J Cardiol 2004 Nov; 44（5）: 179 – 187

Effect of Physical Exercise Training
on Health-Related Quality of Lifeand Exercise Tolerance in Patients
With Left Ventricular Dysfunction
Genji

TODA, MD

Shigemori

SHIBATA, MD

Reiichiro

NAKAMIZO, MD

Shinji
Katsusuke

SETO, MDYANO, MD, FJCC

Abstract ─────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────
Objectives. The improvement of exercise tolerance and quality of life
（QOL）are essential in the treatment of patients with heart failure. The influence of physical exercise training on QOL was investigated inpatients with left ventricular dysfunction.
Methods. Health-related QOL was evaluated using the Medical Outcomes Study Short-Form 36 Health
Status Survey（SF-36）before and 3 months after individualized exercise training determined by cardiopulmonary exercise testing in 65 patients. The 44 patients who could carry out more than two-thirds of theprescribed exercise were classified into two groups : Group A（11 patients）with left ventricular ejection
fraction ＜ 40% and Group B（33 patients）with left ventricular ejection fraction ＞− 40%. The remaining 21
patients served as the control group.
Results. The mean value of SF-36 improved significantly with exercise training only in Group A・± 3.5 to 21.4 ±（50.8 ± 25.3 to 62.1 ± 22.2, p ＜ 0.05）. Group A also had an increase in peak V O（18.92
3.6 ml/min/kg, p ＜ 0.005）
and a decrease in brain natriuretic peptide. The 24 patients（9 in Group A, 15 inGroup B）with improved SF-36 values after the exercise training showed a negative correlation between
・＝− 0.606, p ＜ 0.05）.
the change of the mental component summary and the peak V O（r2Conclusions. Exercise training improves both the QOL, especially the mental component, and the exercise tolerance in patients with left ventricular dysfunction.
─────────────────────────────────────────────────────────────────────────────────────────────────────────────────────J Cardiol 2004 Nov ; 44（5）
: 179−187

Key Words
Quality of life health-related, SF-36

INTRODUCTION
Cardiac rehabilitation has been developed primarily to reintegrate post-myocardial infarction
patients into society. Recently, exercise training
therapy has been indicated not only for ischemic
heart disease but also for heart failure, and its efficacy has been widely established1−6）. Patients withchronic heart failure have a deteriorating quality of

Exercise tests

Heart failure

life（QOL）as their condition worsens due to various
factors, including poor exercise tolerance and anxiety4,7）. QOL improvement is one of the important
targets in the treatment of patients with heart failure. The correct amount of exercise training may
allow such patients to resume an active life andmay eliminate their anxiety about exercise loading.
Consequently, exercise training can be expected togive patients improved exercise tolerance and──────────────────────────────────────────────
長崎大学大学院医歯薬学総合研究科 循環病態制御内科学 : 〒 852−8501 長崎県長崎市坂本町 1−7−1
Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki
University School of Medicine, Nagasaki
Address for correspondence : TODA G, MD, Department of Cardiovascular Medicine, Course of Medical and Dental Sciences,
Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Sakamoto-cho 1−7−1, Nagasaki, Nagasaki 852−
8501
Manuscript received July 8, 2004 ; revised August 23, 2004 ; accepted August 24, 2004

179

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Toda, Shibata, Nakamizo et al

QOL3,4,8）. However, whether the exercise training
improves QOL remains controversial. The differing
views on the effect of exercise training on QOL
may result from differences in the QOL assessment
methods, and the variations in the duration and content of the exercise training in the studies investigating the relationship between exercise training
and QOL, ranging from only physical training tomore comprehensive programs, with and without
supervision. For example, in the case of unsupervised exercise training, it is not easy to be certainthat the subjects could or did carry out the prescribed exercise training adequately.
Recently, the Medical Outcomes Study Short9）
Form 36 Health Status Survey（SF-36）
has become
widely recognized as a useful outcome measurethat can objectively express a subjective healthrelated QOL. We examined and compared thechanges in the health-related QOL occurring as aresult of the exercise training using SF-36
10）in patients with and with（Japanese version 1.2）
out left ventricular dysfunction and in patients that
could not adequately carry out the exercise training.
SUBJECTS AND METHODS

