esults on the effect of exercise on the heart's size and function, however. "We knew that exercise could improve fitness and exercise capacity by about 15 percent, and that exercise could make muscles stronger and larger. But we didn't know the effects of exercise training on ventricular remodelling," Dr. Haykowsky said.

The analysis showed that ejection fraction improved significantly in patients who did aerobic training (2.59 percent, on average). Similarly, the patients' enlarged hearts became significantly smaller, with a reduction in both end-diastolic volume (11.mL, on average) and end-systolic volume (12.87 mL). By comparison, patients who combined aerobic exercise with strength training showed no significant improvements in ejection fraction or the size of the heart. The single study that evaluated strength training alone showed a drop in ejection fraction, but it was not statistically significant; the study did not measure changes in the size of the heart.

Dr. Haykowsky speculated that weight lifting and other forms of strength training may not have shown the benefits of aerobic training in reshaping the heart because strength training results in a heightened pressure load, which may actually increase the stress on the heart. The importance of the new study is that it provides guidance in designing an exercise program for patients with heart failure, according to Stanley A. Rubin, M.D., F.A.C.C., chief of inpatient cardiology and a professor of medicine at the Veterans Affairs-UCLA Medical Program in Los Angeles.

"This study clarifies for heart failure patients and for their doctors the best form of exercise training," said Dr. Rubin, who wrote an accompanying editorial in the June 19 issue of JACC. "But it's not a bed of roses. The patient needs to be motivated, have realistic expectations of the small but real benefit of exercise and, in particular, understand that this form of treatment must be accompanied by ext
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