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NHLBI Topics of Special Interest (TOSI)

HL-132: Advancing Research in Exercise Therapy for Chronic Heart Failure (R01)


  1. Identify exercise training regimens that reduce morbidity and improve quality of life and physical functioning in chronic Heart Failure (HF) patients, taking into account different HF subpopulations (e.g., HF-rEF and HF-pEF), concomitant drug and/or device therapy, comorbidities, age, and gender.
  2. Develop regimens that are acceptable to HF patients and optimize adherence to effective regimens.

Purpose and Rationale of the Initiative

NHLBI is interested in supporting applications that address the question of which exercise training regimens (including consideration of duration and intensity) and combinations with other therapies work best to reduce morbidity and improve QOL and physical functioning in chronic HF patients, taking into account different subpopulations. Addressing the role of differential adherence to tested exercise regimens in explaining differences in clinical outcomes is also of special interest.

Despite a variety of pharmacologic and device therapies for persons with chronic HF, prognosis and quality of life remain poor. Exercise intolerance is the primary chronic symptom in patients with reduced ejection fraction HF (HF-rEF) and is a strong determinant of their impaired quality of life (QOL). Exercise training improves exercise intolerance and QOL in patients with HF-rEF, and has become an accepted adjunct therapy based on fairly extensive evidence, including a number of randomized trials, most of which were of modest size.

Although it is important to understand the physiologic mechanisms of the benefits of exercise in HF patients, mechanistic studies are beyond the scope of this topic of special interest. Applications could be submitted as time-dependent ancillary studies to funded clinical trials.

Selected Research Examples

Some specific examples may include, but are not limited to:

  • Randomized clinical trial (RCT) to compare the effects of aerobic plus resistance training versus aerobic training alone on QOL, physical functioning, and hospitalizations in HF patients with HF-pEF.
  • RCT examining the effects of aerobic training on fitness and clinical events in HF patients with CRT or LVAD.
  • RCT based in senior centers examining the effects of different doses (duration and/or intensity) of tailored aerobic and resistance exercises on physical functioning and QOL in elderly persons with limited mobility due to arthritis and other co-morbidities.
  • RCT comparing a cognitive-behavioral approach with a motivation-enhancing approach (e.g., motivational interviewing) on clinical benefits from and adherence to a combination aerobic and resistance exercise regimen in HF patients.
  • An adaptive treatment trial comparing the effects of varying exercise dose (frequency and duration) and delivery setting (home vs. clinic vs. senior center) on hospitalizations, QOL, physical functioning, and adherence to an exercise regimen in elderly HF patients.

Submission Dates

Standard receipt dates apply as indicated in the parent RO1 FOA: PA-13-302 Research Project Grant (Parent R01).

Application and Submission Information

Investigators interested in developing applications for these topics are encouraged to submit investigator‐initiated R01 applications under PA-13-302. At the beginning of the title, please include the following characters: HL-. In the first sentence of the abstract, please include the specialized code: HL-132.

Contact Information

Lawton S. Cooper, M.D., M.P.H.
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute
Telephone: 301-435-0419




Last Updated: October 2013

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