Exercise-based cardiac rehabilitation (CR) has been shown to significantly improve cardiovascular health and overall well-being in patients with congestive heart failure (CHF). However, a substantial number of CHF patients also suffer from comorbid conditions, such as knee osteoarthritis (OA), which can impede their ability to engage in physical activity and, consequently, derive full benefits from CR. Knee OA is characterized by pain, stiffness, and reduced joint mobility, which can significantly limit exercise capacity and adherence to CR programs. This dual burden poses a unique challenge, necessitating tailored rehabilitation approaches that accommodate both cardiovascular and musculoskeletal limitations. This study aims to evaluate the effectiveness of an exercise-based CR program specifically adapted for patients with CHF and coexisting knee OA, focusing on improvements in cardiovascular function, joint mobility, pain management, and overall quality of life.

This study will employ a randomized controlled trial (RCT) design involving 100 patients diagnosed with both CHF and knee OA. Participants will be randomly assigned to either an intervention group or a control group. The intervention group will undergo a 12-week exercise-based CR program tailored to accommodate their knee OA, incorporating low-impact aerobic exercises, strength training, and flexibility exercises specifically designed to minimize knee joint stress. The control group will receive standard medical care without the structured exercise program. Primary outcomes will include changes in cardiovascular fitness, assessed by peak oxygen uptake (VO2 peak), and knee function, measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes will assess pain levels, quality of life using the SF-36 questionnaire, and adherence rates to the rehabilitation program. Data will be collected at baseline, post-intervention (12 weeks), and at a 6-month follow-up to evaluate both immediate and long-term effects. Statistical analyses will be conducted to compare the outcomes between the two groups and determine the efficacy of the tailored CR program.

Keywords: Exercised-based cardiac rehabilitation, Congestive heart failure, knee osteoarthritis, low impact aerobic exercise, strength training

Inclusion Criteria:

• Patients with a confirmed diagnosis of CHF, classified according to the New York Heart Association (NYHA) functional classification II-III.
• Radiographically confirmed diagnosis of knee OA, based on the Kellgren-Lawrence grading system (grade II-III).
• Adults aged 40-80 years
• Left ventricular ejection fraction (LVEF) ≤ 40% as measured by echocardiography within the last 6 months.
• Patients must be on stable pharmacologic therapy for CHF for at least 4 weeks prior to enrollment.

Exclusion Criteria:

• Presence of severe comorbid conditions that could interfere with the study protocol or pose a risk to the patient, such as severe pulmonary disease, advanced renal or liver disease, or active malignancy.
• Kellgren-Lawrence grade IV knee OA or recent knee surgery within the last 6 months.
• Presence of inflammatory arthritis, such as rheumatoid arthritis or gout
• Recent myocardial infarction (within the past 3 months), unstable angina, or recent coronary artery bypass graft surgery.
• Any condition that contraindicates exercise participation, such as severe hypertension (BP > 180/110 mmHg), uncontrolled arrhythmias, or severe aortic stenosis.
• Significant cognitive impairment or psychiatric disorder that would interfere with adherence to the exercise protocol.
• Patients already participating in regular, structured exercise programs exceeding moderate intensity (>150 minutes per week)