cases. These 44 patients were further divided into
Groups A and B based on left ventricular ejection
fraction（LVEF）values that were determined using
echocardiography. Group A consisted of 11 patientswith LVEF ＜ 40% and Group B consisted of 33
patients with LVEF ＞− 40%. The remaining 21
patients who answered the questionnaire as4）having carried out half of the prescribed exercise, or 5）having carried out less than half of theprescribed exercise, or 6）not being able to carryout the prescribed exercise prescription, were used
as controls. Five patients had LVEF ＜ 40%, and 16
patients had LVEF ＞− 40%. The patients in the control group were also asked the reasons why they
could not carry out the prescribed exercise. We
examined the health-related QOL using SF-36
before and 3 months after the exercise training, andcompared the scores between the three groups. The
patient characteristics of the three groups are shownin Table 1.
Medications for heart failure such as
angiotensin-converting enzyme inhibitors,
angiotensin-Ⅱ receptor antagonists,β-blockers,
diuretics and digitalis were not altered throughout
the exercise training period.

Study population
The subjects consisted of 65 outpatients, 42 men
and 23 women aged from 37 to 81 years（mean age
61.0 ± 11.0 years）
who were given an exercise prescription based on cardiopulmonary exercise testing
between May 2001 and April 2002. The patients
had the following underlying diseases : 37 ischemic
heart diseases ; 17 dilated cardiomyopathy ; 4
hypertrophic non-obstructive cardiomyopathy ; 6
operated valvular heart diseases ; and 1 arteriosclerosis obliterans. There were no patients whose cardiac condition had worsened or had been unstablewithin at least 1 month before starting the exercise
training, and there were no patients who showedsigns of myocardial ischemia during the cardiopulmonary exercise testing.
The subjects were divided into three groups
based on a questionnaire that surveyed the degreeof fulfillment of the prescribed exercise training 3
months from the start of the exercise program. The
44 patients who answered the questionnaire as1）having carried out more than the prescribed
exercise training, or 2）having carried out the prescribed exercise training, or 3）having carried out
more than two-thirds of the prescribed exercise
training, were classified as exercise achievement

Cardiopulmonary exercise testing
All patients underwent a symptom-limited bicycle ergometer exercise test immediately before
starting the exercise training. A continuous ramp
protocol at a constant rate of 50 rpm was used witha work rate that was increased by 15 W/min after a2-minute rest period. Standard 12-lead electrocardiography was continuously monitored throughout
the test. Their arterial blood pressure was measured
by cuff sphygmomanometry at rest and subsequently every minute during the exercise and recovery
phase. Breath-by-breath gas exchange measurements were performed with a computerized metabolic cart（JAEGER, Oxycon Alpha）. Oxygen
uptake（・V O2）, carbon dioxide production（・V CO2）,
minute ventilation and the respiratory exchange
ratio were measured. Peak ・V O2 was determined as・
the highest V O 2 achieved during exercise. The
anaerobic threshold was measured by the V-slope
method. We regarded the values of peak ・V O2 as anindex of exercise tolerance. Cardiopulmonary exercise testing and brain natriuretic peptide measurements were performed before and 3 months after
starting the exercise training in 8 of the 11 patientsin Group A.
J Cardiol 2004 Nov; 44（5）: 179 – 187

Exercise Training in Left Ventricular Dysfunction

181

Table 1 Baseline characteristics of the subjects
Group A
（n＝11）

Group B
（n＝33）

6/5

23/10

13/8

61.8±10.562.8±11.2

58.3±10.9

Ischemic heart disease

5

22

10

Dilated cardiomyopathy

6

3

8

Hypertrophic cardiomyopathy

0

2

2

Valvular heart disease

0

5

1

Arteriosclerosis obliterance

0

1

0

Ⅰ

1

14

9

Ⅱ

3

15

8

Ⅲ

7

4

4

Ⅳ

0

0

0

LVEF
（%）

30.5±7.959.6±9.0＊

54.1±16.9＊

LVDD
（mm）
・
2
AT VO（2 ml/kg/m ）・
2
Peak VO（
2 ml/kg/m ）64.8±5.950.3±6.4＊

53.6±8.4＊

12.7±3.1

15.1±3.6

14.3±4.0

20.4±5.724.3±7.0

22.0±6.5

Sex（male/female）
Age（yr）

Control（n＝21）

Underlying heart disease

NYHA classification

Continuous values are mean±SD. ＊p＜0.0001 compared to the values in Group A.
Group A : exercise achievement cases, LVEF＜40%. Group B : exercise achievement cases, LVEF＞−40%.
Control : exercise non-achievement cases.
NYHA＝New York Heart Association ; LVEF＝left ventricular ejection fraction ; LVDD＝left ventricular・・
diastolic diameter ; AT VO2＝oxygen consumption at anaerobic threshold level ; Peak VO2＝oxygen consumption atpeak exercise level.

