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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Date data sharing statement initially provided
Type of registration
Prospectively registered

Titles & IDs
Public title
Determining the influence of leg and respiratory muscle function in heart failure
Scientific title
Identifying the impact of peripheral and respiratory muscle training on metaboreflex and cardiac outcomes in heart failure
Secondary ID [1] 300446 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Heart failure 316111 0
Condition category
Condition code
Cardiovascular 314398 314398 0 0
Other cardiovascular diseases

Study type
Description of intervention(s) / exposure
The interventions being assessed are different types of exercise training or control for eight weeks for participants with heart failure:
Arm 1: Peripheral muscle training (such as cycle ergometry for leg training)
Arm 2: Respiratory muscle training (using a threshold loading device for inspiratory muscle training, such as a POWERbreathe device)
Arm 3: Peripheral and respiratory muscle training
Arm 4: No training
Arm 5: healthy controls (no training, assessed pre and post)
Patients in the respiratory muscle training and respiratory muscle+peripheral training groups will perform respiratory muscle training for 30 min, 5 times per week, for 8 weeks using a threshold-loading device (POWERbreathe, HaB International Ltd., Southam, UK) set at a workload equal to 60% of their maximal inspiratory pressure (MIP). Participants will breathe through the PowerBreathe device with a normal breathing frequency (not paced breathing) during these sessions. MIP will be assessed at the beginning of each training week, in order to optimise the training workload commensurate with any gains in respiratory muscle strength. Each week, 4 training sessions will be performed at home and 1 training session will be performed in the laboratory under supervision of a physiotherapist or exercise physiologist to ensure compliance with the training protocol. Participant compliance to home-based training will be monitored with home exercise diaries.
The peripheral and respiratory muscle training+ peripheral muscle groups will attend the laboratory 3 times per week for the leg muscle training. At each visit, subjects will perform 30 min of constant load exercise, intermittently (5 min exercise, 1 min active recovery) on a cycle ergometer with the workload set to 65–75% of the maximal work determined via the exercise test conducted at baseline.
Intervention code [1] 316738 0
Treatment: Other
Intervention code [2] 316739 0
Intervention code [3] 318113 0
Treatment: Devices
Comparator / control treatment
The 3 exercise arms will be compared to two non-exercising groups, one with heart failure (main comparator) and one with healthy, matched control participants.
Control group

Primary outcome [1] 322750 0
Echocardiography, using a Vivid E9™ ultrasound scanner (GE Vingmed Ultrasound AS, Horten, Norway) with a transthoracic matrix phased-array transducer (4V-D, GE Vingmed Ultrasound AS) will be used to assess global longitudinal strain.
Timepoint [1] 322750 0
Baseline and 8 weeks after intervention commencement
Primary outcome [2] 322751 0
Changes in the respiratory muscle metaboreflex response. This will be assessed using the composite of changes in beat to beat blood pressure, heart rate (Finapres Nova, Finapres Medical Systems, The Netherlands) and inactive limb blood flow (duplex Doppler ultrasound ,Terason T3200, Burlington, MA, USA). The reflex will be elicited by using an inspiratory threshold-loading protocol, (POWERbreathe HaB International Ltd., Southam, UK).
Timepoint [2] 322751 0
Baseline and 8 weeks after intervention commencement
Primary outcome [3] 322752 0
Changes in the peripheral muscle metaboreflex response. This will be assessed using the composite of changes in beat to beat blood pressure, heart rate (Finapres Nova, Finapres Medical Systems, The Netherlands) and inactive limb blood flow (duplex Doppler ultrasound ,Terason T3200, Burlington, MA, USA). The reflex will be elicited by exercising the limb, then occluding blood flow with a rapid cuff inflation to a suprasystolic pressure (Hokanson E20, Bellevue, WA, USA) for 3 minutes.
Timepoint [3] 322752 0
Baseline and 8 weeks after intervention commencement
Secondary outcome [1] 379569 0
Near infrared spectroscopy (NIRS) assessment of muscle oxidative capacity. Recovery kinetics of muscle oxygen consumption will be determined following a brief bout of exercise, followed by a repeated rapid suprasystolic cuffing protocol (Hokanson E20, Bellevue, WA, USA) using a continuous-wave NIRS device (Oxymon MK III, Artinis Medical Systems, The Netherlands)
Timepoint [1] 379569 0
Baseline and 8 weeks after intervention commencement
Secondary outcome [2] 379570 0
Vascular endothelial function- flow mediated dilation (FMD) technique, using duplex Doppler ultrasound (Terason T3200, Burlington, MA, USA).
Timepoint [2] 379570 0
Baseline and 8 weeks after intervention commencement
Secondary outcome [3] 379571 0
A cardiopulmonary exercise test (VO2peak) will be conducted using a metabolic cart.
Timepoint [3] 379571 0
Baseline and 8 weeks after intervention commencement
Secondary outcome [4] 379572 0
6 minute walk test distance will be used as a measure of functional capacity.
Timepoint [4] 379572 0
Baseline and 8 weeks after intervention commencement

Key inclusion criteria
New York Heart Association (NYHA) functional class II-III outpatients will be screened to meet the following inclusion criteria: For heart failure with reduced ejection fraction (HFrEF) - i) history of ischemic or dilated cardiomyopathy, duration of HF symptoms >1 year, ii) stable symptoms > 3 months, iii) left ventricular ejection fraction less than, or equal to 35%, iv) at least one prior hospitalisation due to chronic heart failure (CHF). Patients with chronic heart failure with preserved ejection fraction (HFpEF), as defined by the Framingham criteria with ejection fraction (EF) greater than, or equal to 50% will be included if they have diastolic dysfunction determined by echocardiography (grade equal to, or greater than 1) and sinus rhythm. Healthy participants, with no prior cardiovascular disease, metabolic disease or severe condition limiting exercise capacity (such as moderate to severe respiratory conditions, neurological or musculoskeletal impairments) will be included as matched control participants (for age and sex).
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Significant valvular or pericardial disease, infiltrative or hypertrophic cardiomyopathy, cor pulmonale, significant pulmonary disease, and peripheral vascular disease.

