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Published in: Trials 1/2018

Open Access 01-12-2018 | Study protocol

Effect of an exercise-based cardiac rehabilitation program “Baduanjin Eight-Silken-Movements with self-efficacy building” for heart failure (BESMILE-HF study): study protocol for a randomized controlled trial

Authors: Xiankun Chen, Wei Jiang, Xiaoli Lin, Cecilia Stålsby Lundborg, Zehuai Wen, Weihui Lu, Gaetano Marrone

Published in: Trials | Issue 1/2018

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Abstract

Background

Exercise-based cardiac rehabilitation is a beneficial therapy for patients with chronic heart failure. The delivery of exercise-based cardiac rehabilitation should adopt an evidence-based approach, as well as be culturally appropriate and sensitive to individual needs and preferences. The Baduanjin Eight-Silken-Movements with Self-efficacy Building for Heart Failure (BESMILE-HF) program is the first to apply a traditional Chinese exercise, Baduanjin, as the core component in an exercise-based cardiac rehabilitation program. This trial aims to assess the efficacy, safety, and acceptability of the addition of the BESMILE-HF program to usual medications for patients with chronic heart failure.

Methods/design

The BESMILE-HF study is a mixed-design study. It includes a two-group, parallel, randomized controlled trial with 200 chronic heart failure patients, as well as a qualitative component. Patients will be randomized into either an intervention group receiving the 12-week BESMILE-HF program plus usual medications, or a control group receiving only usual medications. The primary outcomes are peak oxygen consumption assessed using a cardiopulmonary exercise test, and disease-specific quality of life using the Minnesota Living with Heart Failure Questionnaire. The secondary outcomes are: exercise performance, exercise self-efficacy, general quality of life, dyspnea and fatigue, depression, cardiac function, prognostic and inflammatory indicator levels, hospitalization, use of medications, and major adverse cardiac events. Assessments will be carried out at baseline, and at the 4th week, 8th week, and 12th week. The qualitative component will include a semi-structure interview describing patients’ experiences with the intervention.

Discussion

This study can provide evidence for how to deliver a contextually adapted exercise-based cardiac rehabilitation program with the potential to be scaled up throughout China.

