m/6f, mean age 59.
Exercise control: n=28,
18m/10f, mean age 58. NYHA
class II/III.
Freyssin
(2012)[3]
FRANCE
100
Total patients N=26. Exercise:
n=12, 6m/6f, mean age 54.
Exercise control: n=14, 7m/7f,
mean age 55.
Iellamo
(2012) [4]
ITALY
100
Total patients N=20 males,
age 62 years. All walking,
High Intensity Interval N=10,
Moderate Intensity
Continuous N=10
Myers
(2012)[5]
SWITZERLAND
Not reported
Total patients N=50. Exercise:
n=24 male, mean age 55.
Control: n=26 male, mean age
57. NYHA class II/III.
Nilsson
(2008)[6]
NORWAY
95
Total patients N=80. Exercise:
n=40, 31m/9f, mean age 69.
Control: n=40, 32m/8f, mean
age 72. NYHA class II/III.
Patwala
(2009)[7]
UK
Not reported
Total patients N=50. Exercise:
n=25. Control: n=25. Both
groups: 92% male, mean age
64. NYHA class III/IV
Roditis
(2007)[8]
GREECE
Not reported
Total patients N=21. Exercise:
n=11, 10m/1f, mean age 63.
Control: n=10, 9m/1f, mean
age 61.
Wisloff *
(2007)[9]
NORWAY
High
Interval
Exercise
Training:
92±2
Total patients N=18. Exercise:
n=9, 7m/2f, mean age 77.
Control: n=9, 7m/2f, mean age
74.
times weekly.
8 weeks of continuous
exercise training, 4
sessions per week, 45
minutes at 80% HRR
gradually increased to
fatigue and 2 hours
walking a day. Total
walking hours: 112.
16 weeks of interval
exercise training, 2
sessions per week, 50
minutes at RPE 15-18
Borg scale.
12 weeks of interval
exercise training, 3
sessions per weeks, 30
minutes at 80-90% peak
HR.
12 weeks of interval
exercise training, 3
sessions per week, 40
minutes at 100-120% of
baseline peak work rate.
Continuous exercise
group; 3 sessions per
week, 50% of baseline
peak work rate.
12 weeks of interval
exercise training, 3
sessions per week, 38
minutes at 90-95% peak
VO2.
Ex Tra: 576
180 cycling
+ 840 walking
Ex Tra: 1062
100
Ex Tra: 450
90
Ex Tra: 265
Ex Cont: 371
120
120
Ex Tra: 204
114
Ex Tra = Exercise Training; Ex Cont = Exercise Control; peak VO2 = maximal oxygen consumption; RPE=rate perceived exertion; peak HR=maximal heart rate;
MHR=Maximum heart rate; HRR=heart rate reserve; m/f=male/female; *=another exercise group in vigorous exercise training.
Vigorous exercise training; patients and training characteristics.
Study
Country
Belardinelli
(2008)[10]
ITALY
Sessions
Attended
(%)
Not reported
Participants include in the
final analysis
Training characteristics
Exercise Volume
Total Patient-Hours
Exercise Volume
Weekly Minutes
Total patients N= 130.
Exercise n= 44, 38m/6f, mean
age 59.
Control n=42, 35m/7f, mean
age 58. Control exercise
(dancing) n= 44, 36m/8f,
mean age 60. NYHA class
II/III.
Total patients N=19. Exercise
n=10, mean age 61. Control
n=9 mean age 62. NYHA
class II/III.
8 weeks of continuous
exercise training, 3
sessions a week per week,
30 minutes per session at
70% of peak VO2.
Ex Tra: 528
90
Braith
(1999)[11]
USA
Not reported
16 weeks of continuous
exercise training, 3
sessions per week, 20-45
minutes per session at 80%
of peak VO2.
16 weeks of interval
exercise training, 3
sessions per week, 30-40
minutes per session at 6070% of HRR.
12 weeks of continuous
exercise training, 3
sessions per week, 45
minutes at 80% of MHR.
14 weeks of exercise
training, 3 sessions per
week, 40 minutes per
session at 75% of peak
VO2.
Ex Tra: 360
135
Brubaker
(2009)[12]
USA
94
Total patients N=59. Exercise
n= 30, mean age 70. Control
n= 29, mean age 69. NYHA
class II/III/IV.
Ex Tra: 965
120
Da Silva
(2002)[13]
BRAZIL
Not reported
Delagardelle
(2008)[14]
LUXEMBOURG
Not reported
Erbs
(2003)[15]
GERMANY
Not reported
Total patients N= 24. Exercise
n=12, 9m/3f, mean age 48.
Control n=12, 9m/3f, mean
age 56. NYHA class I/II/III.
Total patients N=60. Ischemic
CHF – Exercise n=22, 29m/2f,
mean age 58. Non–ischemic
CHF – Exercise n=23, 22m/7f,
mean age 59. Control n=15,
13m/2f, mean age 56. NYHA
class II/III/IV.
Total patients N=73. Exercise
n=36. 26 from moderate CHF,
mean age 55. 10 from
advanced CHF, mean age 51.
Control n= 37. NYHA class
II/III.
Ex Tra: 324
135
Ex Tra (Ischemic
CHF) : 619
Ex Tra (NonIschemic CHF): 647
120
24 weeks of continuous
exercise training, 7
sessions per week, 20
minutes per session at 70%
of peak VO2.
Ex Tra: 1996
140
Franco
(2006)[16]
BRAZIL
Not reported
Total patients N=29. Exercise
n=17, 13m/4f, mean age 56.
