Original Scientific Paper Maintaining physical fitness of patients with chronic heart failure: a randomized controlled trial Paul J. Beckers a,b , Johan Denollet b,c , Nadine M. Possemiers a , Kurt Wuyts a , Christiaan J. Vrints a,b and Viviane Marie Conraads a,b a Department of Cardiology, Antwerp University Hospital, Edegem, b University of Antwerp, Antwerp, Belgium and c CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands Received 3 February 2010 Accepted 13 March 2010 Background We aimed to compare the effects of three different training advices, after 1 year, following a 6 months supervised cardiac rehabilitation period in patients with chronic heart failure (CHF). Methods Sixty-nine CHF patients were randomized, at the end of their rehabilitation period, either to usual care (UC) or to UC and controlled home training (HT), prolonged supervised training (ST) or preferred training (PT). Treadmill cardio- pulmonary exercise testing was performed before rehabilitation, postrehabilitation and thereafter at 3-month intervals during the 1-year follow-up. submaximal exercise capacity [Oxygen consumption and workload at the respiratory compensation point (VO 2 RCP, WattRCP) and submaximal workload (SMW) efficiency (SMW/HR) at 70% of the initial maximal workload] was chosen as a primary endpoint, because health status in CHF patients depends largely on their ability to perform activities at a submaximal level. Results After 6 months of rehabilitation, the four groups (UC, HT, ST and PT) were comparable with regard to cardiac rehabilitation-derived benefit, both at the submaximal and maximal level. Although exercise capacity during follow-up declined in both UC and HT patients, ST and especially PT patients maintained and even improved VO 2 peak and VO 2 RCP. However, only PT patients managed to maintain or even increase submaximal (WattRCP and SMW/HR ratio) workload (P = 0.045 and < 0.0001 for interaction, respectively). Ventilatory-derived prognostic markers during treadmill cardio pulmonary exercise testing evolved similarly in the four subgroups. Conclusion This study suggests that engagement in physical training of their own choice (PT), might be the optimal training modality for maintaining physical capacity in CHF patients. Eur J Cardiovasc Prev Rehabil 17:660–667  c 2010 The European Society of Cardiology European Journal of Cardiovascular Prevention and Rehabilitation 2010, 17:660–667 Keywords: cardiac rehabilitation, chronic heart failure, exercise capacity, exercise training, follow-up, maintenance Introduction Exercise training is an effective intervention in patients with chronic heart failure (CHF); it improves physical capacity [1], reverses central and peripheral determinants of exercise intolerance and addresses several of the underlying basic molecular mechanisms and neurohormo- nal maladaptation [2,3]. Accordingly, the European Asso- ciation of Cardiovascular Prevention and Rehabilitation endorses exercise-based cardiac rehabilitation as an effective way to improve cardiovascular health outcomes in patients with CHF [4]. Of note, health status of CHF patients may depend more on their ability to perform tasks at a submaximal (SM) level (i.e. without perceiving symptoms of fatigue and dyspnoea), rather than at peak aerobic capacity. In contrast, most clinical trials in CHF focus on the effect of exercise training on peak oxygen uptake (VO 2 peak) and implemented relatively short supervised training (ST) periods, with poor follow-up thereafter. Improving compliance with treatment recommendations is a core Correspondence to Dr Viviane Marie Conraads, MD, PhD, Department of Cardiology, Cardiac Rehabilitation Centre, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium Tel: +32 3 821 39 73; fax: +32 3 821 39 74; e-mail: viviane.conraads@uza.be 1741-8267  c 2010 The European Society of Cardiology DOI: 10.1097/HJR.0b013e328339ccac Copyright © The European Society of Cardiology. Unauthorized reproduction of this article is prohibited.