Blood Flow Restriction Combined With Aerobic or Resistance Exercise in Heart Failure

Comparison of the Effects of Aerobic or Resistance Exercises Combined With Blood Flow Restriction on Muscle Oxygenation, Serum BNP Levels, Functional Capacity, and Quality of Life in Patients With Heart Failure

The aim of this study is to compare the clinical effects of aerobic and resistance exercise modalities combined with blood flow restriction in patients with stable heart failure, and to determine the most effective, feasible, and evidence-based rehabilitation approach. In individuals with heart failure, limited exercise tolerance increases the importance of training strategies that can induce high physiological adaptations with low mechanical loads. In this context, exercise interventions combined with blood flow restriction have attracted increasing attention due to their low-intensity nature and potential clinical benefits. This study is designed as a prospective, parallel-group, randomized controlled clinical trial to be conducted in 40 patients diagnosed with stable heart failure. Participants will be randomized into two groups: a blood flow restriction- combined aerobic exercise group and a blood flow restriction-combined resistance exercise group, both applied under supervision three times per week for eight weeks. All participants will be assessed before and after the intervention in terms of muscle oxygenation, serum B-type natriuretic peptide (BNP) levels, functional capacity, and quality of life. The expected outcome of this study is to obtain comparative data on the clinical effectiveness of blood flow restriction- combined exercise interventions in patients with stable heart failure and to identify which exercise modality provides superior clinical benefits. The findings are anticipated to contribute to the development of short-term, low-cost rehabilitation protocols and to provide evidence-based guidance for clinical practice.

Inclusion Criteria:

• NYHA functional class I-III,
• HFrEF and/or HFmrEF with left ventricular ejection fraction <50%,
• functional capacity that does not prevent participation in exercise, and
• clinical stability within the last 3 months.

Exclusion Criteria:

• history of acute coronary syndrome or revascularization within the last 12 months,
• uncontrolled hypertension, defined as ≥180/≥110 mmHg or 160-179/100--109 mmHg despite treatment, or uncontrolled arrhythmia,
• conditions contraindicating the application of blood flow restriction training, such as significant peripheral arterial disease or atherosclerosis obliterans,
• severe orthopedic or neurological limitations that would prevent exercise,
• presence of atrial fibrillation or a pacemaker,
• severe liver disease,
• impaired renal function, defined as eGFR <30 mL/min,
• peripheral neuropathy,
• dialysis,
• moderate to severe valvular disease,
• moderate to severe COPD,
• hospitalization due to cardiovascular causes within the last 30 days,
• intracranial aneurysm, arteriovenous malformation, cerebral neoplasm, or abscess,
• angina pectoris and use of medications known to affect ischemic conditioning/occlusion, such as cyclosporine or glibenclamide,
• use of dual antiplatelet therapy or anticoagulants, including NOACs, low-molecular-weight heparin, or vitamin K antagonists.