Control n=12, 9m/3f, mean
age 52. NYHA class II.
Fu*(2011)[17]
TAIWAN
Not reported
Total patients N= 40. Exercise
n=14, 9m/5f, mean age 68.
Control n= 13, 9m/4f, mean
age 68. NYHA class II/III.
Giannuzi
(2003)[18]
ITALY
85
Total patients N=89. Exercise
n= 45, mean age 60. Control
n=44, mean age 61. NYHA
class II/III.
Gielen
(2012)[19]
GERMANY
Not reported
Hambrecht
(2000)[20]
GERMANY
60
Total patients N=60. Exercise
n=30 in two groups; (less than
55 year and more than 65
year). Control n=30 in two
control group (less than 55
year and more than 65 year).
NYHA classes II/III.
Total patients N=73. Exercise
n=36, mean age 54. Control
n=37 mean age 55, NYHA
class I/II/III.
Hawkowsky
(2005)[21]
CANADA
Jakovljevic
(2010)[22]
UK
60: 3 months
supervised
training.
49: 3 months
unsupervised
training.
Not reported
Total patients N= 20. Exercise
n=10. Control n=10. Both
group mean age 72. NYHA
class I/II/III.
Total patients N= 21. Exercise
n=11, 8m/3f, mean age 65.
Control n=10, 8m/2f, mean
age 63. NYHA class I/II.
16 weeks of continuous
exercise training, 3
sessions per week, 32
minutes per session at
ANT.
12 weeks of interval
exercise training, 3
sessions per week, 15
minutes per session at 80%
of peak VO2.
26 weeks of continuous
exercise training, 4
sessions per week, 30
minutes per session at 60%
of peak VO2 plus homebased training.
4 weeks of exercise
training, 4 sessions per
week, 20 minutes per
session at 70% of peak
VO2. Additional group
training session 60 minutes
per week.
26 weeks of continuous
exercise training, 7
sessions per week, 20
minutes per session at 70%
of MHR plus 1 group
exercise session per week.
24 weeks of exercise
training, 2 sessions per
week, 30 minutes per
session at 70% of HRR.
Ex Tra: 432
96
Ex Tra: 126
45
Ex Tra: 2340
120
Ex Tra: 158
80
Ex Tra: 2162
140
Ex Tra: 240
Ex Cont: 240
60
12 weeks of exercise
training, 5 sessions per
week, 28 minutes per
session at 60-80% of peak
VO2.
Ex Tra: 310
140
Jette
(1991)[23]
GERMANY
Not
reported.
Total patients N=36. Exercise
n=7 in <30% LVEF, mean age
48, n=11 in ≥30% LVEF,
mean age 45. Control n= 8 in
< 30% LVEF, mean age 47,
n=10 in ≥ 30% LVEF, mean
age 43. NYHA class I/II/III.
Total patients N= 169.
Exercise n=84, 64m/20f, mean
age 66. Control n=85,
62m/23f, mean age 70. NYHA
class I/II/III.
Jolly
(2009)[24]
UK
74: 4 week;
63: 10 week;
54: 45 week
Karapolat
(2009)[25]
TURKEY
90: First
group
87.5: Second
group.
Total patients N= 68. Exercise
n=32, 66%m, mean age 45.
Control exercise n=36, 62%m,
mean age 44. NYHA class
II/III.
Keteyian
(1999)[26]
USA
Not reported
Klecha (2007)
[27]
POLAND
Not reported
Total patients N=43. Exercise
n=21, mean age 57. Control
n=22 mean age 55. NYHA
class II/III.
Total patients N=50. Exercise
n=25, 20m/5f, mean age 60.
Control n=20, 18m/7f, mean
age 61. NYHA class II/III.
Klocek
(2005)[28]
POLAND
Not reported
Total patients N=42. Exercise
n=14 in constant workload,
mean age 54, n=14 in
progressive workload, mean
age 57. Control n=14, mean
age 55. NYHA class II/III.
4 weeks of exercise
training, 5 sessions per
week, 15 minutes per
session at 70-80% of MHR
plus 30-60 minutes
walking per day.
Ex Tra (<30%LVEF):
35
Ex Tra (>30%LVEF):
55
75 cycling
+ 420 walking
26 weeks of exercise
training, 5 sessions per
week, 25 minutes per
session at 70% of peak
VO2 plus home-based
program at 4,10 and 20
weeks.
8 weeks of exercise
training, 3 sessions per
week, 30 minutes per
session at 60-70% of peak
VO2. Control group did a
walking program at 6070% of peak VO2, 60-70%
HRR and 13-15 Borg
scale.
24 weeks of exercise
training, 3 sessions per
week, 33 minutes per
session at 80% of HRR.
24 weeks of exercise
training, 3 sessions per
week, 45 minutes per
session at 80% of MHR.
Ex Tra: 4586
125
Ex Tra: 384
Ex Cont: 432
90
Ex Tra: 832
99
Ex Tra: 1350
135
24 weeks of exercise
training, 3 sessions per
week, 25 minutes per
session at 75% of MHR.
Ex Tra (constant
workload): 423
Ex Tra (progressive
workload): 423
75
Kulcu
(2007)[29]
TURKEY
100
Total patients N= 44. Exercise
n=23, mean age 60. Control
n=21, mean age 58. NYHA
class II/III.
8 weeks of exercise
training, 3 sessions per
week, 60 minutes per
session at 70% of MHR.
Ex Tra: 552
180
Laurent
(2009)[30]
FRANCE
Not reported
Total patients N=24. Exercise
n=12, mean age 55. Control
exercise n=12, mean age 53.