Trial registration

ClinicalTrials.gov, ID: NCT03180320. Registered on 2 June 2017.
Appendix
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Literature
1.
go back to reference Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, et al. Heart Disease and Stroke Statistics – 2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):e38–360.CrossRefPubMed Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, et al. Heart Disease and Stroke Statistics – 2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):e38–360.CrossRefPubMed
2.
go back to reference Jiang H, Ge J. Epidemiology and clinical management of cardiomyopathies and heart failure in China. Heart. 2009;95(21):1727–31.CrossRefPubMed Jiang H, Ge J. Epidemiology and clinical management of cardiomyopathies and heart failure in China. Heart. 2009;95(21):1727–31.CrossRefPubMed
3.
go back to reference 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure. An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 2016;22(9):659–69.CrossRef 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure. An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 2016;22(9):659–69.CrossRef
4.
go back to reference Fleg JL, Cooper LS, Borlaug BA, Haykowsky MJ, Kraus WE, Levine BD, Pfeffer MA, Pina IL, Poole DC, Reeves GR, et al. Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail. 2015;8(1):209–20.CrossRefPubMedPubMedCentral Fleg JL, Cooper LS, Borlaug BA, Haykowsky MJ, Kraus WE, Levine BD, Pfeffer MA, Pina IL, Poole DC, Reeves GR, et al. Exercise training as therapy for heart failure: current status and future directions. Circ Heart Fail. 2015;8(1):209–20.CrossRefPubMedPubMedCentral
5.
go back to reference Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, Singh S. Exercise-based rehabilitation for heart failure. The Cochrane database of systematic reviews. 2014;(4):Cd003331. Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, Singh S. Exercise-based rehabilitation for heart failure. The Cochrane database of systematic reviews. 2014;(4):Cd003331.
6.
go back to reference Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.CrossRefPubMed Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.CrossRefPubMed
8.
go back to reference Conraads VM, Deaton C, Piotrowicz E, Santaularia N, Tierney S, Piepoli MF, Pieske B, Schmid JP, Dickstein K, Ponikowski PP, et al. Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2012;14(5):451–8.CrossRefPubMed Conraads VM, Deaton C, Piotrowicz E, Santaularia N, Tierney S, Piepoli MF, Pieske B, Schmid JP, Dickstein K, Ponikowski PP, et al. Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2012;14(5):451–8.CrossRefPubMed
9.
go back to reference Pozehl B, Duncan K, Hertzog M, Norman JF. Heart Failure Exercise And Training Camp: effects of a multicomponent exercise training intervention in patients with heart failure. Heart Lung. 2010;39(6 Suppl):S1–13.CrossRefPubMedPubMedCentral Pozehl B, Duncan K, Hertzog M, Norman JF. Heart Failure Exercise And Training Camp: effects of a multicomponent exercise training intervention in patients with heart failure. Heart Lung. 2010;39(6 Suppl):S1–13.CrossRefPubMedPubMedCentral
10.
go back to reference Sun XG. Rehabilitation practice patterns for patients with heart failure: the Asian perspective. Heart Fail Clin. 2015;11(1):95–104.CrossRefPubMed Sun XG. Rehabilitation practice patterns for patients with heart failure: the Asian perspective. Heart Fail Clin. 2015;11(1):95–104.CrossRefPubMed
11.
go back to reference Zhang Z, Pack Q, Squires RW, Lopez-Jimenez F, Yu L, Thomas RJ. Availability and characteristics of cardiac rehabilitation programmes in China. Heart Asia. 2016;8(2):9–12.CrossRefPubMedPubMedCentral Zhang Z, Pack Q, Squires RW, Lopez-Jimenez F, Yu L, Thomas RJ. Availability and characteristics of cardiac rehabilitation programmes in China. Heart Asia. 2016;8(2):9–12.CrossRefPubMedPubMedCentral
12.
go back to reference Chinese Rehabilitation Medical Association Professional Committee of Cardiovascular Diseases; Committee of Cardio-Cerebral-Vascular Diseases of GSC. Chinese expert consensus on cardiac rehabilitation for patients with chronic stable heart failure [in Chinese]. Zhonghua Xin Xue Guan Bing Za Zhi. 2014;42(9):714–20. Chinese Rehabilitation Medical Association Professional Committee of Cardiovascular Diseases; Committee of Cardio-Cerebral-Vascular Diseases of GSC. Chinese expert consensus on cardiac rehabilitation for patients with chronic stable heart failure [in Chinese]. Zhonghua Xin Xue Guan Bing Za Zhi. 2014;42(9):714–20.
13.
go back to reference Jin H, Wei Q, Chen L, Sun Q, Zhang Y, Wu J, Ma G, Liu N. Obstacles and alternative options for cardiac rehabilitation in Nanjing, China: an exploratory study. BMC Cardiovasc Disord. 2014;14:20.CrossRefPubMedPubMedCentral Jin H, Wei Q, Chen L, Sun Q, Zhang Y, Wu J, Ma G, Liu N. Obstacles and alternative options for cardiac rehabilitation in Nanjing, China: an exploratory study. BMC Cardiovasc Disord. 2014;14:20.CrossRefPubMedPubMedCentral
14.
go back to reference Wang XQ, Pi YL, Chen PJ, Liu Y, Wang R, Li X, Chen BL, Zhu Y, Yang YJ, Niu ZB. Traditional Chinese Exercise for Cardiovascular Diseases: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Heart Assoc. 2016;5(3):e002562.CrossRefPubMedPubMedCentral Wang XQ, Pi YL, Chen PJ, Liu Y, Wang R, Li X, Chen BL, Zhu Y, Yang YJ, Niu ZB. Traditional Chinese Exercise for Cardiovascular Diseases: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Heart Assoc. 2016;5(3):e002562.CrossRefPubMedPubMedCentral
