Document Type : Original Articles


1 Department of Physiotherapy, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2 Sport Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Heart Failure and Heart Transplantation, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Clinical Sciences, School of Rehabilitation Sciences, Rofeideh Rehabilitation Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

5 Department of Cardiology, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran


Background: Patients with chronic heart failure (CHF) are characterized by debilitating muscle weakness, the inability to move, and resultant psychological disadvantages. The current study investigated the acute effects of resistance
exercise (RE) and their impact on psychological health and peak muscle contraction (PMC) in patients with CHF.
Methods: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with CHF (NYHA Class II, III) underwent initial assessments of the 6-minute walking test (6MWT),psychological response to exercise, and PMC. They were randomly divided into three groups, namely R1, R2, and the control group. The intervention consisted of a short aerobic exercise comprising 15 minutes of walking at an intensity of 50%-reserved heart rate for all three groups and an additional RE with the intensity of 50%-1RM and 75%-1RM for groups R1 and R2, respectively.
Results: No significant difference among the groups were observed in 6MWT,peak muscle contraction, and psychological response to exercise after the intervention (P≥0.05). PMC and psychological response to exercise improved significantly in all groups; however, only group R2 showed a significant increase in 6MWT after the intervention. Positive well-being (PWB) had a positive correlation with peak muscle contraction of the left knee extensors and dorsiflexors, and psychological dystress (PD) and FAT were negatively correlated to walking distance and PMC of the left knee extensors and dorsiflexors.
Conclusions: Performing just one session of exercise had significant beneficial impacts on PMC and psychological response in patients with CHF, regardless of exercise type or RE intensity. However, walking distance (6MWT) increased
significantly in the R2 group (75% of 1-RM), indicating that performing higher resistance exercise is safe and leads to functional advantages in CHF patients.There was a positive relationship between PWB and 1RM and a negative
relationship between both psychological distress (PD) and fatigue and 1RM.


