***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 Patients with heart failure are a growing population within cardiac rehabilitation . The purpose of this study was to compare , through a single-centre , parallel-group , r and omized controlled trial , the effects of Nordic walking and st and ard cardiac rehabilitation care on functional capacity and other outcomes in patients with moderate to severe heart failure . METHODS Between 2008 and 2009 , 54 patients ( aged 62.4 ± 11.4 years ) with heart failure ( mean ejection fraction = 26.9 % ± 5.0 % ) were r and omly assigned to st and ard cardiac rehabilitation care ( n = 27 ) or Nordic walking ( n = 27 ) ; both groups performed 200 to 400 minutes of exercise per week for 12 weeks . The primary outcome , measured after 12 weeks , was functional capacity assessed by a 6-minute walk test ( 6MWT ) . RESULTS Compared with st and ard care , Nordic walking led to higher functional capacity ( Δ 125.6 ± 59.4 m vs Δ 57.0 ± 71.3 m travelled during 6MWT ; P = 0.001 ) , greater self-reported physical activity ( Δ 158.5 ± 118.5 minutes vs Δ 155.5 ± 125.6 minutes ; P = 0.049 ) , increased right grip strength ( Δ 2.3 ± 3.5 kg vs Δ 0.3 ± 3.1 kg ; P = 0.026 ) , and fewer depressive symptoms ( Hospital Anxiety and Depression Scale score = Δ -1.7 ± 2.4 vs Δ -0.8 ± 3.1 ; P = 0.014 ) . No significant differences were found for peak aerobic capacity , left-h and grip strength , body weight , waist circumference , or symptoms of anxiety . CONCLUSIONS Nordic walking was superior to st and ard cardiac rehabilitation care  in improving functional capacity and other important outcomes in patients with heart failure . This exercise modality is a promising alternative for this population Background Exercise training has now become established practice in patients with chronic heart failure . Women are often under-represented in intervention studies compared to men . For this reason it was our aim to conduct a combined endurance and muscle strength training program to evaluate its effect on clinical performance data and health-related psychosocial factors in women and men . Methods One hundred and sixteen women , mean age 69 ± 9 years , body mass index ( BMI ) 25.8 ± 4.9 , and 169 men , mean age 66 ± 9 years , BMI 26.6 ± 3.6 underwent combined endurance/resistance training .  The training program lasted 29 ± 7 days and comprised bicycle ergometer training , a 6-min walk test as a training unit and muscle strength training for the lower and upper extremities . Results Differences between women and men were found in clinical parameters . In particular , statistically significant differences were revealed between the women and men with regard to cardiopulmonary performance . Quality of life was significantly improved on discharge with regard to both physical and mental health , whereas anxiety and depression showed no significant alteration . Conclusion A specialized in-hospital program for women and men combining endurance/resistance training and education is feasible . But our program revealed a very low level of cardiopulmonary performance in women . Women need to be encouraged and motivated to participate in such programs Exercise is now considered an important component of management in chronic heart failure ( CHF ) , but little is known about central hemodynamic changes that occur during different exercise modalities in these patients . Seventeen patients ( ejection fraction 25 + /- 2 % ) undertook brachial artery and right heart catheterization and oxygen consumption assessment at rest , during submaximal and peak cycling ( Cyc ) , and during submaximal upper and lower limb resistance exercise .  Cardiac output ( CO ) increased relative to baseline during peak Cyc ( P < 0.05 ) but did not change during submaximal Cyc or upper or lower limb exercise .  Heart rate ( HR ) was lowest during upper limb exercise and progressively increased during lower limb exercise , submaximal Cyc , and peak Cyc , with significant differences between each of these ( P < 0.01 ) . Conversely , stroke volume ( SV ) decreased during submaximal Cyc and lower limb exercise and was lower during peak and submaximal Cyc and lower limb exercise than during upper limb exercise ( P < 0.05 ) . CHF patients are dependent on increases in HR to increase CO during exercise when SV may decline . Resistance exercise , performed at appropriate intensity , induces a similar hemodynamic burden to aerobic exercise in patients with CHF Background : In chronic heart failure ( CHF ) , cardiac cachexia is often associated with the terminal stage of this disease . In animal studies it has been demonstrated that myostatin , a key regulator of skeletal muscle mass , is elevated in advanced stages of this syndrome . Design : The aim of the present study was to investigate the expression of myostatin in patients with late stage CHF ( NYHA IIIb ) in comparison to healthy subjects . Furthermore the effects of physical exercise on myostatin were analyzed . Methods : Twenty-four patients were either r and omized to a sedentary control group ( CHF-S ) or exercise training ( CHF-E ) .  