***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown . Methods and Results — The effects of a nurse-led , multidisciplinary , home-based intervention ( HBI ) in a typically elderly cohort of patients with chronic heart failure initially r and omized to either HBI ( n=149 ) or usual postdischarge care ( UC ) ( n=148 ) after a short-term hospitalization were studied for up to 10 years of follow-up ( minimum 7.5 years of follow-up ) . Study end points were all-cause mortality , event-free survival ( event was defined as death or unplanned hospitalization ) , recurrent hospital stay , and cost per life-year gained . Median survival in the HBI cohort was almost twice that of UC ( 40 versus 22 months ; P<0.001 ) , with fewer deaths overall ( HBI , 77 % versus 89 % ; adjusted relative risk , 0.74 ; 95 % CI , 0.53 to 0.80 ; P<0.001 ) . HBI was associated with prolonged event-free survival ( median , 7 versus 4 months ; P<0.01 ) . HBI patients had more unplanned readmissions ( 560 versus 550 ) but took 7 years to overtake UC ; the rates of readmission ( 2.04±3.23 versus 3.66±7.62 admissions ; P<0.05 ) and related hospital stay ( 14.8±23.0 versus 28.4±53.4 days per patient per year ; P<0.05 ) were significantly lower in the HBI group . HBI was associated with 120 more life-years per 100 patients treated compared with UC ( 405 versus 285 years ) at a cost of $ 1729 per additional life-year gained when we accounted for healthcare costs including the HBI . Conclusions — In altering the natural history of chronic heart failure relative to UC ( via prolonged survival and reduced frequency of recurrent hospitalization  ) , HBI is a remarkably cost- and time-effective strategy over the longer term Systemic arterial compliance ( SAC ) makes an important contribution to cardiac afterload , and thus is a significant determinant of left ventricular work . Previous studies have suggested that arterial compliance may be reduced in patients with congestive heart failure ( CHF ) , and that SAC is increased after a 4-week exercise training programme in healthy , sedentary individuals . The present study aim ed to investigate the effects of an 8-week exercise training programme on arterial mechanical properties , left ventricular performance and quality of life in CHF patients . A total of 21 patients with NYHA class II or III CHF ( mean+/-S.D. age 55+/-13 years ) were r and omly allocated to either an 8-week exercise training group or a " usual lifestyle " control group .  SAC , as determined non-invasively using applanation tonometry and Doppler aortic velocimetry , increased from 0.57+/-0.11 to 0.77+/-0.14 arbitrary compliance units ( mean+/-S.E.M. ; P=0.01 ) in the exercise group , while no change occurred in the control group . Left ventricular structure and function was assessed by echocardiography , and these parameters were unchanged over the 8-week study period . Exercise training significantly increased exercise capacity , measured by a 6-min walking test ( 474+/-27 to 547+/-34 m ; P=0.008 ) . Quality of life , as assessed using the Minnesota Living with Heart Failure Evaluation , demonstrated a decrease in heart failure symptoms from 46+/-7 to 24+/-5 units ( P=0.01 ) following the exercise training programme . These data show that exercise training improves SAC in patients with CHF . The accompanying improvement in exercise capacity may be due , in part , to an improvement in arterial function BACKGROUND The time required for oxygen uptake ( O(2 ) ) to return to baseline level ( recovery kinetics ) is prolonged in patients with reduced ventricular function , and the degree to which it is prolonged is related to the severity of heart failure , markers of abnormal ventilation , and prognosis . In the present study , we sought to determine the effect of exercise training on O(2 ) recovery kinetics in patients with reduced ventricular function . METHODS Twenty-four male patients with reduced ventricular function after a myocardial infa rct ion were r and omized to either a 2-month high-intensity residential exercise training program or to a control group .  