Please select the eligibility criteria that correspond to the clinical trial below.
Title: Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure- Clinical Study
Brief Summary: Aim of the clinical multicenter study (OptimEx-CLIN) is to assess the optimal exercise intervention in patients with Heart Failure with preserved Ejection Fraction (HFpEF; also termed diastolic heart failure) that will best improve peak oxygen uptake (Peak Vo2) and additionally diastolic function (assessed echocardiographically). The investigators hypothesize that exercise training reverses HFpEF and that intensity of exercise training is more important than duration.


Options:
A: 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
B: Inclusion Criteria:

* Diagnosis of chronic HF
* Percentage of blood pumped from the left ventricle (ventricular ejection fraction) less than 40% for at least 1 year prior to study entry
* Stable medical regimen, defined as no major changes in medication, in the 3 months prior to study entry
* New York Heart Association Classification of Class I (no activity limitations), Class II (slight activity limitations), or Class III (marked activity limitations)
* English-speaking

Exclusion Criteria:

* Unstable angina, myocardial infarction, cardiac resynchronization, or major cardiac surgery within 3 months prior to study entry
* History of cardiac arrest or diagnosis of peripartum cardiomyopathy within 6 months prior to study entry
* Unstable ventricular arrhythmias or structural valvular disease
* Current participation in a conventional cardiac rehabilitation program
* Inability to perform a bicycle stress test at study entry
* Lower extremity amputation or other inability to walk due to conditions other than HF
* Severe cognitive dysfunction preventing informed consent and understanding of tai chi concept
* Current regular practice of tai chi
* Current participation in a tai chi pilot study or other studies
C: Inclusion Criteria:

* Sedentary (structured exercise \< 2x 30 min/wk)
* At least 40 years old
* Preserved systolic function LVEF \> 50%
* Signs and symptoms of heart failure class NYHA II or III
* Diastolic dysfunction (E/é \> 15 or E/é 8-15 and NT-proBNP \> 220 pg/ml)
* Clinically stable for \>= 6 weeks
* Optimal medical treatment for \>= 6 weeks
* Written informed consent

Exclusion Criteria:

* Non- HFpEF causes for HF symptoms (significant valvular or coronary disease, uncontrolled hypertension or arrhythmias, primary cardiomyopathies)
* Significant pulmonary disease (FEV1 \< 50% predicted, COPD GOLD III-IV)
* Inability to exercise or conditions that may interfere with exercise intervention
* Myocardial infarction in the previous three months
* Signs of ischemia during exercise testing
* Comorbidity that may influence one- year prognosis
* Participation in another clinical trial
D: Inclusion Criteria:

1. Diagnosis of heart failure with reduced ejection fraction (left ventricular ejection fraction \<40%) with New York Heart Association (NYHA) class II or III symptoms.
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.

Answer: C