15.
go back to reference Piepoli MF, Conraads V, Corra U, Dickstein K, Francis DP, Jaarsma T, McMurray J, Pieske B, Piotrowicz E, Schmid JP, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011;13(4):347–57.CrossRefPubMed Piepoli MF, Conraads V, Corra U, Dickstein K, Francis DP, Jaarsma T, McMurray J, Pieske B, Piotrowicz E, Schmid JP, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011;13(4):347–57.CrossRefPubMed
16.
go back to reference Norton K, Norton L, Sadgrove D. Position statement on physical activity and exercise intensity terminology. J Sci Med Sport. 2010;13(5):496–502.CrossRefPubMed Norton K, Norton L, Sadgrove D. Position statement on physical activity and exercise intensity terminology. J Sci Med Sport. 2010;13(5):496–502.CrossRefPubMed
17.
go back to reference Pan L, Yan J, Guo Y, Yan J. Effects of Tai Chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail. 2013;15(3):316–23.CrossRefPubMed Pan L, Yan J, Guo Y, Yan J. Effects of Tai Chi training on exercise capacity and quality of life in patients with chronic heart failure: a meta-analysis. Eur J Heart Fail. 2013;15(3):316–23.CrossRefPubMed
18.
go back to reference Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, Davis RB, Phillips RS. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. 2011;171(8):750–7.CrossRefPubMedPubMedCentral Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, Davis RB, Phillips RS. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med. 2011;171(8):750–7.CrossRefPubMedPubMedCentral
19.
go back to reference Zou L, SasaKi JE, Wang H, Xiao Z, Fang Q, Zhang M. A systematic review and meta-analysis Baduanjin Qigong for health benefits: randomized controlled trials. Evid Based Complement Altern Med. 2017;2017:4548706.CrossRef Zou L, SasaKi JE, Wang H, Xiao Z, Fang Q, Zhang M. A systematic review and meta-analysis Baduanjin Qigong for health benefits: randomized controlled trials. Evid Based Complement Altern Med. 2017;2017:4548706.CrossRef
21.
go back to reference Ferrier S, Blanchard CM, Vallis M, Giacomantonio N. Behavioural interventions to increase the physical activity of cardiac patients: a review. Eur J Cardiovasc Prev Rehabil. 2011;18(1):15–32.CrossRefPubMed Ferrier S, Blanchard CM, Vallis M, Giacomantonio N. Behavioural interventions to increase the physical activity of cardiac patients: a review. Eur J Cardiovasc Prev Rehabil. 2011;18(1):15–32.CrossRefPubMed
22.
go back to reference Rajati F, Sadeghi M, Feizi A, Sharifirad G, Hasandokht T, Mostafavi F. Self-efficacy strategies to improve exercise in patients with heart failure: a systematic review. ARYA Atheroscler. 2014;10(6):319–33.PubMedPubMedCentral Rajati F, Sadeghi M, Feizi A, Sharifirad G, Hasandokht T, Mostafavi F. Self-efficacy strategies to improve exercise in patients with heart failure: a systematic review. ARYA Atheroscler. 2014;10(6):319–33.PubMedPubMedCentral
23.
go back to reference Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337 Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337
24.
go back to reference Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7.CrossRefPubMedPubMedCentral Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7.CrossRefPubMedPubMedCentral
26.
go back to reference Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.CrossRefPubMed Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.CrossRefPubMed
27.
go back to reference Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16(6):e1–194.CrossRefPubMed Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16(6):e1–194.CrossRefPubMed
28.
29.
go back to reference ACSM's Guidelines for Exercise Testing and Prescription 9th ed. Canada: Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia; 2013. ACSM's Guidelines for Exercise Testing and Prescription 9th ed. Canada: Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia; 2013.
30.
go back to reference Wade DT. Outcome measures for clinical rehabilitation trials: impairment, function, quality of life, or value? Am J Phys Med Rehabil. 2003;82(10 Suppl):S26–31.CrossRefPubMed Wade DT. Outcome measures for clinical rehabilitation trials: impairment, function, quality of life, or value? Am J Phys Med Rehabil. 2003;82(10 Suppl):S26–31.CrossRefPubMed
31.
go back to reference Malhotra R, Bakken K, D’Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC Heart Fail. 2016;4(8):607–16.CrossRefPubMed Malhotra R, Bakken K, D’Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC Heart Fail. 2016;4(8):607–16.CrossRefPubMed
32.
go back to reference Ho CC, Clochesy JM, Madigan E, Liu CC. Psychometric evaluation of the Chinese version of the Minnesota Living with Heart Failure Questionnaire. Nurs Res. 2007;56(6):441–8.CrossRefPubMed Ho CC, Clochesy JM, Madigan E, Liu CC. Psychometric evaluation of the Chinese version of the Minnesota Living with Heart Failure Questionnaire. Nurs Res. 2007;56(6):441–8.CrossRefPubMed
33.