O(2 ) kinetics in recovery from maximal exercise were calculated before and after the study period and expressed as the slope of a single exponential relation between O(2 ) and time during the first 3 min of recovery . RESULTS Peak O(2 ) increased significantly in the exercise group ( 19.4 + /- 3.0 mL/kg/min vs 25.1 + /- 4.7 mL/kg/min , p < 0.05 ) , whereas no change was observed in control subjects . The O(2 ) half-time in recovery was reduced slightly after the study period in both groups ( 108.7 + /- 33.1 to 102.1 + /- 50.5 s in the exercise group and 122.3 + /- 68.7 to 107.5 + /- 36.0 s in the control group ) ; neither the change within or between groups was significant . The degree to which O(2 ) was prolonged in recovery was inversely related to measures of exercise capacity ( peak O(2 ) , watts achieved , and exercise time ; r = - 0.48 to - 0.57 ; p < 0.01 ) and directly related to the peak ventilatory equivalents for oxygen ( r = 0.59 , p < 0.01 ) and carbon dioxide ( r = 0.57 , p < 0.01 ) . CONCLUSION Two months of high-intensity training did not result in a faster recovery of O(2 ) in patients with reduced ventricular function . This suggests that adaptations to exercise training manifest themselves only during , but not in , recovery from exercise AIM To assess changes in quality of life ( QoL ) and oxygen consumption produced by two different patterns of physical training in patients with congestive heart failure ( CHF ) . MATERIAL AND METHODS 42 men ( mean age 55.9+/-8.1 years ) with ischaemic CHF lasting 3.1+/-1.0 years . Patients were r and omised into three groups each consisting of 14 men : group A -- with constant workload , group B-with progressive/increasing workload , each trained up to 6 months and group C -- not trained .  QoL was assessed at baseline and at 6 months by means of the Psychological General Well-being Index ( PGWB ) and the Subjective Symptoms Assessment Profile ( SSA-P ) .  Cardiopulmonary exercise test and echocardiography were performed twice . RESULTS At 6 months improvement in PGWB total index was observed , both in groups A and B ( p<0.01 ) . Men from groups A and B reported less cardiac symptoms ( p<0.01 ) , emotional distress ( p<0.01 ) , peripheral circulatory symptoms ( p<0.01 ) and dizziness ( p<0.01 ) in SSA-P. Improvement in sexual life was observed only in group B ( p<0.01 ) . Overall improvement of QoL was greater in group B than in group A as well as oxygen uptake ( p<0.01 ) . Higher QoL correlated positively with peak VO2 only in group B ( r=0.56 , p<0.05 ) . CONCLUSIONS Physical training improves QoL  in men with CHF , but only progressive/increasing workload seems to markedly improve oxygen uptake . Improvement of QoL is related to psychological well-being and physical complaints associated with CHF BACKGROUND We aim ed to determine the role of skeletal muscle mitochondrial ATP production rate ( MAPR ) in relation to exercise tolerance after resistance training ( RT ) in chronic heart failure ( CHF ) . METHODS AND RESULTS Thirteen CHF patients ( New York Heart Association functional class 2.3 + /- 0.5 ; Left ventricular ejection fraction 26 + /- 8 % ; age 70 + /- 8 years ) underwent testing for peak total body oxygen consumption ( VO(2peak ) ) , and resting vastus lateralis muscle biopsy . Patients were then r and omly allocated to 11 weeks of RT ( n = 7 ) , or continuance of usual care ( C ; n = 6 ) , after which testing was repeated . Muscle sample s were analyzed for MAPR , metabolic enzyme activity , and capillary density . VO(2peak ) and MAPR in the presence of the pyruvate and malate ( P+M ) substrate combination , representing carbohydrate metabolism , increased in RT ( P < .05 ) and decreased in C ( P < .05 ) , with a significant difference between groups ( VO(2peak ) , P = .005 ; MAPR , P = .03 ) . There was a strong correlation between the change in MAPR and the change in peak total body oxygen consumption ( VO(2peak ) ) over the study ( r = 0.875 ; P < .0001 ) , the change in MAPR accounting for 70 % of the change in VO(2peak ) . CONCLUSIONS These findings suggest that mitochondrial ATP production is a major determinant of aerobic capacity in CHF patients and can be favorably altered by