At baseline and after 12 weeks mRNA and myostatin protein in the peripheral skeletal muscle as well as myostatin serum concentration were measured . Furthermore 12 age-matched healthy men were compared to all patients at baseline ( HC ) . Results : CHF patients showed a two-fold increase of myostatin mRNA ( p = 0.05 ) and a 1.7-fold ( p = 0.01 ) augmentation of protein content in skeletal muscle compared to healthy subjects . In late-stage CHF , exercise training led to a 36 % reduction of the mRNA and a 23 % decrease of the myostatin protein compared to baseline . The serum concentration of myostatin revealed no significant alteration between the groups . Conclusion : In the skeletal muscle , myostatin increases significantly in the course of CHF . The observed effects of a significant reduction of myostatin in skeletal muscle after 12 weeks of exercise training demonstrate the reversibility of molecular changes that might be able to halt the devastating process of muscle wasting in chronic heart failure 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 Alterations in circulating angiogenic cells ( CAC ) and endothelial progenitor cells ( EPC ) , known to contribute to endothelial repair , could explain the reversal of endothelial function in response to exercise training . Moreover , training-induced vascular remodeling might affect the acute response of EPC and CAC following a single exercise bout . We studied the impact of exercise training on CAC function and numbers of CD34+/KDR+ EPC in patients with chronic heart failure ( CHF ) and we assessed the effect of acute exercise on CAC and EPC in sedentary and trained patients . Twenty-one sedentary CHF patients underwent 6-month exercise training  and were compared to a non-trained control group ( n = 17 ) and 10 healthy age-matched subjects . At baseline and follow-up , flow-mediated dilation was assessed and grade d exercise testing ( GXT ) was performed . Before and immediately after GXT , CAC migratory capacity was assessed in vitro and circulating CD34+/KDR+ EPC were quantified using flow cytometry . At baseline , CAC migration was significantly impaired in sedentary CHF patients but normalized acutely after GXT . Training corrected endothelial dysfunction , which coincided with a 77 % increase in CAC migration ( P = 0.0001 ) . Moreover , the GXT-induced improvement detected at baseline was no longer observed after training . Numbers of CD34+/KDR+ EPC increased following 6-month exercise training ( P = 0.021 ) , but were not affected by GXT , either prior or post-training . In conclusion , the present findings demonstrate for the first time that exercise training in CHF reverses CAC dysfunction and increases numbers of CD34+/KDR+ EPC , which is accompanied by improvement of peripheral endothelial function . The acute exercise-induced changes in CAC function wane with exercise training , suggesting that repetitive exercise bouts progressively lead to functional endothelial repair AIMS Diastolic dysfunction ( DD ) was identified as a predictor of adverse prognosis in heart failure with reduced ejection fraction ( HFREF ) . It is , however , unknown if DD is improved by exercise training , which is known to induce reverse remodelling , and if the training effect is attenuated in elderly HFREF patients . We therefore assessed DD in a cohort of referent controls ( RCs ) and HFREF patients and studied the response of DD to endurance exercise in two age groups ( ≤55 years and ≥65 years ) . METHODS AND RESULTS Sixty RC ( 30 ≤ 55 years , mean age 50 ± 5 years ; 30 ≥ 65 years , 72 ± 4 years ) and 60 HFREF patients ( 30 ≤ 55 years , 46 ± 5 years ; 30 ≥ 65 years , 72 ± 5 years , EF 28 ± 5 % ) were r and omized to 4 weeks of supervised endurance training or to a control group . Exercise training was effective in reducing LV isovolumetric relaxation time by 29 % in young and by 26 % in old HFREF patients ( P < 0.05 for both ) . As assessed by tissue Doppler , septal E ' increased by 37 % in young and by 39 % among old HFREF patients ( P < 0.005 for both ) result ing in a significant decrease in the E/E ' ratio from 13 ± 1 to 10 ± 1 in young and 14 ± 1 to 11 ± 1 in old HFREF patients ( P < 0.05 for both ) . Serum levels of N-terminal pro brain natriuretic peptide were significantly reduced after endurance training in HFREF patients of all ages . CONCLUSION In HFREF , diastolic function is significantly impaired in all age groups  . Endurance training is highly effective in improving left ventricular diastolic function in HFREF patients regardless of age . 
    Output:
    
Subgroup analysis revealed  that  AE reduced LVEDV ( − 10.21 ml ; P = 0.007 , I2 = 0 % ) , while RT and combined RT and AE had no effect on LVEDV compared with control participants .
RT results in a greater gain in V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $ $ peak , and induces no deleterious effects on cardiac function in HF patients