32 weeks of exercise
training, 5 sessions per
week, 30 minutes per
session at 60-70% of HRR.
Ex Tra: 960
150
LeMaitre
(2004)[31]
UK
Not reported
Total patients N=46. Exercise
n=24. Control n=22, mean age
for both groups were 62.
83%m NYHA class II/III.
Ex Tra: 360
150
Linke
(2005)[32]
GERMANY
Not reported
Total patients N=23. Exercise
N=12, mean age 55. Control
n=11, mean age 52. NYHA
class II/III.
Ex Tra: 721
140
Maiorana
(2011)[33]
AUSTRALIA
85
Total patients N=24. Exercise
n=12, 11m/1f, mean age 61.
Control n=12, 11m/1f, mean
age 64. NYHA class I/II/III.
Ex Tra: 289
120
McKelvie
(2002)[34]
CANADA
70
Ex Tra: 7020
90
Mueller
(2007)[35]
SWITZERLAND
Not reported
Total patients N=181.
Exercise n=90, 74m/16f, mean
age 65. Control n=91, 73m/18
f, mean age 66. NYHA class
I/II/III.
Total patients N= 50. Exercise
n=25. Control n=25, mean age
for both groups were 55.
6 weeks of continuous
exercise training, 5
sessions per week, 30
minutes per session at 70%
of MHR.
26 weeks of continuous
exercise training, 7
sessions per week, 20
minutes per session at 70%
of peak VO2.
12 weeks of exercise
training, 3 sessions per
week, 40 minutes per
session at 70% of peak
VO2.
52 weeks of exercise
training, 3 sessions per
week, 30 minutes at 70%
of MHR.
Ex Tra: 100
60 cycling
+ 630 walking
Myers
(2001)[36]
SWITZERLAND
Not reported
4 weeks of continuous
exercise training, 2
sessions per week, 30
minutes at 80% of MHR
plus walking 90 minutes
per day.
8 weeks of exercise
training, 4 sessions per
week, 45 minutes per
session at 70% of peak
VO2.
Ex Tra: 288
180
Total patients N=24. Exercise
n=12 mean age 56. Control
n=12, mean age 56. NYHA
class II/III.
Niebauer
(2005)[37]
UK
Not reported
Total patients N= 27. Exercise
n=18, mean age 54. Control
n= 9, mean age 51.
O’Connor
(2009)[38]
USA, CANADA,
FRANCE.
70% up to
one year
follow-up
Total patients N=2331.
Exercise n=1159, 812m/347f.
Control n=1172, 858m/314f.
NYHA class II/III/IV.
Oka
(2000)[39]
USA
100
Total patients N=40. Exercise
n=20, 17m/3f, age > 30.
Control n=20, 14m/6f, age >
30. NYHA class II/III.
Passino
(2008)[40]
ITALY
Not reported
Prescott
(2009)[41]
DENMARK
Not reported
Total patients N= 148.
Exercise n=71, 62m/9f, mean
age 61. Control n=19, 14m/5f,
mean age 63. NYHA class
II/III.
Total patients N= 43. Exercise
n=20, 16m/4f, mean age 68.
Control n=23, 18m/5f, mean
age 67. NYHA class II/III.
Roveda
(2003)[42]
BRAZIL
85-98
Total patients N= 16. Exercise
n=7, 5m/2f, Control n=9,
6m/3f, 35-60 years of age.
NYHA class II/III.
Sarullo
(2006)[43]
ITALY
93
Total patients N=60. Exercise
n=30, 23m/7f, mean age 53.
Control n=30, 22m/8f, mean
age 53. NYHA class II/III.
8 weeks of continuous
exercise training, 5
sessions per week, 20
minutes at 80% of MHR
plus 20 minutes homebased training.
12 weeks of continuous
exercise training, 5
sessions per week, 40
minutes per session at 70%
of HRR plus walking and
resistance training.
12 weeks of continuous
exercise training, 3
sessions per week, 50
minutes at 70% of MHR
plus resistance training 2
sessions per week.
39 weeks of exercise
training, 3 sessions per
week, 30 minutes at 65%
of peak VO2.
Ex Tra: 238
100
Ex Tra: 46591
200
Ex Tra: 598
150
Ex Tra: 4153
90
8 weeks of exercise
training, 2 sessions per
week, 24 minutes at 7080% of peak VO2 plus 2030 minutes walking.
16 weeks of continuous
exercise training, 3
sessions per week, 25-40
minutes at ANT.
Ex Tra: 128
48 cycling
+ 210 walking
Ex Tra: 225
120
12 weeks of exercise
training, 3 sessions per
week, 30 minutes per
session at 70% of peak
VO2.
Ex Tra: 540
90
Senden
(2005)[44]
NETHERLAND
100-overall
88supervised
training
Total patients N=61. Exercise
n=25, 20m/5f. Control n=36,
25m/11f. Mean age for both
group were 59.8. NYHA class
II/III.
Total patients N=34. Exercise
n=18, 12m/6f, mean age 59.
Control n=16, 13m/3f, mean
age 59. NYHA class II/III.
26 weeks of supervised
and home-based exercise
training, 4 sessions per
week, 11minutes per
session at 70% of MHR.
12 weeks of exercise
training, 2 sessions per
week, 60 minutes per
session at 60% of HRR.
