Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2021; 13(9): 514-525
Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.514
Effects of exercise training on diastolic and systolic dysfunction in patients with chronic heart failure
Ioannis Chaveles, Ourania Papazachou, Manal al Shamari, Dimitrios Delis, Argirios Ntalianis, Niki Panagopoulou, Serafim Nanas, Eleftherios Karatzanos
Ioannis Chaveles, 1st Department of Cardiology - Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, “Evaggelismos” Hospital, Athens 10676, Greece
Ourania Papazachou, Niki Panagopoulou, Department of Cardiology, ”Helena Venizelou” Hospital, Athens 10676, Greece
Ourania Papazachou, Manal al Shamari, Dimitrios Delis, Niki Panagopoulou, Serafim Nanas, Eleftherios Karatzanos, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
Argirios Ntalianis, Heart Failure Unit, Department of Clinical Therapeutics, ”Alexandra” Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
Author contributions: Chaveles I, Ntalianis A, Panagopoulou N, Shamari MA, and Delis D engaged in acquisition of data (echocardiographic measurements, cardiopulmonary exercise testing, and application of exercise rehabilitation program); Chaveles I and Karatzanos E contributed to the data analysis and results interpretation; Chaveles I and Papazachou O drafted the manuscript; Papazachou O, Nanas S and Katatzanos E critically revised the manuscript; All authors gave final approval.
Institutional review board statement: The study was approved by the Administration Board and the Ethics Committee of the 'Evangelismos' Hospital (Athens, Greece) (approval number: 43/28.03.2016).
Clinical trial registration statement: The clinical trial has been registered with (NCT04916184).
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Eleftherios Karatzanos, PhD, Consultant Physician-Scientist, Instructor, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, ”Evaggelismos” Hospital, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str, Athens 10676, Greece.
Received: April 3, 2021
Peer-review started: April 3, 2021
First decision: May 13, 2021
Revised: May 26, 2021
Accepted: July 23, 2021
Article in press: July 23, 2021
Published online: September 26, 2021

Chronic heart failure (CHF) is a complex syndrome characterized by a progressive reduction of the left ventricular (LV) contractility, low exercise tolerance, and increased mortality and morbidity. Diastolic dysfunction (DD) of the LV, is a keystone in the pathophysiology of CHF and plays a major role in the progression of most cardiac diseases. Also, it is well estimated that exercise training induces several beneficial effects on patients with CHF.


To evaluate the impact of a cardiac rehabilitation program on the DD and LV ejection fraction (EF) in patients with CHF.


Thirty-two stable patients with CHF (age: 56 ± 10 years, EF: 32% ± 8%, 88% men) participated in an exercise rehabilitation program. They were randomly assigned to aerobic exercise (AER) or combined aerobic and strength training (COM), based on age and peak oxygen uptake, as stratified randomization criteria. Before and after the program, they underwent a symptom-limited maximal cardiopulmonary exercise testing (CPET) and serial echocardiography evaluation to evaluate peak oxygen uptake (VO2peak), peak workload (Wpeak), DD grade, right ventricular systolic pressure (RVSP), and EF.


The whole cohort improved VO2peak, and Wpeak, as well as DD grade (P < 0.05). Overall, 9 patients (28.1%) improved DD grade, while 23 (71.9%) remained at the same DD grade; this was a significant difference, considering DD grade at baseline (P < 0.05). In addition, the whole cohort improved RVSP and EF (P < 0.05). Not any between-group differences were observed in the variables assessed (P > 0.05).


Exercise rehabilitation improves indices of diastolic and systolic dysfunction. Exercise protocol was not observed to affect outcomes. These results need to be further investigated in larger samples.

Keywords: Chronic heart failure, Cardiovascular effects, Cardiac rehabilitation, Aerobic exercise, Strength training, Diastolic dysfunction

Core Tip: In this study, the exercise training rehabilitation (aerobic exercise with/ without strength training) effects on indices of diastolic and systolic cardiac function, were evaluated in stable chronic heart failure patients. Exercise training overall induced benefits on the diastolic dysfunction grade, the ejection fraction of the left ventricle, the right ventricular systolic pressure, as well as aerobic exercise capacity.