Effect of Individualized Combined Exercise Versus Group-Based Maintenance Exercise in Patients With Heart Disease and Reduced Exercise Capacity: THE DOPPELHERZ TRIAL

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To compare individualized endurance + resistance exercises (ICE) with a traditional cardiac maintenance program (CMP) on exercise performance in patients with cardiac disease and low exercise capacity.


Patients eligible for cardiac rehabilitation with peak exercise capacity <6 metabolic equivalents (METs) were randomly allocated to once-weekly ICE or CMP for 6 mo. ICE used 60 min of individualized moderate endurance and strength exercises. CMP used 60 min of group calisthenics plus relaxation and flexibility exercises. Maximal and submaximal endurance and strength exercise performance were assessed at baseline and 6 mo.


Seventy patients (70 ± 9 y; 38% female) were included in the intention-to-treat analyses. Large and significant improvements in both submaximal endurance and maximal strength were observed in the ICE group compared with the CMP group. Submaximal exercise duration (+111 ± 112 sec vs +14 ± 120 sec, P < .01), workload (+16 ± 16 W vs +2 ± 17 W, P < .01), and muscular strength (+7 ± 8 kg vs 0 ± 7 kg and +16 ± 14 kg vs 0.2 ± 12 kg for upper- and lower-body strength, P < .01) all favored ICE over CMP. No significant between-group differences were observed in peak exercise performance (+0.05 ± 0.17 W/kg vs +0.04 ± 0.17 W/kg, P = .83) or peak oxygen uptake (−0.1 ± 3.1 mL/kg/min vs +0.6 ± 3.2 mL/kg/min, P = .38).


Patients with cardiac disease and low exercise capacity improved submaximal exercise performance and muscular strength with once-weekly ICE but not with CMP. Neither ICE nor CMP led to an improvement in peak exercise endurance performance. The implementation of ICE in this population would be feasible and may result in greater benefit for performing activities of daily living.

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