Ex Tra: 468
44
Van den BergEmons
(2004)[45]
NETHERLAND
84
Ex Tra: 432
120
Willenheimer
(1998)[46]
SWEDEN
74.5
Total patients N= 49. Exercise
n=22, mean age 64. Control
n=27, mean age 64. NYHA
class I/II/III.
Ex Tra: 792
135
95±3
Total patients N=18. Exercise
n=9, mean age 74. Control
n=4, mean age 75.
16 weeks of exercise
training, 3 sessions per
week, 45 minutes per
session at 80% of peak
VO2.
12 weeks of continuous
exercise training, 3
sessions per week, 47
minutes at 75% of peak
VO2.
Wisloff
( 2007)[9]
NORWAY
Ex Tra: 253
141
Ex Tra. = Exercise Training; Ex Cont = Exercise Control; peak VO2= maximal oxygen consumption; RPE=rate perceived exertion; peak HR=maximal heart rate;
MHR=Maximum heart rate; HRR=heart rate reserve; m/f=male/female; *=another exercise group in moderate exercise training.
Moderate exercise training; patients and training characteristics.
Study
Country
Belardinelli
(1999)[47]
ITALY
Sessions
Attended (%)
89
Participants include in the
final analysis
Total patients N=99. Exercise
n=50, 45m/5f, mean age 56.
Control n=49, 43m/6f, mean
age 53. NYHA class II/III/IV.
Training characteristics
8 weeks of continuous
exercise training, 3
sessions per week, 40
minutes at 60% of peak
VO2 plus 44 weeks of
maintenance phase, 2
sessions per week with
same intensity and session
duration.
Exercise Volume
Total Patient-Hours
Ex Tra: 804
Exercise Volume
Weekly Minutes
120
Beniaminovitz
(2002)[48]
USA
Not reported
Total patients N=25. Exercise
n=17, 12m/5f, mean age 50.
Control n=8, 6m/2f, mean age
48.
Butterfield
(2008)[49]
AUSTRALIA
89
Total patients N=19. Exercise
n=13. Control n=6.
Cider
(2003)[50]
SWEDEN
95
Total patients N=25. Exercise
n=15, 11m/5f, mean age 75.
Control n=10, 6m/3f, mean
age 75. NYHA class II/III.
Collins
(2004)[51]
USA
57
Total patients N=27. Exercise
n=12, mean age 63. Control
n= 15, mean age 66. NYHA
class I/II/III.
Cowie
(2011)[52]
UK
86 – Hospital
77 – homebased
Daskapan
(2005)[53]
TURKEY
97:First group
81:Second
group
Dracup
(2007)[54]
USA
44
Total patients N= 60. Exercise
(hospital) n= 20, 18m/2f,
mean age 66, exercise (homebased) n=20, 16m/4f, mean
age 71. Control n=20, 17m/3f,
mean age 61. NYHA class
II/III.
Total patients N=22. Exercise
n=11, 8m/3f, mean age 52.
Control n=11, 8m/3f, mean
age 49. NYHA class II/III.
Total patients N=173.
Exercise n=86, 63m/23f,
mean age 53, 87 in control
group 61m/26f, mean age 55.
NYHA class II/III/IV.
12 weeks of continuous
exercise training, 3
sessions per week, 30
minutes at 50% of peak
VO2.
12 weeks of interval
exercise training, 6
sessions per week, 45
minutes per session at
intensity between 3 and 5
scale (5 the highest
intensity), hospital- and
home-based.
8 weeks of exercise
training, 3 sessions per
week, 45 minutes per
session at 40- 70% of
MHR.
12 weeks of interval
exercise training, 3
sessions per week, 50
minutes per session at 70%
of peak VO2.
Ex Tra: 306
90
Ex Tra: 702
270
Ex Tra: 270
135
Ex Tra: 359
150
12 weeks of continuous
exercise training, 2
sessions per week, 30
minutes at 75% of peak
VO2.
Ex Tra (hospital): 240
Ex Tra (home-based):
240
60
12 weeks of exercise
training, 3 sessions per
week, 30 minutes per
session at 60% of MHR.
52 weeks of continuous
exercise training, 4
sessions per week, 45
minutes at 40-60% of
MHR.
Ex Tra: 198
Ex Cont: 198
90
Ex Tra: 13416
180
Erbs
(2010)[55]
GERMANY
Not Reported
Total patients N= 37. Exercise
n=18, mean age 60, Control
n=19, mean age 62. NYHA
class III.
Fu (2011)[17]
TAIWAN
Not reported
Total patients N= 40. Exercise
n=13, 8m/5f, mean age 66.
Control n=13, 9m/4f, mean
age 68. NYHA class II/III.
Harjola
(2006)[56]
FINLAND
100
Total patients N= 17. Exercise
n=8, mean age 50. Control
n=9, mean age 50. NYHA
class I/II/III.
Kiilavuori
(1996)[57]
FINLAND
100
Total patients N= 27. Exercise
n=12, 12m. Control n=15,
14m/1f. Age < 65 for both
groups. NYHA class II/III.
Kobayashi
(2003)[58]
JAPAN
Not reported
Total patients N=28. Exercise
n=14, 12m/2f, mean age 55.
Control n=14, 8m/6f, mean
age 62. NYHA class II/III.
Koukouvou
(2004)[59]
GREECE
100
Total patients N=26. Exercise
n=16, mean age 52. Control
n=10, mean age 53. NYHA
class II/III.
Laoutaris
(2011)[60]
GREECE
Not reported
Total patients N=15. Exercise
n=10, 10m, mean age 37.
Control n=5, 4m/1f, mean age
42.
