Please select the eligibility criteria that correspond to the clinical trial below.
Title: Increasing Exercise Capacity of Patients With Heart Failure by Wii Gaming (HF-Wii) A Randomized Controlled Trial
Brief Summary: The study objectives are to determine the effectiveness of structured access to a Wii game computer compared to motivational support only in heart failure patients on exercise capacity and daily activity. Secondly, to determine the effectiveness of structured access to a Wii game computer compared to motivational support only in heart failure patients on the combined endpoint of death, readmission and quality of life.

The following research questions will be addressed:

* What is the effectiveness of structured introduction and access to a Wii game computer in patients with heart failure to improve their exercise capacity compared to patients with heart failure in a control group who only receive motivational support?
* What is the effectiveness of structured introduction and access to a Wii game computer in patients with heart failure compared to patients with heart failure in a control group who only receive motivational support to increase their daily physical activity, decrease health care use and improve quality of life?
* What are experiences of heart failure patients and how is their exercise motivation when they are introduced and instructed to play with a Wii game computer?


Options:
A: Inclusion Criteria:

* Age greater than or equal to 60 years of age
* Symptoms of congestive heart failure
* Able to understand and give informed consent

Exclusion Criteria:

* Age \<60 years
* Does not have CHF
* Significant change in cardiac medication \<3 weeks
* Myocardial infarction \<3 weeks
* CABG surgery \<3 months
* Angina pectoris not controlled during daily activity by pharmacological therapy or at \<4 METS activity
* Sustained hypertension with systolic\> 190 and diastolic\> 110 on medications
* Valvular heart disease as the primary etiology of CHF
* Significant aortic stenosis
* Stroke of \<3 months or with any physical restriction impairment that would prevent participation in exercise programs
* Chronic obstructive pulmonary disease on therapy that limits exercise duration
* Uncontrolled diabetes mellitus
* Active treatment for cancer or other noncardiovascular conditions with life expectancy less than three years
* Anemia "10 gms Hb)
* Renal insufficiency (cr \>2.5 mg/dl)
* Psychiatric disease - uncontrolled major psychoses, depressions, dementia, or personality disorder
* Dementia - MMSE \~24 "22 for \~8th grade education)
* Lack of an acoustic window sufficient to allow definition of endocardial borders on the screening echocardiogram.
* Plans to leave area or be admitted to a nursing home within 2 years.
* Inability to walk at least 420 feet in 6 minutes without a cane or other assistive device.
* Inability to exercise at or near home.
* At the discretion of the clinical staff, it is believed that the participant cannot or will not complete the protocol because of frailty, illness, or other reason.
* Participation in a regular exercise regimen more than one time per week for at least twenty minutes per session; including but not limited to walking, swimming, weight lifting, golfing, or taking an exercise class.
* Inability to ambulate without cane or other assistive device during biomechanics testing or treadmill.
* Inability to attend at least fourteen weeks of the facility-based intervention
B: Inclusion Criteria:

1. Diagnosis of heart failure with preserved (HFpEF) or mid-range (HFmrEF) ejection fraction with New York Heart Association (NYHA) class II or III symptoms. The diagnosis requires the following conditions to be fulfilled:

   1. the presence of symptoms and/or signs of heart failure,
   2. left ventricular ejection fraction ≥50% (HFpEF) or 40-49% (HFmrEF),
   3. elevated levels of natriuretic peptides (BNP \>35 pg/ml and/or NT-proBNP \>125 pg/mL),
   4. objective evidence of other cardiac functional and structural alterations underlying heart failure.
2. Physically inactive, as determined by a question "As a rule, do you do at least half an hour of moderate or vigorous exercise (such as walking or a sport) on five or more days of the week?".

Exclusion Criteria:

1. Signs and symptoms of decompensated heart failure, uncontrolled arrhythmia or effort angina, severe or symptomatic aortic stenosis, persistent hypotension, recent shocks delivered by the automated implantable cardioverter defibrillator.
2. Co-morbid conditions that would affect adherence to trial procedures (e.g. inflammatory arthritis, active malignancy, renal disease requiring dialysis, uncontrolled diabetes, major depression or other significant psychiatric disorders, cognitive impairment, significant hearing or visual impairment).
3. Major surgery planned within the next 12 months.
4. Life expectancy shorter than 12 months.
5. Inability to walk from any reason.
6. Baseline six-minute walking distance \>450 meters. Patients covering more than 450 meters in the baseline six-minute walk test (6MWT) are excluded due to a possible ceiling effect.
7. Pregnancy.
8. Failure to perform the 6MWT.
C: Inclusion Criteria:

* Diagnosed with HF (NYHA I-IV) (independent of Ejection Fraction: both patients with a preserved ejection fraction (HFPEF) or reduced ejection fraction (HFREF) can be included)
* Older than 18 years, there is no upper age limit
* Speak/understand the language of the country where the intervention is taken place

Exclusion Criteria:

* The patient is expected to be unable to use the Nintendo Wii due to visual (see a TV screen at a distance of 3 m) cognitive (assessed by the HF nurse or cardiologist) or motor impairment (the patient should be able to swing his arm at least 10 times in a row)
* The patient has restrictions that would them unable patients to fill in data collection material
* The patient has a life expectancy shorter than 6 months
D: Inclusion Criteria:

* Heart failure clinical score greater than or equal to 3
* Age 60 and over
* Normal ejection fraction greater than or equal to 50%
* BMI greater than or equal to 30

Exclusion Criteria:

* Valvular heart disease
* Significant change in cardiac medication \<4 weeks
* Uncontrolled hypertension
* Recent or debilitating stroke
* Cancer or other noncardiovascular conditions with life expectancy less than 2 years
* Significant Anemia
* Renal insufficiency (creatinine \>2.5mg/dl)
* Psychiatric disease- uncontrolled major psychoses, depressions, dementia, or personality disorder
* Plans to leave area within 6 months
* Refuses informed consent
* Failure to pass screening test:pulmonary function, echocardiogram,or exercise

Answer: C