  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6-e245.
  2. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. heart. 2007;93(9):1137-46.
  3. Von Haehling S, Ebner N, Dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nature Reviews Cardiology. 2017;14(6):323-41.
  4. von Haehling S, Arzt M, Doehner W, Edelmann F, Evertz R, Ebner N, et al. Improving exercise capacity and quality of life using non‐invasive heart failure treatments: evidence from clinical trials. European Journal of Heart Failure. 2021;23(1):92-113.
  5. Piepoli MF, Coats AJS. The ‘skeletal muscle hypothesis in heart failure’revised. Oxford University Press; 2013. p. 486-8.
  6. Adsett J, Mullins R. Evidence based guidelines for exercise and chronic heart failure. Pathways home project. 2010:4-17.
  7. Kubzansky LD, Huffman JC, Boehm JK, Hernandez R, Kim ES, Koga HK, et al. Positive psychological well-being and cardiovascular disease: JACC health promotion series. Journal of the American College of Cardiology. 2018;72(12):1382-96.
  8. MeAuley E, Courneya KS. The subjective exercise experiences scale (SEES): Development and preliminary validation. Journal of Sport and Exercise Psychology. 1994;16(2):163-77.
  9. Schoenfeld BJ, Ogborn D, Krieger JW. Dose-response relationship between weekly resistance training volume and increases in muscle mass: A systematic review and meta-analysis. Journal of sports sciences. 2017;35(11):1073-82.
  10. O'Connor PJ, Herring MP, Caravalho A. Mental health benefits of strength training in adults. American Journal of Lifestyle Medicine. 2010;4(5):377-96.
  11. Ekkekakis P, Hall EE, Petruzzello SJ. Evaluation of the circumplex structure of the Activation Deactivation Adjective Check List before and after a short walk. Psychology of Sport and Exercise. 2005;6(1):83-101.
  12. Ekkekakis P. The dual-mode theory of affective responses to exercise in metatheoretical context: I. Initial impetus, basic postulates, and philosophical framework. International Review of Sport and Exercise Psychology. 2009;2(1):73-94.
  13. Van Landuyt LM, Ekkekakis P, Hall EE, Petruzzello SJ. Throwing the mountains into the lakes: On the perils of nomothetic conceptions of the exercise-affect relationship. Journal of Sport and Exercise Psychology. 2000;22(3):208-34.
  14. Ekkekakis P, Hall EE, Petruzzello SJ. Variation and homogeneity in affective responses to physical activity of varying intensities: an alternative perspective on dose–response based on evolutionary considerations. Journal of sports sciences. 2005;23(5):477-500.
  15. Pietrabissa G, Castelnuovo G, Manzoni GM, Cattivelli R, Molinari E, Gondoni LA. Psychological well-being as an independent predictor of exercise capacity in cardiac rehabilitation patients with obesity. Frontiers in Psychology. 2020;10:2973.
  16. Radzewitz A, Miche E, Herrmann G, Nowak M, Montanus U, Adam U, et al. Exercise and muscle strength training and their effect on quality of life in patients with chronic heart failure. European journal of heart failure. 2002;4(5):627-34.
  17. Heffernan KS, Kelly EE, Collier SR, Fernhall B. Cardiac autonomic modulation during recovery from acute endurance versus resistance exercise. European Journal of Preventive Cardiology. 2006;13(1):80-6.
  18. Bjarnason-Wehrens B, Mayer-Berger W, Meister E, Baum K, Hambrecht R, Gielen S. Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation. European Journal of Preventive Cardiology. 2004;11(4):352-61.
  19. Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? European journal of preventive cardiology. 2016;23(16):1715-33.
  20. Organization WH. Nutritional anaemias: tools for effective prevention and control. 2017.
  21. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods. 2009;41(4):1149-60.
  22. de Souza Mesquita FO, da Silva PBP, da Silva Neto HR, Moreira SR, Sobral Filho DC, Catai AM, et al. Acute effects of high-intensity interval training and moderate-intensity continuous training on linear and nonlinear heart rate variability measures in arterial hypertension. Research, Society and Development. 2021;10(7):e47110712106-e.
  23. Bibeau WS, Moore JB, Mitchell NG, Vargas-Tonsing T, Bartholomew JB. Effects of acute resistance training of different intensities and rest periods on anxiety and affect. The Journal of Strength & Conditioning Research. 2010;24(8):2184-91.
  24. Ziaeirad M, Ziaei G, Mohammady M. Correlation of fatigue intensity with demographic and clinical characteristics of patients with congestive heart failure. Journal of Clinical Nursing and Midwifery. 2017;6(3):72-81.
  25. Williams N. The MRC breathlessness scale. Occupational medicine. 2017;67(6):496-7.
  26. Eskandari S, Heravi-Karimooi M, Foroughan M, Ebadi A, Kharameh ZT. Quality of life in heart failure patients using the Minnesota Living with Heart Failure Questionnaire (MLHF). Payesh (Health Monitor). 2016;15(5):559-66.
  27. Arnold CM, Warkentin KD, Chilibeck PD, Magnus CR. The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. The Journal of Strength & Conditioning Research. 2010;24(3):815-24.
  28. Kendall F, McCreary E, Provance P, Rodgers M, Romani W. 2005. Muscles, Testing and Function With Posture and Pain. Williams & Wilkins, Baltimore.
  29. Giannitsi S, Bougiakli M, Bechlioulis A, Kotsia A, Michalis LK, Naka KK. 6-minute walking test: a useful tool in the management of heart failure patients. Therapeutic advances in cardiovascular disease. 2019;13:1753944719870084.
  30. BARR CS. Comparison of accuracy and diagnostic validity of a novel non-invasive electrocardiographic monitoring device with a standard 12-lead ECG recording device.
  31. Fleck SJ, Kraemer W. Designing resistance training programs, 4E: Human Kinetics; 2014.
  32. She J, Nakamura H, Makino K, Ohyama Y, Hashimoto H. Selection of suitable maximum-heart-rate formulas for use with Karvonen formula to calculate exercise intensity. International Journal of Automation and Computing. 2015;12(1):62-9.
  33. Bjarnason-Wehrens B. Recommendations for resistance exercise in cardiac rehabilitation: Do they need reconsideration? : SAGE Publications Sage UK: London, England; 2019. p. 1479-82.
  34. Rokka S, Mavridis G, Kouli O. The impact of exercise intensity on mood state of participants in dance aerobics programs. Physical Culture & Tourism. 2010;17(3):241-5.
  35. Szabo A. Acute psychological benefits of exercise: Reconsideration of the placebo effect. Journal of Mental Health. 2013;22(5):449-55.
  36. Williams DM, Dunsiger S, Jennings EG, Marcus BH. Does affective valence during and immediately following a 10-min walk predict concurrent and future physical activity? Annals of Behavioral Medicine. 2012;44(1):43-51.
  37. Williams DM. Exercise, affect, and adherence: an integrated model and a case for self-paced exercise. Journal of sport & exercise psychology. 2008;30(5):471.
  38. Arent SM, Landers DM, Matt KS, Etnier JL. Dose-response and mechanistic issues in the resistance training and affect relationship. Journal of Sport and Exercise Psychology. 2005;27(1):92-110.
  39. Bellezza PA, Hall EE, Miller PC, Bixby WR. The influence of exercise order on blood lactate, perceptual, and affective responses. The Journal of Strength & Conditioning Research. 2009;23(1):203-8.
  40. O'Connor PJ, Bryant CX, Veltri JP, Gebhardt SM. State anxiety and ambulatory blood pressure following resistance exercise in females. Medicine & Science in Sports & Exercise. 1993.
  41. Hargreaves EA, Stych K. Exploring the peak and end rule of past affective episodes within the exercise context. Psychology of Sport and Exercise. 2013;14(2):169-78.
  42. Portugal EM, Lattari E, Santos TM, Deslandes AC. Affective responses to prescribed and self-selected strength training intensities. Perceptual and motor skills. 2015;121(2):465-81.
  43. Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation. 2021;143(10):e763-e83.
  44. Day ML, McGuigan MR, Brice G, Foster C. Monitoring exercise intensity during resistance training using the session RPE scale. The Journal of Strength & Conditioning Research. 2004;18(2):353-8.
  45. Pritchett RC, Green JM, Wickwire PJ, Kovacs M. Acute and session RPE responses during resistance training: Bouts to failure at 60% and 90% of 1RM. South African Journal of Sports Medicine. 2009;21(1).