Initial Ex Tra (hospitalbased); 12 weeks of
continuous exercise
training (home-based), 7
sessions per week, 20-30
minutes at 40-60% of
MHR plus 60 minutes
walking.
12 weeks of continuous
exercise training, 3
sessions per week, 30
minutes at below 60% of
peak VO2.
12 weeks of continuous
exercise training, 3
sessions per week, 30
minutes at 50-60% of peak
VO2.
12 weeks of continuous
exercise training, 3
sessions per week, 30
minutes at 50-60% of peak
VO2.
12 weeks of exercise
training, 2 sessions per
week, 30 minutes at ANT.
Ex Tra: 756
210 cycling
+ 420 walking
Ex Tra: 234
90
Ex Tra: 144
90
Ex Tra 216
90
Ex Tra: 168
60
24 weeks of exercise
training, 4 sessions per
week, 60 minutes per
session at 70% of peak
VO2.
10 weeks of exercise
training, 3-5 sessions per
week, 45 minutes per
session at Borg scale 12-14
plus walking for 30-45
minutes per day.
Ex Tra: 1536
240
Ex Tra: 375
225 cycling
+ 315 walking
Lima
(2010)[61]
BRAZIL
94.9
Total patients N= 40. Exercise
n=21, 11m/10f, mean age 49.
Control n=19, 12m/7f, mean
age 50. NYHA class I/II/III.
Mandic
(2009)[62]
CANADA and
NEW
ZEALAND
78 ± 25 for Ex
Tra group 1
and 2
Meyer
(2005)[63]
GERMANY
49 days-over
4 days per
week
Total patients N= 42. Exercise
(aerobic) n=14, 11m/3f, mean
age 63. Exercise
(aerobic+resistance) n=15,
11m/4f, mean age 59. Control
n=13, 10m/3f, mean age 76.
NYHA class I/II/III.
Total patients N=54. Exercise
n=26, 21m/5f, mean age 59.
Control n=28, 23m/5f, mean
age 55. NYHA class II/III.
Parnell
(2002)[64]
AUSTRALIA
100
Total patients N= 21. Exercise
n=11, 10m/1f, mean age 57.
Control n=10, 9m/1f, mean
age 53. NYHA class II/III.
Piotrowicz
(2010)[65]
POLAND
100: First
group
100: Second
group
Pozehl
(2003)[66]
USA
99.28
Total patients N= 131.
Exercise n=75, 64m/11f,
mean age 56. Control n=56,
53m/3f, mean age 60. NYHA
class II/III.
Total patients N=23. Exercise
n=16, 14m/2f, mean age 59.
Control n=7, 6m/1f, mean age
55. NYHA class II/III/IV.
Servantes
(2012)[67]
BRAZIL
98.5- Aerobic
100.2- Aerobic
and strength
training
Total patients N=45. Exercise
(aerobic) n=17, mean age 52.
Exercise (aerobic+strength)
n=17, mean age 51. Control
n=11, mean age 53. NYHA
class II/III.
12 weeks of continuous
exercise training, 3
sessions per week, 30
minutes at 55-65% of
MHR.
12 weeks of exercise
training, 3 sessions per
week, 30 minutes per
session at 70% of peak
VO2.
Ex Tra 378
90
Ex Tra (aerobic): 252
Ex Tra
(aerobic+resistance):
270
90
12 weeks of continuous
exercise training, 5
sessions per week, 45
minutes per session at
ANT.
8 weeks of continuous
exercise training, 6
sessions per week, 60
minutes at 50-60% of
MHR.
8 weeks of continuous
exercise training, 3
sessions per week, 10-30
minutes at 40-70% of
HRR.
12 weeks of exercise
training, 3 sessions per
week, 20 minutes at 80%
of peak VO2.
Ex Tra: 1170
225
Ex Tra: 528
360
Ex Tra: 900
Ex Cont: 672
90
Ex Tra: 190
60
12 weeks of continuous
exercise training, 3
sessions per week, 45
minutes at ANT.
Ex Tra (aerobic): 459
Ex Tra
(aerobic+strength):
459
135
Sturm
(1999)[68]
AUSTRIA
90
Total patients N= 26. Exercise
n=13, mean age 55. Control
n= 13 mean age 53. NYHA
class II/III.
Wielenga
(1998)[69]
NETHERLAN
D
85.4
Total patients N= 67. Exercise
n=35, mean age 62. Control
n= 32, mean age 64. NYHA
class II/III.
12 weeks of continuous
exercise training, 2-3
sessions per week, 20-50
minutes at 50% of peak
VO2.
12 weeks of continuous
exercise training, 3
sessions per week, 20-30
minutes at 60% of HRR.
Ex Tra: 388
150
Ex Tra: 630
90
Ex. Tra = Exercise Training; Ex Cont = Exercise Control; peak VO2= maximal oxygen consumption, RPE=rate perceived exertion, peak HR=maximal heart rate,
MHR=Maximum heart rate, HRR=heart rate reserve, m/f=male/female
Low exercise training; patients and training characteristics.
Study
Country
ITALY
Sessions
Attended (%)
100
Participants include in the
final analysis
Total patients N= 27. Exercise
n=18, 16m/2f, mean age 56.
Control n=9, 7m/2f, mean age
57. NYHA class II/III.
Belardinelli
(1995)[70]
Bocalini
(2008)[71]
BRAZIL
89±4
Total patients N=42. Exercise
n=22 19m/3f, mean age 61.
Control n=20, 18m/2f, mean
age 60. NYHA class II/III.