Exercise prescription
The exercise prescription was based on the
results of cardiopulmonary exercise testing immediately before exercise training, with unsupervised
walking on a level road for more than 30 min as theexercise method. The frequency of exercise training
was once or twice a day, 3 to 5 days per week.
Exercise intensity was designated with a target
pulse rate and symptom level. The target pulse rate
was set as the heart rate at the anaerobic thresholdlevel measured by cardiopulmonary exercise testing. For patients with severe left ventricular dysfunction, the target heart rate was set based on the
1 min period before the anaerobic threshold level.
We instructed the patients to do the exercise within
the limit of their symptoms as denoted by the Borg
index11）13, feeling somewhat hard .
Health-related QOL SF-36
10）
SF-36
（Japanese version 1.2）
is a self-administered questionnaire suitably translated into Japanese
to evaluate the health-related QOL. The 36-item
questionnaire is scored on a scale ranging from 0 to
J Cardiol 2004 Nov; 44（5）: 179 – 187

100, with higher scores representing a higher QOL,
and consists of the following eight sub-scales :1）physical functioning（ PF）, 2）role-physical（RP）, 3）body pain（BP）, 4）general health（GH）,5）vitality（VT）, 6）social functioning（SF）,
7）role-emotional（RE）, and 8）mental health（MH）. Sub-scales of categories 1）to 4）were calculated as the physical component summary（PCS）,and sub-scales of categories 5）to 8）were calculated as the mental component summary（MCS）.
The study complied with the Declaration of
Helsinki, the locally appointed ethics committee
approved the research protocol, and informed consent was obtained from the subjects.
Statistical analysis
Data before and after the exercise training werecompared using paired Student s t-tests. Comparisons of the patients characteristics and SF-36
scores between three groups were made using thechi-square test or ANOVA. Linear regression
analyses were performed using Fisher s exact test.
Values of p ＜ 0.05 were considered to be statisti-

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Toda, Shibata, Nakamizo et al

cally significant. Data were expressed as meanvalue ± standard deviation.
RESULTS
Change in SF-36 scores with exercise training
The mean scores of SF-36 values before andafter the exercise training for the three groups areshown in Fig. 1. Before exercise training, the meanscore in Group A was significantly lower than thatin Group B（50.8 ± 25.3 vs 74.0 ± 17.5, p ＝0.001）. However, the mean scores significantly
increased after exercise training only in Group A（Group A : from 50.8 ± 25.3 to 62.1 ± 22.2, p ＝0.015, Group B : from 74.0 ± 17.5 to 75.7 ± 14.0,
p ＝ 0.510, control group : from 67.8 ± 20.3 to
64.1 ± 26.5, p ＝ 0.250）.
The scores of sub-scales PCS and MCS before
and 3 months after exercise training in the threegroups are shown in Table 2. All scores of eachsub-scale before exercise training in Group A were
low compared to those in the other two groups, but
all increased after exercise training. The increase inRP（from 25.0 ± 38.7 to 50.0 ± 41.8, p ＝ 0.041）,
PCS（from 49.1 ± 21.4 to 59.4 ± 23.5, p ＝ 0.018）,
and MCS（from 52.5 ± 30.7 to 64.8 ± 22.8, p ＝0.039）
were statistically significant for Group A. In
Group B, most scores before exercise training wererelatively high, and did not change significantly
after exercise training, although most scores
increased slightly. In the control group, the scores
after exercise training showed a slight decrease in

Fig. 1 Changes in mean SF-36 values before and 3
months after exercise training
The score in Group A was significantly lower comparedto that in Group B at baseline, and increased significantly after exercise training. The score in Group B was relatively high at baseline and did not show a significant
increase after exercise training. In the control group, thescore after exercise training decreased slightly compared to baseline levels.
SF-36 ＝ Medical Outcomes Study Short-Form 36
Health Status Survey.