muscle strengthening exercise BACKGROUND In HF-ACTION ( Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training ) , exercise training improved functional capacity in heart failure with reduced ejection fraction ( HFrEF ) . Previous studies have suggested that diabetes mellitus ( DM ) may be associated with an attenuated response to exercise . We explored whether DM attenuated the improvement in functional capacity with exercise . METHODS AND RESULTS HF-ACTION r and omized 2331 patients with HFrEF to medical therapy with or without exercise training over a median follow-up of 2.5 years . We examined the interaction between DM and exercise response measured by change in 6-minute walk distance ( 6MWD ) and peak VO2 . We also examined outcomes by DM status . In HF-ACTION , 748 ( 32 % ) patients had DM . DM patients had lower functional capacity at baseline and had lower exercise volumes at 3 months . There was a significant interaction between DM status and exercise training for change in peak VO2 ( interaction P = .02 ) , but not 6MWD . In the exercise arm , DM patients had a smaller mean increase in peak VO2 than non-DM patients ( P = .03 ) . There was no interaction between DM and exercise on clinical outcomes . After risk adjustment , DM was associated with increased all-cause mortality/hospitalization ( P = .03 ) . CONCLUSIONS In HF-ACTION , DM was associated with lower baseline functional capacity , an attenuated improvement in peak VO2 , and increased hospitalizations BACKGROUND Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure ( HF ) ; this has not been rigorously tested in a large clinical sample . We sought to investigate whether tai chi , as an adjunct to st and ard care , improves functional capacity and quality of life in patients with HF . METHODS A single-blind , multisite , parallel-group , r and omized controlled trial evaluated 100 out patients with systolic HF ( New York Heart Association class I-III , left ventricular ejection fraction ≤40 % ) who were recruited between May 1 , 2005 , and September 30 , 2008 . A group-based 12-week tai chi exercise program ( n = 50 ) or time-matched education ( n = 50 , control group ) was conducted . Outcome measures included exercise capacity ( 6- minute walk test and peak oxygen uptake ) and disease-specific quality of life ( Minnesota Living With Heart Failure Question naire ) . RESULTS Mean ( SD ) age of patients was 67 ( 11 ) years ; baseline values were left ventricular ejection fraction , 29 % ( 8 % ) and peak oxygen uptake , 13.5 mL/kg/min ; the median New York Heart Association class of HF was class II . At completion of the study , there were no significant differences in change in 6-minute walk distance and peak oxygen uptake ( median change [ first quartile , third quartile ] , 35 [ -2 , 51 ] vs 2 [ -7 , 54 ] meters , P = .95 ; and 1.1 [ -1.1 , 1.5 ] vs -0.5 [ -1.2 , 1.8 ] mL/kg/min , P = .81 ) when comparing tai chi and control groups ; however , patients in the tai chi group had greater improvements in quality of life ( Minnesota Living With Heart Failure Question naire , -19 [ -23 , -3 ] vs 1 [ -16 , 3 ] , P = .02 ) . Improvements with tai chi were also seen in exercise self-efficacy ( Cardiac Exercise Self-efficacy Instrument , 0.1 [ 0.1 , 0.6 ] vs -0.3 [ -0.5 , 0.2 ] , P < .001 ) and mood ( Profile of Mood States total mood disturbance , -6 [ -17 , 1 ] vs -1 [ -13 , 10 ] , P = .01 ) . CONCLUSION Tai chi exercise may improve quality of life , mood , and exercise self-efficacy in patients with HF . Trial Registration clinical trials.gov Identifier : NCT00110227 OBJECTIVES The authors hypothesized 
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Compared to no exercise control , CR appears to have no impact on mortality in the short term ( < 12 months ' follow-up ) .
Low- to moderate- quality evidence shows that CR probably reduces the risk of all-cause hospital admissions and may reduce HF-specific hospital admissions in the short term ( up to 12 months ) .
CR may confer a clinical ly important improvement in health-related quality of life , although we remain uncertain about this because the evidence is of low quality .