Jonsdottir
(2005)[72]
ICELAND
Not reported
Total patients N= 43. Exercise
n=21, 16m/5f, mean age 68.
Control n=22, 18m/4f, mean
age 69. NYHA class II/III.
Witham
(2007)[73]
UK
Not reported
Total patients N= 42. Exercise
n= 23, 10m/13f. Control n=19,
9m/10f, mean age for both
groups 81. NYHA class II/III.
Training characteristics
8 weeks of continuous
exercise training, 3
sessions per week, 30
minutes at 40% of peak
VO2.
26 weeks of continuous
exercise training, 3
sessions per week, 20-40
minutes at 50% of peak
VO2.
22 weeks of continuous
exercise training, 2
sessions per week, 15
minutes at 50% of MHR
12 weeks of continuous
exercise training, 2
sessions per week, 60
minutes at < 50% of peak
VO2.
Exercise Volume
Total Patient-Hours
Ex Tra: 216
Exercise Volume
Weekly Minutes
90
Ex Tra: 1150
120
Ex Tra: 231
30
Ex Tra: 552
120
Witham
(2012)[74]
UK
Study
77
Total patients N=107.
Exercise n= 53, 35m/18f,
mean age 80. Control n=54,
37m/17f, mean age 80. NYHA
class II/III.
Withdrawal
8 weeks plus 16 weeks
(home) of continuous
exercise training, 2
sessions per week, 60
minutes at < 50% of peak
VO2.
Ex Tra: 2544
120
Adverse Events
Ex. Tra. = Exercise Training; peak VO2. = maximal oxygen consumption; RPE=rate perceived exertion; peak HR=maximal heart rate; MHR=Maximum heart
rate; HRR=heart rate reserve; m/f=male/female.
Online Table 4.
High Intensity Training: Details of study withdrawal, deaths, hospitalization and cardiac events in patients.
Exercise
7 withdrawal
Control
6 withdrawal
Exercise
0 deaths or hospitalization and
1 cardiac event
Control
0 deaths or hospitalization and
1 cardiac event
Beckers (2008)*
0 withdrawal
2 withdrawal
1 death, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or
cardiac events
Freyssin (2012)*
0 withdrawal
0 withdrawal
2 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or
cardiac events
Iellamo (2012)
2 withdrawal
2 withdrawal
0 deaths, hospitalization or
events
0 deaths, hospitalization or events
Myers (2012)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or
cardiac events
Nilsson (2008)
2 withdrawal
2 withdrawal
0 deaths, hospitalization and
cardiac events
1 death, 0 hospitalization and
1 cardiac event
Roditis (2007)*
5 withdrawal
3 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or
cardiac events
Wisloff (2007)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization or cardiac
events
Patwala (2009)
Not Reported
Not Reported
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or
cardiac events
Anagnostakou
(2011)*
* = study which compared exercise group versus exercise control group.
Vigorous Intensity Training: Details of study withdrawal, deaths, hospitalization and cardiac events in patients.
Study
Exercise
Withdrawal
Control
Exercise
Adverse Events
Control
Belardinelli (2008)
1 withdrawal
4 withdrawal
0 deaths or hospitalization and
1 cardiac event
0 deaths or hospitalization and 1 cardiac
event
Brubaker (2009)
0 withdrawal
7 withdrawal
2 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization or cardiac
events
Da Silva (2002)
0 withdrawal
3 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 2 hospitalizations and 0 cardiac
events
Erbs (2003)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Franco (2006)
3 withdrawal
0 withdrawal
2 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Giannuzi (2003)
0 withdrawal
0 withdrawal
0 deaths, 2 hospitalizations and
0 cardiac events
1 death, 1 hospitalization and 0 cardiac
events
Gielen (2012)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Hambrecht (2000)
4 withdrawal
2 withdrawal
0 deaths, 2 hospitalizations and
1 cardiac event
2 deaths, 0 hospitalization or cardiac
events
Haykowsky (2005)*
3 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Jette (1991)a
3 withdrawal
1 withdrawal
0 deaths, 3 hospitalizations and
1 cardiac event
0 deaths, 0 hospitalization or cardiac
events
Jette (1991)b
1 withdrawal
1 withdrawal
0 deaths,1 hospitalization and 1 0 deaths, 0 hospitalization or cardiac
cardiac event
events
Jolly (2009)
0 withdrawal
0 withdrawal
2 deaths, 0 hospitalization or
cardiac events
3 deaths, 0 hospitalization or cardiac
events
Karapolat (2009)*
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Keteyian (1999)
5 withdrawal
3 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization and 1 cardiac
event
Klecha (2007)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Kulcu (2007)
2 withdrawal
4 withdrawal
0 deaths, 0 hospitalization and
1 cardiac event
1 death, 0 hospitalization and 1 cardiac
event
Laurent (2009)*
0 withdrawal
0 withdrawal
0 deaths, 2 hospitalizations and
2 cardiac events
0 deaths, 0 hospitalization or cardiac
events
Linke (2005)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Maiorana (2011)
0 withdrawal
2 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization and 1 cardiac
event
Mc Kelvie (2002)
26
withdrawal
16 withdrawal
9 deaths, 0 hospitalization and
1 cardiac event
8 deaths, 0 hospitalization and 1 cardiac
event
Mueller (2007)
1 withdrawal
2 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Myers (2001)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
O’Connor (2009)
37
withdrawal
46 withdrawal
Oka (2000)
2 withdrawal
2 withdrawal
Passino (2008)
2 withdrawal
Prescott (2009)
189 deaths, 729
hospitalizations and 0 cardiac
events
0 deaths, 0 hospitalization or
cardiac events
198 deaths, 760 hospitalizations and 0
cardiac events
5 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 5 hospitalizations and 0
cardiac events
11
withdrawal
3 withdrawal
2 deaths, 0 hospitalization or
cardiac events
4 deaths, 0 hospitalization or cardiac
events
Roveda (2003)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Sarullo (2006)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Senden (2005)
8 withdrawal
8 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Willenheimer (1998) 1 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 3 hospitalizations and 0
cardiac events
Wisloff (2007)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization or cardiac
events
Braith (1999)
Not Reported
Not Reported
1 death, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
0 deaths, 0 hospitalization or cardiac
events
Delagardelle (2008)
a
Not Reported
Not Reported
Not reported
Not reported
Delagardelle (2008)
b
Not Reported
Not Reported
Not reported
Not reported
Fu (2011)
Not Reported
Not Reported
Not reported
Not reported
Jakovljevic (2010)*
Not Reported
Not Reported
Not reported
Not reported
Klocek (2004)a
Not Reported
Not Reported
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Klocek (2004)b
Not Reported
Not Reported
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
LeMaitre (2004)
Not Reported
Not Reported
Not reported
Not reported
Niebauer (2005)
Not Reported
Not Reported
Not reported
Not reported
Van Den BergEmons (2003)
Not Reported
Not Reported
Not reported
Not reported
* = study which compared exercise group versus exercise control group; a & b = A study with different exercise group versus control.