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Sealed, opaque envelopes will be used to randomise participants with heart failure. Healthy control participants will not take part in any intervention and are only to attend baseline and follow up assessments.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software (i.e. computerised sequence generation)
Masking / blinding
Who is / are masked / blinded?

Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment status
Not yet recruiting
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)

Funding & Sponsors
Funding source category [1] 304862 0
Name [1] 304862 0
Curtin University
Address [1] 304862 0
GPO Box U1987, Perth WA 6845
Country [1] 304862 0
Funding source category [2] 304864 0
Name [2] 304864 0
Spinnaker Health Research Foundation
Address [2] 304864 0
Spinnaker Health Research Foundation
PO Box 480
Fremantle WA 6959
Country [2] 304864 0
Primary sponsor type
Curtin University
GPO Box U1987, Perth WA 6845
Secondary sponsor category [1] 305203 0
Name [1] 305203 0
Address [1] 305203 0
Country [1] 305203 0

Ethics approval
Ethics application status
Ethics committee name [1] 305273 0
South Metropolitan Health Service Human Research Ethics Committee
Ethics committee address [1] 305273 0
Level 2, Education Building, Fiona Stanley Hospital
14 Barry Marshall Parade
MURDOCH Western Australia 6150
Ethics committee country [1] 305273 0
Date submitted for ethics approval [1] 305273 0
Approval date [1] 305273 0
Ethics approval number [1] 305273 0

Brief summary
Exercise intolerance is a major cause of morbidity and a predictor of mortality in patients with heart failure (HF). Although many patients with HF have a dilated left ventricle and reduced ejection fraction, approximately 50% of patients have clinical manifestations of HF with a normal sized heart and normal systolic function. As such, HF is now categorised as reduced (HFrEF) vs preserved (HFpEF) ejection fraction. An important distinction of HFpEF patients is that traditional pharmacological therapies used to treat HFrEF have not improved quality of life or survival. There is currently limited understanding of HFpEF pathophysiology, thus there is a need for investigations that will lead to novel therapeutic approaches in the treatment of this condition. It is now appreciated that leg muscles become dysfunctional in HF, and generate an abnormal neural signal (a 'metaboreflex') that disrupts cardiovascular and respiratory control, enhancing ventilation and breathlessness, causing exercise intolerance (EI). A similar metaboreflex occurs within respiratory muscles, which reduces blood flow to the active limbs in these patients, exacerbating the metaboreflex arising from the legs in a detrimental positive-feedback manner, hastening the onset of breathlessness and EI. However, no studies have directly compared this reflex physiology in HFrEF and HFpEF. This proposal aims to identify metaboreflex contribution to EI by determining if the leg and respiratory muscle metaboreflexes contribute equally to EI in both HFrEF and HFpEF, their influence on cardiac function, and if exercise training attenuates metaboreflex signalling. The outcomes of this proposal will have clinical relevance and lead to the development of novel therapeutic interventions, through a combination of exercise prescription and pharmacological targeting of the metaboreflex in the early stages of HF and may lead to an elusive therapy that will improve quality of life and survival in patients with HFpEF.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 99842 0
Prof Luke Haseler
Address 99842 0
School of Physiotherapy and Exercise Science, Curtin University,
GPO Box U1987, Perth WA 6845
Country 99842 0
Phone 99842 0
+61 8 9266 3634
Fax 99842 0
Email 99842 0
Contact person for public queries
Name 99843 0
Prof Luke Haseler
Address 99843 0
School of Physiotherapy and Exercise Science, Curtin University,
GPO Box U1987, Perth WA 6845
Country 99843 0
Phone 99843 0
+61 8 9266 3634
Fax 99843 0
Email 99843 0
Contact person for scientific queries
Name 99844 0
Prof Luke Haseler
Address 99844 0
School of Physiotherapy and Exercise Science, Curtin University,
GPO Box U1987, Perth WA 6845
Country 99844 0
Phone 99844 0
+61 8 9266 3634
Fax 99844 0
Email 99844 0

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
What data in particular will be shared?
Individual participant data collected during the trial underlying published results, after de-identification.
When will data be available (start and end dates)?
After publication, subject to journal's requirements regarding embargo periods, with no end date determined yet.
Available to whom?
Researchers who provide a methodologically sound proposal.
Available for what types of analyses?
Data will be available only to achieve the aims in the approved proposal.
How or where can data be obtained?
Access subject to approvals by the Principal Investigator, Professor Luke Haseler, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Fax: +61 8 9266 3699 Telephone: +61 8 9266 3634 Email:
What supporting documents are/will be available?
No other documents available
Summary results
No Results