Table 2 SF-36 scores before and after exercise training
Group A
（n＝11）PFGroup B
（n＝33）

BeforeAfter

67.3±26.1

69.5±23.0＊

Control（n＝21）

BeforeAfter

BeforeAfter

81.4±14.584.2±12.375.5±20.1

72.9±24.1RP

25.0±38.7

50.0±41.8

79.5±34.5

75.8±33.972.6±37.0

65.5±45.7

BP58.1±31.768.3±25.9

67.7±28.773.8±24.0

72.4±22.6

73.5±27.4GH

45.9±16.9

49.6±17.0

57.6±12.8

57.6±12.447.9±17.0

50.3±25.8VT48.6±29.5

62.7±24.5

65.8±16.0

68.0±19.2

59.0±24.1

51.0±27.0SF

62.5±36.2

69.3±25.2

86.0±18.9

81.1±21.5

77..4±26.1

70.8±29.4RE

39.4±49.0

57.6±49.6

79.8±37.2

88.9±28.568.3±42.8

66.7±42.2MH59.6±24.8

69.5±16.4

74.5±16.7

76.1±18.2

69.7±21.062.3±23.9＊

PCS

49.1±21.4

59.4±23.5＊

71.6±17.7

72.9±14.4

67.1±18.6

65.5±27.8MCS52.5±30.764.8±22.8＊

76.5±18.2

78.5±16.0

68.6±23.8

62.7±27.5

Values are mean±SD. ＊p＜0.05 compared to the values before exercise training.
PF＝physical functioning ; RP＝role-physical ; BP＝body pain ; GH＝general health ; VT＝vitality ; SF＝social functioning ; RE＝
role-emotional ; MH＝mental health ; PCS＝physical component summary ; MCS＝mental component summary. Other abbreviation as
in Fig. 1.

J Cardiol 2004 Nov; 44（5）: 179 – 187

Exercise Training in Left Ventricular Dysfunction

183

Fig. 2 Difference of SF-36 sub-scales before and 3 months after exercise training
The degree of improvement in Group A was high in most subscales, especially in RP, RE and VT. Many
sub-scales showed slight improvement in Group B, and slight deterioration in the control group.
Abbreviations as in Fig. 1, Table 2.

many items compared to the baseline levels, withthe decrease in MH being statistically significant（from 69.7 ± 21.0 to 62.3 ± 23.9, p ＝ 0.029）.
Degree of change in SF-36 scores with exercise
training
The differences in the SF-36 sub-scales before
and after exercise training in the three groups areshown in Fig. 2. The positive values represent
improvement of the health-related QOL. The
degree of improvement in Group A was relatively
high in most sub-scales, especially in RP, RE andVT, compared to those in the other groups. In
Group B, there were many sub-scales that showed aslight improvement, whereas in the control group,
many sub-scales showed a slight deterioration.
Exercise tolerance and SF-36 scores
The relationships of PCS and MCS to the peak・VO2 measured before exercise training are shown in
Fig. 3. There were significant positive correlations
between both scores and the peak ・V O2. The correlation between PCS and peak ・V O2 was stronger thanthat between MCS and peak ・V O（PCS: r ＝ 0.581,
2
p ＜ 0.0001, MCS : r ＝ 0.436, p ＜ 0.0005）.
There were no significant correlations between
the differences in both scales before and after exercise training and the peak ・V O2 measured before
J Cardiol 2004 Nov; 44（5）: 179 – 187

exercise training in all subjects（PCS : r ＝ 0.111,
p ＝ 0.382, MCS : r ＝ 0.007, p ＝ 0.955）. However,in the 24 patients（ 9 patients in Group A, 15
patients in Group B）whose mean SF-36 values
increased after exercise training, there was a significant negative correlation between the degree ofchange in MCS and the peak ・V O（PCS: r＝2− 0.289, p ＝ 0.173, MCS : r ＝− 0.606, p ＝0.001 ; Fig. 4）.
Change of brain natriuretic peptide and peak・
V O2 with exercise training
Fig. 5 shows the values of brain natriuretic peptide and the peak ・V O2 before and after exercise
training in 8 of 11 patients in Group A. After exercise training, their brain natriuretic peptide showeda downward trend（from 279.4 ± 304.0 to 123.6 ±111.5 pg/ml, p ＝ 0.117）
and the peak ・V O2 increased
significantly（ from 18.9 ± 3.5 to 21.4 ±3.6 ml/min/kg, p ＝ 0.003）.
Reasons for non-achievement of the exercise
prescription in the control group
The patients in the control group could not carryout the exercise prescription fully because of anxiety over the exercise training（eight patients）, notime for exercise training（ seven patients）, no
recognition of the necessity for exercise training

