Previous studies found that skeletal myopathy, including impaired muscle metabolic capacity and muscle fibre transformation, may be the primary limiting factors of exercise capacity (Okita et al 1998, Vescovo et al 1998). Other studies correlated the improvement of muscle strength, aerobic, and anaerobic performance with increases in muscle fibre cross-sectional area as well as in citrate synthase activity, and lactate dehydrogenase and muscle mitochondrial ATP production rates

(Pu et al 2001, Williams et al 2007a). In addition to the muscular level, an improvement of neurovascular level Rapamycin price could also contribute to the improvement in 6-minute walk distance. Chronic heart failure in patients with skeletal myopathy may induce sympathetic nerve activation with resultant peripheral vasoconstriction (Clark et al 1996). Plasma

norepinephrine levels at rest and submaximal exercise may decrease after high repetitions and moderate resistance training (Tyni-Lenné et al 2001) and thus increase blood flow in response to submaximal activity, such as the 6-minute walk test (Selig et al 2004). The results of this review suggest that resistance training alone does not significantly improve peak oxygen consumption. Two studies we reviewed (Selig et al 2004, Tyni-Lenné et al 2001) reported increments of 8% and 10%, respectively. Combining resistance with aerobic Quisinostat training failed to demonstrate a greater increase in peak oxygen consumption than aerobic training alone. Similar effects on peak oxygen consumption

among three types of Thiamine-diphosphate kinase exercise training were noted by Feiereisen and colleagues (2007), with gains of 17%, 11%, and 14% for groups undertaking resistance, aerobic, and combined exercise training respectively. Resistance training can have a direct effect on blood flow and metabolism of skeletal muscles independent of any central adaptation due to the specificity of exercise training (Pu et al 2001, Selig et al 2004). If peripheral muscle weakness plays a role in exercise limitation, resistance training may be helpful to improve exercise capacity even though the peak oxygen consumption may not change after training (Delagardelle et al 2002, Feiereisen et al 2007, Hulsmann et al 2004). Delagardelle and colleagues (2002) found combined training was superior to endurance training alone in terms of left ventricular function, peak oxygen consumption, and strength. The inconsistent finding may result from differences in training mode, intensity, or volume of exercise. Further investigation is needed. Two meta-analyses have reported that exercise training significantly improves quality of life in people with chronic heart failure (Flynn et al 2009, van Tol et al 2006). Nevertheless, there remain disagreements about the effect of resistance exercise alone on quality of life (Cider et al 1997, Tyni-Lenné et al 2001).