Moderate Intensity Training: Details of study withdrawal, deaths, hospitalization and cardiac events in patients.
* = study which compared exercise group versus exercise control group; a & b = A study with different exercise group versus control.
Study
Exercise
Withdrawal
Control
Exercise
Adverse Events
Control
Belardinelli (1999)
2 withdrawal
3 withdrawal
0 deaths or hospitalization and
1 cardiac event
0 deaths, 0 hospitalization or cardiac
events
Beniaminovitz
(2002)
3 withdrawal
1 withdrawal
1 death, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Butterfield (2008)
0 withdrawal
0 withdrawal
2 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Cider (2003)
1 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Collins (2004)
2 withdrawal
1 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Cowie (2011)a
5 withdrawal
4 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Cowie (2011)b
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Daskapan (2005)*
3 withdrawal
4 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Dracup (2007)
1 withdrawal
1 withdrawal
0 deaths, 38 hospitalizations
and 0 cardiac events
0 deaths, 37 hospitalizations and 0
cardiac events
Erbs (2010)
1 withdrawal
1 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization or cardiac
events
Kobayashi (2003)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Lima (2010)
3 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths or hospitalization and 1 cardiac
event
Mandic (2009)a
3 withdrawal
3 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or 3 cardiac
events
Mandic (2009)b
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Meyer (2005)
6 withdrawal
5 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Piotrowicz (2010)*
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Pozehl (2003)
1 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization or cardiac
events
Servantes (2012)a
2 withdrawal
3 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization and 1 cardiac
event
Servantes (2012)b
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Sturm (1999)
2 withdrawal
1 withdrawal
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Wielenga (1998)
6 withdrawal
7 withdrawal
0 deaths, 1 hospitalization and
0 cardiac events
0 deaths, 0 hospitalization or cardiac
events
Fu (2011)
Not Reported
Not Reported
Not reported
Not reported
Harjola (2006)
0 withdrawal
0 withdrawal
Not reported
Not reported
Kiilavuori (1996)
Not Reported
Not Reported
Not reported
Not reported
Koukouvou (2004)
0 withdrawal
0 withdrawal
Not reported
Not reported
Laoutaris (2011)
Not Reported
Not Reported
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Parnell (2002)
Not Reported
Not Reported
0 deaths, 0 hospitalization or
cardiac events
0 deaths, 0 hospitalization or cardiac
events
Low Intensity Training: Characteristic of Randomize Controlled Trials that reported deaths, hospitalization and cardiac
events in Chronic Heart Failure patients.
Withdrawal
Adverse Events
Study
Exercise
Control
Exercise
Control
0 deaths or hospitalization and 0 deaths, 0 hospitalization or
Belardinelli (1995) 1 withdrawal 0 withdrawal
1 cardiac event
cardiac events
Bocalini (2008)
2 withdrawal
3 withdrawal
1 death, 0 hospitalization or
cardiac events
1 death, 3 hospitalizations and 0
cardiac events
Jonsdottir (2005)
2 withdrawal
2 withdrawal
2 deaths, 0 hospitalization or
cardiac events
0 deaths or hospitalization and 1
cardiac event
Witham (2007)
0 withdrawal
0 withdrawal
0 deaths, 0 hospitalization or
cardiac events
1 death, 0 hospitalization or cardiac
events
Witham (2012)
29 withdrawal 19 withdrawal
3 deaths, 0 hospitalization or
2 deaths, 0 hospitalization or
cardiac events
cardiac events
Online Table 5. Assessment of Study Quality
Other commonly used tools e.g. JADAD are relatively insensitive to detecting study quality of physical training interventions. We chose
the PEDRO scale as it is designed for use by physical therapists and is probably the tool most closely related to the needs of exercise
scientists. That said, the implementation of subject and investigator blinding in physiotherapy studies is sometimes possible, blinding is
extremely difficult, even impossible, in most exercise training studies. For this reason, we omitted these items from the PEDRO scale as all
included studies would have scored 0.
