***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 Few studies have investigated changes in autonomic function after training in patients with cardiovascular diseases , particularly patients with congestive heart failure ( CHF ) .  Heart rate recovery ( HRR ) is a strong predictor of mortality in coronary artery disease ( CAD ) patients . The aim of this study was to determine the effect of 8 weeks of supervised exercise training on autonomic function , which were assessed by heart rate , systolic blood pressure ( SBP ) , and rate-pressure product ( RPP ) in CHF patients . METHODS 65 patients aged 57 - 82 years with CHF were assigned to two groups r and omly . The first group received a supervised 8-week aerobic training program of 30 - 45 min sessions , 3 days per week on alternate days , while controls received st and ard medical care and were followed up . Body weight , body mass index , functional capacity , resting heart rate , HRR , resting systolic blood pressure , peak heart rate , peak systolic blood pressure , and RPP were measured before and after the study period . Medications and diet recommendations remained unchanged in both groups during the study period . RESULTS The exercise group consisted of 33 patients with mean age of 61.54 ± 5.89 years and the controls were 32 patients with mean age of 60.94 ± 5.03 years . One-way analysis of variance ( ANOVA ) with repeated measures revealed a statistically significant difference in the exercise group compared to the control group regarding body mass index , resting heart rate , heart rate recover , functional capacity , peak heart rate , peak systolic blood pressure , peak RPP after 8 weeks ( P ≤ 0.05 ) . CONCLUSION In conclusion , a multidisciplinary CR program with supervised exercise training support significantly improves functional capacity and autonomic function in CHF patients . Therefore , a supervised and guided exercise training program is safe and beneficial for patients with CHF with different etiologies Background Heart rate recovery ( HRR1 ) immediately after exercise reflects parasympathetic activity , which is markedly attenuated in chronic heart failure ( CHF ) patients . The aim of our study was to examine both continuous and interval exercise training effects on HRR1 in these patients . Design The population study consisted of 29 stable CHF patients that participated at a rehabilitation program of 36 sessions , three times per week . Of the 29 patients , 24 completed the program . Patients were r and omly assigned to interval { n = 10 [ 100 % peak work rate ( WRp ) for 30 s , alternating with rest for 30 s ] } and to continuous training [ n = 14 ( 50%WRp ) ] . Methods All patients performed a symptom-limited cardiopulmonary exercise test on a cycle ergometer before and after the completion of the program . Measurements included peak oxygen uptake ( VO2p ) , anaerobic threshold ( AT ) , WRp , first degree slope of VO2 during the first minute of recovery ( VO2/t-slope ) , chronotropic response [ % chronotropic reserve ( CR ) = ( peak HR - resting HR ) × 100/(220 - age - resting HR ) ] , HRR1 ( HR difference from peak exercise to one minute after ) . Results After the completion of the rehabilitation program there was a significant increase of WRp , VO2p , AT and VO2/t-slope ( by 30 % , P=0.01 ; 6 % , P=0.01 ; 10 % , P=0.02 ; and 27 % , P=0.03 respectively for continuous training and by 21 % , P≤0.05 ; 8 % , P=0.01 ; 6 % , P = NS ; and 48 % , P=0.02 respectively for interval training ) . However , only patients exercised under the continuous training regime had a significant increase in HRR1 ( 15.0±9.0 to 24.0±12bpm ; P=0.02 ) and CR ( 57±19 to 72±21 % , P=0.02 ) , in contrast with those assigned to interval training ( HRR1 : 21 ± 11 to 21 ± 8 bpm ; P = NS and CR : 57 ± 18 to 59 ± 21 % , P = NS ) . Conclusions Both continuous and interval exercise training program improves exercise capacity  in CHF patients . However , continuous rather than interval exercise training improves early HRR1 , a marker of parasympathetic activity , suggesting a greater contribution to the autonomic nervous system BACKGROUND Patients with chronic heart failure ( CHF ) have a continuing high mortality . Autonomic dysfunction may play an important role in the pathophysiology of cardiac death in CHF . UK-HEART examined the value of heart rate variability ( HRV ) measures as independent predictors of death in CHF . METHODS AND RESULTS In a prospect i ve study powered for mortality , we recruited 433 out patients 62+/-9.6 years old with CHF ( NYHA functional class I to III ; mean ejection fraction , 0.41+/-0.17 ) .  Time-domain HRV indices and conventional prognostic indicators were related to death by multivariate analysis . During 482+/-161 days of follow-up , cardiothoracic ratio , SDNN , left ventricular end-systolic diameter , and serum sodium were significant predictors of all-cause mortality . The risk ratio for a 41.2-ms decrease in SDNN was 1.62 ( 95 % CI , 1.16 to 2.44 ) . The annual mortality rate for the study population in SDNN subgroups was 5.5 % for > 100 ms , 12.7 % for 50 to 100 ms , and 51.4 % for < 50 ms . SDNN , creatinine , and serum sodium were related to progressive heart failure death . Cardiothoracic ratio , left ventricular end-diastolic diameter , the presence of nonsustained ventricular tachycardia , and serum potassium were related to sudden cardiac death . A reduction in SDNN was the most powerful predictor of the risk of death due to progressive heart failure . CONCLUSIONS CHF is associated with autonomic dysfunction , which can be quantified by measuring HRV . A reduction in SDNN identifies patients at high risk of death and is a better predictor of death due to progressive heart failure than other conventional clinical measurements . High-risk subgroups identified by this measurement are c and i date s for additional therapy after prescription of an ACE inhibitor BACKGROUND The aim of this study is to evaluate the prevalence of  depressive symptoms ( DS ) and its relation on hospitalization for cardiovascular ( CV ) causes and all-cause mortality risk among out patients with HF . METHODS A prospect i ve study was conducted on 130 adult out patients with HF . The  Beck Depression Inventory Scale-second edition ( BDI-II ) was used to screen for DS .  