Background:Patients with congestive heart failure (CHF) have impaired functional capacity and inferior quality of life. The clinical manifestations are associated with structural and functional impairments in skeletal muscle, emphasizing a need for feasible rehabilitation strategies beyond optimal anticongestive medical treatment. We investigated whether low-load blood flow restricted resistance exercise (BFRRE) or remote ischemic conditioning (RIC) could improve functional capacity and quality of life in patients with CHF and stimulate skeletal muscle myofibrillar and mitochondrial adaptations.Methods:We randomized 36 patients with CHF to BFRRE, RIC, or nontreatment control. BFRRE and RIC were performed 3× per week for 6 weeks. Before and after intervention, muscle biopsies, tests of functional capacity, and quality of life assessments were performed. Deuterium oxide was administered throughout the intervention to measure cumulative RNA and subfraction protein synthesis. Changes in muscle fiber morphology and mitochondrial respiratory function were also assessed.Results:BFRRE improved 6-minute walk test by 39.0 m (CI, 7.0–71.1, P=0.019) compared with control. BFRRE increased maximum isometric strength by 29.7 Nm (CI, 10.8–48.6, P=0.003) compared with control. BFRRE improved quality of life by 5.4 points (CI, −0.04 to 10.9; P=0.052) compared with control. BFRRE increased mitochondrial function by 19.1 pmol/s per milligram (CI, 7.3–30.8; P=0.002) compared with control. RIC did not produce similar changes.Conclusions:Our results demonstrate that BFRRE, but not RIC, improves functional capacity, quality of life, and muscle mitochondrial function. Our findings have clinical implications for rehabilitation of patients with CHF and provide new insights on the myopathy accompanying CHF.Clinical Trial Registration:URL: https://www.clinicaltrials.gov. Unique identifier: NCT03380663.

中文翻译：

---

限流阻力运动和远程缺血条件对心力衰竭患者功能能力和心肌细胞适应性的影响。

背景：患有充血性心力衰竭（CHF）的患者功能能力受损，生活质量较差。临床表现与骨骼肌的结构和功能受损有关，强调除了最佳抗充血药物治疗以外，还需要可行的康复策略。我们调查了低负荷血流阻力抵抗运动（BFRRE）或远程缺血性调节（RIC）是否可以改善CHF患者的功能能力和生活质量并刺激骨骼肌肌原纤维和线粒体适应性研究。方法：我们将36例CHF患者随机分组进行BFRRE，RIC或非治疗控制。BFRRE和RIC每周进行3次，共6周。干预前后，肌肉活检，功能能力测试，并进行了生活质量评估。在整个干预过程中都施用了氘化氢，以测量累积的RNA和亚组分蛋白质的合成。结果：BFRRE将6分钟步行测试提高了39.0 m（CI，7.0–71.1，P = 0.019）与对照相比。与对照相比，BFRRE使最大等距强度增加了29.7 Nm（CI，10.8–48.6，P = 0.003）。与对照组相比，BFRRE使生活质量提高了5.4点（CI，-0.04至10.9；P = 0.052）。BFRRE使线粒体功能每毫克增加19.1 pmol / s（CI，7.3–30.8；P= 0.002）与对照相比。RIC没有产生类似的变化。结论：我们的结果表明BFRRE可以改善功能能力，生活质量和肌肉线粒体功能，而RIC则不能。我们的发现对CHF患者的康复具有临床意义，并为CHF伴随的肌病提供了新的见解。临床试验注册：URL：https://www.clinicaltrials.gov。唯一标识符：NCT03380663。