Background: Exercise Training is beneficial in heart failure patients, while training opportunities are limited. Pedelecs represent a novel training possibility for these patients, while safety and efficacy of pedelec training in heart failure is unknown. Therefore, we conducted a pilot study to address these issues. The study “HI-Herz.BIKE Saar” (August 2017 - September 2019) examined the health benefits and training effects of e-bikes (pedelecs) in patients from ambulatory heart groups with moderate chronic heart failure (CHI).

Methods: Ten subjects with a strictly defined NYHA stage II-III heart failure and a LVEF of =50% were selected. The presented clinical study is explicitly marked as a pilot study, as a new, so far not tested technique was used for exercise control. When selecting the heart failure patients defined in this way, a higher number of subjects could not be reached at only one study center. Participants cycled once weekly for 60-150 min and 20-50 km with a follow-up of 2 years as detailed in the Methods section. The new HeartGo® system used here for the first time allows heart rate- controlled training on a special pedelec via a smartphone app. The groups were accompanied during the training rides by a doctor and a paramedic. The training units were increased in duration, distance, and target frequency every six months. Frequency behavior, pedaling and motor load on the pedelec as well as clinical data such as ejection fraction, a biomarker (NT-pro BNP), risk factors, arterial blood pressure, and ergometric tests were measured.

Results: Pedelec training in heart failure subjects resulted in significant increases of the index of well-being (p<0.05) and of leftventricular ejection fraction by 29% (p<0.05). This was paralleled by a significant decrease in the heart failure parameter NT-pro BNP by 27% (p<0.05), and a significant increase in performance (ergometric power +44%, p<0.05). Moreover, systolic blood pressure decreased significantly by 11% (p<0.05). In contrast, Body Mass Index and cholesterol levels showed no significant changes. No cardiac complications occurred.

Conclusions: These results suggest that pedaling is not only safe for stable heart NYHA II-III failure patients with an EF =50%, but can induce significant improvements in cardiac performance indices. The subjects were enthusiastic and satisfied with this form of training. The results of this pilot study with its methodological weaknesses should be verified in a larger follow-up study.

Heart rate-controlled training, HeartGo® system, Chronic heart failure, Pedelec