Pozehl 2008

Methods	Parallel group RCT
Participants	N Randomised: 21 (exercise 15; control 6) Diagnosis (% of participants): Aetiology: ischaemic 71%; non‐ischaemic 29% NYHA: Class II 39%; Class III 52%; Class IV 9% LVEF: exercise 27.9% (SD 7.0); control 29.7% (SD 8.7) Case mix: 100% as above Age (yr): exercise 66.3 (SD 9.6); control 66 (SD 12.6) Male: 90% White: 100% Inclusion/exclusion criteria Inclusion: able to speak and read English; stable NYHA Class II‐IV no change in medical therapy for 30 days; resting LVEF < 40% measured by echocardiography or gated equilibrium radionuclide angiography; medical diagnosis of HF either ischaemic or non‐ischaemic; and standard pharmacological therapy for HF (diuretics, angiotensin‐converting enzyme inhibitors and beta‐blockers) Exclusion: participation in a formal exercise programme < 30 days prior to this study; clinical evidence decompensated HF; and any of the following medical conditions: AF, acute MI < 3 months, unstable angina pectoris, end‐stage renal disease or orthopaedic impediments to exercise
Interventions	Exercise:Total duration: 24 wk Aerobic/resistance/mix: mix Frequency: 3 sessions/wk Duration: 30 min aerobic, 20 min resistance Intensity: 60‐85% max VO2, 12‐14 Borg scale Modality: aerobic: treadmill, stationary bike, rower, arm ergometer; resistance: light upper‐body exercises (military press, biceps curl and lateral deltoid raises) and lower‐body exercises (knee extension, side hip raise and hip extension) with 1‐10 lb hand and ankle weights. Wall push‐ups, abdominal curl‐ups, pelvic tilts, or a combination Setting: first 12 wk at the hospital and remaining sessions were unsupervised at rehabilitation centre Other: strategies from social learning theory (goal‐setting, feedback and problem‐solving guidance) utilised to facilitate, improve adherence to the training programme
Outcomes	Mortality
Comparison	Usual medical care
Country and setting	USA Single centre
Follow‐up	6 months (after randomisation)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Not reported
Selective reporting (reporting bias)	Low risk	Outcomes described in methods are reported in results
Intention‐to‐treat analysis?	Low risk	Although not stated, groups appear to analysed according to initial randomised allocation
Incomplete outcome data?	Low risk	"One subject in the control group died of myocardial infarction and one subject in the exercise training group was diagnosed with cancer and unable to continue the exercise training."No imputation undertaken
Groups balanced at baseline?	Low risk	"Subjects did not differ in fatigue or dyspnea by type of HF (ischemic vs. nonischemic) or years since diagnosis of HF (length of time since diagnosis)"
Groups received same intervention?	Unclear risk	Not reported