CHRONIC HEART FAILURE - HIGH INTENSITY TRAINING: Quality metrics of included studies
Eligibility
Random
criteria
allocation of
Allocation
similar at
specified
participants
concealed
Anagnostakou (2011)
YES
YES
Beckers (2008)
YES
Freyssin (2012)
Reporting of
measures
between
Point measures
assessed in
Intention
group
and measures
Assessors
85% of
to treat
statistical
of variability
Overall
baseline
blinded
participants
analysis
comparison
reported
pedro
YES
YES
YES
YES
YES
YES
YES
8
YES
YES
YES
YES
YES
YES
YES
YES
8
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Iellamo (2012)
YES
YES
NO
YES
NO
NO
NO
YES
YES
4
Myers (2012)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Nilsson (2008)
YES
YES
YES
YES
YES
YES
YES
YES
7
Patwala (2009)
YES
YES
YES
NO
YES
YES
YES
YES
YES
7
Roditis (2007)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Wisloff (2007)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Study name
MEDIAN SCORE 6.5
Groups
Outcome
NO
CHRONIC HEART FAILURE - VIGOROUS INTENSITY TRAINING: Quality metrics of included studies
Eligibility
Random
criteria
allocation of
Allocation
similar at
specified
participants
concealed
Belardinelli (2008)
YES
YES
Braith (1999)
YES
Brubaker (2009)
Reporting of
measures
between
Point measures
assessed in
Intention
group
and measures
Assessors
85% of
to treat
statistical
of variability
Overall
baseline
blinded
participants
analysis
comparison
reported
pedro
YES
YES
NO
YES
YES
YES
YES
7
YES
NO
YES
NO
YES
YES
YES
YES
6
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Da Silva (2002)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Delagardelle (2008)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Erbs (2003)
YES
YES
NO
YES
NO
NO
YES
YES
YES
5
Franco (2006)
YES
YES
NO
YES
NO
NO
NO
YES
YES
4
Fu (2011)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Giannuzi (2003)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Gielen (2012)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Hambrecht (2000)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Haykowsky (2005)
YES
YES
NO
NO
NO
NO
YES
YES
YES
4
Jakovljevic (2010)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Jette (1991)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Jolly (2009)
YES
YES
YES
YES
NO
YES
YES
YES
YES
7
Karapolat (2009)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Study name
Groups
Outcome
Keteyian (1999)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Klecha (2007)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Klocek (2005)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Kulcu (2007)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Laurent (2009)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
LeMaitre (2004)
YES
YES
NO
NO
NO
YES
YES
YES
YES
5
Linke (2005)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Maiorana (2011)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Mc Kelvie (2002)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Mueller (2007)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Myers (2001)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Niebauer (2005)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
O’Connor (2009)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Oka (2000)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Passino (2008)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Prescott (2009)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Roveda (2003)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Sarullo (2006)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Senden (2005)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Van Den Berg-Emons
(2004)
Willenheimer (1998)
YES
YES
NO
NO
NO
YES
YES
YES
YES
5
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Wisloff ( 2007)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
MEDIAN SCORE 6
CHRONIC HEART FAILURE - MODERATE INTENSITY TRAINING: Quality metrics of included studies
Study name
Eligibility
Random
Allocation
Groups
Assessors
Outcome
Intention
criteria
allocation of
concealed
similar at
blinded
measures
to treat
Reporting of Point measures Overall
between
and measures
pedro
specified
participants
baseline
assessed in
analysis
group
of variability
85% of
statistical
reported
participants
comparison
Belardinelli (1999)
YES
YES
YES
YES
YES
YES
NO
YES
YES
7
Beniaminovitz (2002)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Butterfield (2008)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Cider (2003)
YES
YES
NO
YES
NO
YES
NO
YES
YES
5
Collins (2004)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Cowie (2011)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Daskapan (2005)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Dracup (2007)
YES
YES
YES
YES
NO
YES
NO
YES
YES
6
Erbs (2010)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Fu (2011)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Harjola (2006)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Kiilavuori (1996)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Kobayashi (2003)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Koukouvou (2004)
YES
YES
NO
YES
NO
NO
NO
YES
YES
4
Laoutaris (2011)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Lima (2010)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Mandic (2009)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Meyer (2005)
YES
YES
NO
YES
NO
NO
NO
YES
YES
4
Parnell (2002)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Piotrowicz (2010)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Pozehl (2003)
YES
YES
NO
NO
NO
YES
YES
YES
YES
5
Servantes (2011)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Sturn (1999)
YES
YES
YES
YES
YES
YES
YES
YES
YES
8
Wielenga (1998)
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
MEDIAN SCORE 6
CHRONIC HEART FAILURE - LOW INTENSITY TRAINING: Quality metrics of included studies
Eligibility
Random
criteria
allocation of
Allocation
similar at
specified
participants
concealed
Belardinelli (1995)
YES
YES
Bocalini (2008)
YES
Jonsdottir (2005)
Reporting of
measures
between
Point measures
assessed in
Intention
group
and measures
Assessors
85% of
to treat
statistical
of variability
Overall
baseline
blinded
participants
analysis
comparison
reported
pedro
NO
NO
NO
YES
YES
YES
YES
5
YES
NO
YES
NO
YES
YES
YES
YES
6
YES
YES
NO
YES
NO
YES
YES
YES
YES
6
Witham (2007)
YES
YES
NO
NO
NO
YES
YES
YES
YES
5
Witham (2012)
YES
YES
YES
NO
YES
YES
NO
YES
YES
6
Study name
Groups
Outcome
MEDIAN SCORE 6
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