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Toda, Shibata, Nakamizo et al

・
Fig. 3 Relationship of peak V O2 to PCS and MCS examined before exercise training
・
There were positive correlations between both scores and the peak V O2. The correlation of PCS and the・・peak V O2 was stronger than that between MCS and the peak V O2.
Abbreviations as in Tables 1, 2.

・Fig. 4 Relationship of the degree of change in PCS and MCS to the peak V O2 in 24 patients withincreased mean SF-36 values after the exercise training
・
There was a significant negative correlation between the degree of change in MCS and the peak V O2. Opencircles show the patients in Group A. Closed circles show the patients in Group B.
Abbreviations as in Tables 1, 2, Fig. 1.

（four patients）, body pain（one patient）, mental
fatigue（one patient）, mental stress（one patient）,
and no place for walking（one patient）.
DISCUSSION
In the present study, the mean SF-36 values, PCS
and MCS, increased significantly after exercise
training only in patients with left ventricular dysfunction who could adequately carry out exercise
training（Group A）. The degree of improvement in

the SF-36 sub-scales（RP, RE and VT）
was high inGroup A. There were significant positive correlations between PCS, MCS and the peak ・V O2 measured before exercise training. In 8 of the 11 GroupA patients, the peak ・V O2 increased significantlywith exercise training. However, in the 24 patients
whose mean SF-36 values increased after exercise
training（9 in Group A, 15 in Group B）, there was asignificant negative correlation between the degreeof change in MCS and the peak ・
V O2.
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Exercise Training in Left Ventricular Dysfunction

185

・
Fig. 5 Changes in brain natriuretic peptide and the peak V O2 with exercise training in 8 of 11
patients in Group A
・The values of brain natriuretic peptide showed a downward trend and the peak V O2 increased significantly
after the exercise training.
BNP ＝ brain natriuretic peptide. Other abbreviations as in Table 1.

The efficacy of exercise training in patients withchronic heart failure has been proven by various
large-scale trials3,4,12）. Exercise training is generally
agreed to improve exercise tolerance1−4,13）. The
mechanism of the improvement appears to be multifactorial, including improvements in cardiac function2,6）, respiratory function1,3,13）, and peripheral circulation including skeletal muscle1,13−17）. Though
the improvement of exercise tolerance and QOL isclosely linked3,4,8）, it is not easy to assess QOL inpatients with chronic heart failure, because QOL
consists of, and thus reflects, various factors,
including mental and physical stress, anxiety,depression, relationships with families and neighbors, physical activity, and occupational problems.
We used SF-36（ Japanese version 1.2）for theassessment of health-related QOL, as prepared foruse with Japanese patients10）. SF-36 has alreadybeen applied to other areas of cardiovascular disease, such as coronary heart disease and heart failure7,18）. SF-36 scores in patients with chronic heart
failure were lower, except for body pain, comparedto the Japanese national norm7）. In our study, allscores of the SF-36 sub-scales examined before theexercise training in patients with left ventricular
dysfunction were low compared to those in patients
without left ventricular dysfunction. Thus, we
assume that SF-36 can comprehensively assess thehealth-related QOL in patients with left ventricular
J Cardiol 2004 Nov; 44（5）: 179 – 187

dysfunction.
Improvement of the health-related QOL by exercise training was found only in Group A. The cardiac condition of Group A patients did not deteriorate after exercise training, as shown by brain natriuretic peptide values. Moreover, their exercise tolerance improved after exercise training, as shownby the change in the peak ・V O2. These changes may
result in improvement of both the physical andmental components of health-related QOL. Most
Group A patients had been forced to remain at rest
before the present study started, because they were
anxious that their heart failure could deteriorate
with exercise. Thus, it is likely that simply being
able to do the exercise training for 3 months without any heart failure was chiefly responsible for
producing the improvement in the mental component of the health-related QOL.
Positive correlations between PCS, MCS and thepeak ・V O2 measured before exercise training werenoted and likely mean that better exercise tolerancein patients was related to the better health-related
QOL obtained. However, there was a significant
negative correlation between the degree of
improvement in MCS and the peak ・V O2, which canbe interpreted to mean that the degree of improvement of mental QOL by the exercise training wasstronger in patients with poor exercise tolerance
than in those with good exercise tolerance.