All-cause mortality and hospitalization for CV causes were registered over 6 years . Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors . RESULTS During a mean follow-up of 6 years , 44 % of patients were classified as having DS . Sixty-two participants died for all causes , representing 61 % of those with DS and 37 % of those without ( p=0.006 ) ; Forty-nine participants ( 38 % ) were hospitalized for CV causes , representing 49 % of those with DS and 29 % of those without ( p=0.027 ) . Logistic regression analysis indicated that DS predicted all-cause mortality ( OR : 2.905 ; 95 % CI:1.228 - 6.870 ; p=0.006 ) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes ( OR : 3.169 ; 95 % CI : 1.230 - 8.164 ; p=0.027 ) . These associations were independent of conventional risk factors . LIMITATIONS Only outpatient sample ; measure of  DS  only at baseline ; cause of death was not known . CONCLUSION This study , first held in a portuguese population , showed that DS are independent predictors of death and hospitalization for CV causes  among HF patients and its impact persists over 6 years Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials Objective : It is unclear which exercise training protocol yields superior heart rate recovery ( HRR ) improvement in heart failure ( HF ) patients . Whether baseline HRR normality plays a role in the improvement is unknown . We hypothesized that an exercise training protocol and baseline HRR normality would be factors in altering HRR in HF patients . Methods : In this prospect i ve , r and omized , controlled and 3 group parallel study , 41 stable HF patients were r and omly assigned to 3-times-weekly training sessions for 12 weeks , consisting of i ) 30 minutes of interval training ( IT ) ( n=17 , 63.7±8.8 years old ) versus ii ) 30 minutes of continuous training ( CT ) ( n=13 , 59.6±6.8 years old ) versus iii ) no training ( CON ) ( n=11 , 60.6±9.9 years old ) . Each patient had cardiopulmonary exercise testing before and after the training program . Maximum heart rates attained during the test and heart rates at 1 and 2 min ( HRR1 and HRR2 ) during the recovery phase were recorded . Paired sample s t-test or Wilcoxon signed-rank test was used for comparisons before and after training . One-way ANOVA or Kruskal-Wallis variance analysis was used for comparisons among groups . Results : HRR1 was unchanged after training . HRR2 improved in the IT group after training , and post-training HRR2 values were significantly faster in the IT group than in controls . Both HRR1 and HRR2 was significantly faster , irrespective of exercise protocol in patients with abnormal baseline values after training . Conclusion : HRR1 did not improve after training . HRR2 improved only in the IT group . Both HRRs in patients with abnormal baseline values improved after both exercise protocol s. IT might be superior to CT in improving HRR2 . Baseline HRR might play a role in its response to exercise Background Post-exercise heart rate recovery ( HRR ) is an index of parasympathetic function associated with clinical outcome in patients with chronic heart failure . However , its relationship with the pro-inflammatory response and prognostic value in consecutive patients with acute decompensated heart failure ( ADHF ) has not been investigated . Methods We measured  HRR  and  pro-inflammatory markers  in 107 prospect ively and consecutively enrolled , recovered ADHF patients ( 71 male , 59 ± 15 years , mean ejection fraction 28.9 ± 14.2 % ) during the pre-discharge period . The primary endpoint included cardiovascular ( CV ) events defined as CV mortality , cardiac transplantation , or rehospitalization due to HF aggravation . Results The CV events occurred in 30 ( 28.0 % ) patients ( 5 cardiovascular deaths and 7 cardiac transplantations ) during the follow-up period ( median 214 days , 11–812 days ) . When the patients with ADHF were grouped by HRR according to the Contal and O’Quigley ’s method , low HRR was shown to be associated with significantly higher levels of serum monokine-induced by gamma interferon ( MIG ) and poor clinical outcome . Multivariate Cox regression analysis revealed that low HRR was an independent predictor of CV events in both enter method and stepwise method . The addition of HRR to a model significantly increased predictability for CV events across the entire follow-up period . Conclusion Impaired  post-exercise HRR is associated with a pro-inflammatory response and independently predicts clinical outcome in patients with ADHF . These findings may explain the relationship between autonomic dysfunction and clinical outcome in terms of the inflammatory response in these patients BACKGROUND The effect of home-based exercise training on neurovascular control in heart failure patients is unknown . AIMS To test the hypothesis that home-based training would maintain the reduction in muscle sympathetic nerve 
    Output:
    
With improvements in HRR , HRV and MSNA  , exercise training appears to facilitate an improvement in parasympathetic tone and reduction in sympathetic activity