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Toda, Shibata, Nakamizo et al

Both home- and hospital-based cardiac rehabilitation are useful in older patients with old myocardial infarction to improve exercise tolerance andQOL8）. With home-based unsupervised exercise
training, it is essential to confirm the patients fulfillment of the prescribed exercise program. In
order to do this, we administered a questionnaire 3
months after the start of exercise training. We separately evaluated the patients who reported that they
could not carry out more than two-thirds of theexercise prescription as the non-achievement
group, which served as the control group. The SF36 values in this control group decreased slightly
after exercise training. Although the control group
included five patients with LVEF values ＜ 40%,
their heart failure did not deteriorate during theobservation period. The worsening of the healthrelated QOL in the control group may be due to thefact that they could not carry out the prescribed
exercise. In view of the reasons given for nonachievement of the exercise training, we became
keenly aware of the importance of adequately
要

explaining the usefulness of exercise training toeach patient and of providing an exercise prescription suited to each patient s lifestyle.
There are several limitations to our study. No
control group not given exercise prescription wasincorporated into the design of this study. Since theexercise training in this study was unsupervised,
the confirmation of whether the exercise training
was really performed depended on the veracity ofpatient responses. Furthermore, the pulse rate thatwas set as one measure of exercise intensity may
not have been measured accurately, especially inpatients with arrhythmia. However, to overcome
this limitation in such patients, the exercise intensity was assessed by classifying their symptoms
according to the Borg index.
CONCLUSIONS
Exercise training improves both QOL, especiallythe mental component, and exercise tolerance inpatients with left ventricular dysfunction.

約

左室機能低下症例の健康関連 Quality of Life および運動耐容能に対する運動療法の効果
戸田
目

源二

柴田

茂守

中溝礼一郎

瀬戸

信二

矢野

捷介

的 : 運動耐容能の低下は心不全患者の quality of life（QOL）を低下させる．そこで低左室機能を有する患者に運動療法を行い，運動耐容能および SF-36 を使用した健康関連 QOL への効果を検討した．
方法 : 対象は心肺運動負荷試験により運動処方を行い，非監視型運動療法を 3 ヵ月以上施行した 65 例（虚血性心疾患 37 例，拡張型心筋症 17 例，弁膜症その他 11 例）である．運動後のアンケー
トにより，運動処方の少なくとも 2/3 以上の運動療法を実行したと回答した 44 例中，心カテーテル
あるいは心エコー図上で左室駆出率が 40% 未満であった 11 例を A 群（男性 6 例，女性 5 例，平均年
齢 61.8 ± 10.5 歳），40% 以上であった 33 例を B 群（男性 23，女性 10，平均年齢 62.8 ± 11.2 歳），運動
処方の半分以下しか実行できなかった 21 例を対照群（男性 13 例，女性 8 例，平均年齢 58.3 ± 10.9 歳）に分類し，運動療法前と 3 ヵ月後の SF-36 の変化を比較検討した．
結果 : 運動前の SF-36 の平均値は A 群が最も低値であったが，運動療法後は A 群のみ改善した（A 群 : 50.8 ± 25.3 → 62.1 ± 22.2，p ＜ 0.05，B 群 : 74.0 ± 17.5 → 75.7 ± 14.0，有意差なし），対照群 :67.8 ± 20.3 → 64.1 ± 26.5，有意差なし）．A 群の最大酸素摂取量は有意に上昇し（18.9 ± 3.5 → 21.4 ±3.6 ml/min/kg，p ＜ 0.005），脳性 Na 利尿ペプチドは低下傾向を示した．SF-36 の平均点数が改善した 24 例（A 群 9 例，B 群 15 例）では精神的サマリースコアの変化と最大酸素摂取量との間に負の相関がみられた（r ＝− 0.606，p ＜ 0.05）．
結論 : 左室機能低下患者では適度の運動療法により運動耐容能が改善し，それによりとくに精神面での QOL の改善がもたらされる．

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Exercise Training in Left Ventricular Dysfunction

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