go back to reference Rector TS, Tschumperlin LK, Kubo SH, Bank AJ, Francis GS, McDonald KM, Keeler CA, Silver MA. Use of the Living With Heart Failure questionnaire to ascertain patients’ perspectives on improvement in quality of life versus risk of drug-induced death. J Card Fail. 1995;1(3):201–6.CrossRefPubMed Rector TS, Tschumperlin LK, Kubo SH, Bank AJ, Francis GS, McDonald KM, Keeler CA, Silver MA. Use of the Living With Heart Failure questionnaire to ascertain patients’ perspectives on improvement in quality of life versus risk of drug-induced death. J Card Fail. 1995;1(3):201–6.CrossRefPubMed
34.
go back to reference Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. American journal of respiratory and critical care medicine. 2003;167(9):1287. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. American journal of respiratory and critical care medicine. 2003;167(9):1287.
35.
go back to reference Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG. Triangulating clinically meaningful change in the Six-minute Walk Test in individuals with chronic heart failure: a systematic review. Cardiopulm Phys Ther J. 2012;23(3):5–15.PubMedPubMedCentral Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG. Triangulating clinically meaningful change in the Six-minute Walk Test in individuals with chronic heart failure: a systematic review. Cardiopulm Phys Ther J. 2012;23(3):5–15.PubMedPubMedCentral
36.
go back to reference Hwang R, Morris NR, Mandrusiak A, Mudge A, Suna J, Adsett J, Russell T. Timed Up and Go Test: a reliable and valid test in patients with chronic heart failure. J Card Fail. 2016;22(8):646–50.CrossRefPubMed Hwang R, Morris NR, Mandrusiak A, Mudge A, Suna J, Adsett J, Russell T. Timed Up and Go Test: a reliable and valid test in patients with chronic heart failure. J Card Fail. 2016;22(8):646–50.CrossRefPubMed
37.
go back to reference Lee LL, Perng SJ, Ho CC, Hsu HM, Lau SC, Arthur A. A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults. Int J Nurs Stud. 2009;46(2):230–8.CrossRefPubMed Lee LL, Perng SJ, Ho CC, Hsu HM, Lau SC, Arthur A. A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults. Int J Nurs Stud. 2009;46(2):230–8.CrossRefPubMed
38.
go back to reference Schweikert B, Hahmann H, Leidl R. Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart. 2006;92(1):62–7.CrossRefPubMed Schweikert B, Hahmann H, Leidl R. Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart. 2006;92(1):62–7.CrossRefPubMed
39.
go back to reference Eurich DT, Johnson JA, Reid KJ, Spertus JA. Assessing responsiveness of generic and specific health related quality of life measures in heart failure. Health Qual Life Outcomes. 2006;4:89.CrossRefPubMedPubMedCentral Eurich DT, Johnson JA, Reid KJ, Spertus JA. Assessing responsiveness of generic and specific health related quality of life measures in heart failure. Health Qual Life Outcomes. 2006;4:89.CrossRefPubMedPubMedCentral
41.
go back to reference Guyatt GH. Measurement of health-related quality of life in heart failure. J Am Coll Cardiol. 1993;22 4 Suppl A:185a–91a.CrossRef Guyatt GH. Measurement of health-related quality of life in heart failure. J Am Coll Cardiol. 1993;22 4 Suppl A:185a–91a.CrossRef
42.
go back to reference Huang TY, Moser DK, Hsieh YS, Lareau SC, Durkin AC, Hwang SL. Validation of Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire with heart failure patients in Taiwan. Am J Crit Care. 2008;17(5):436–42.PubMed Huang TY, Moser DK, Hsieh YS, Lareau SC, Durkin AC, Hwang SL. Validation of Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire with heart failure patients in Taiwan. Am J Crit Care. 2008;17(5):436–42.PubMed
43.
go back to reference Zannad F, Garcia AA, Anker SD, Armstrong PW, Calvo G, Cleland JG, Cohn JN, Dickstein K, Domanski MJ, Ekman I, et al. Clinical outcome endpoints in heart failure trials: a European Society of Cardiology Heart Failure Association consensus document. Eur J Heart Fail. 2013;15(10):1082–94.CrossRefPubMed Zannad F, Garcia AA, Anker SD, Armstrong PW, Calvo G, Cleland JG, Cohn JN, Dickstein K, Domanski MJ, Ekman I, et al. Clinical outcome endpoints in heart failure trials: a European Society of Cardiology Heart Failure Association consensus document. Eur J Heart Fail. 2013;15(10):1082–94.CrossRefPubMed
44.
go back to reference Macfarlane D, Chan A, Cerin E. Examining the validity and reliability of the Chinese version of the International Physical Activity Questionnaire, long form (IPAQ-LC). Public Health Nutr. 2011;14(3):443–50.CrossRefPubMed Macfarlane D, Chan A, Cerin E. Examining the validity and reliability of the Chinese version of the International Physical Activity Questionnaire, long form (IPAQ-LC). Public Health Nutr. 2011;14(3):443–50.CrossRefPubMed
46.
go back to reference Swank AM, Horton J, Fleg JL, Fonarow GC, Keteyian S, Goldberg L, Wolfel G, Handberg EM, Bensimhon D, Illiou MC, et al. Modest increase in peak VO2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circ Heart Fail. 2012;5(5):579–85.CrossRefPubMedPubMedCentral Swank AM, Horton J, Fleg JL, Fonarow GC, Keteyian S, Goldberg L, Wolfel G, Handberg EM, Bensimhon D, Illiou MC, et al. Modest increase in peak VO2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circ Heart Fail. 2012;5(5):579–85.CrossRefPubMedPubMedCentral
Metadata
Title
Effect of an exercise-based cardiac rehabilitation program “Baduanjin Eight-Silken-Movements with self-efficacy building” for heart failure (BESMILE-HF study): study protocol for a randomized controlled trial
Authors
Xiankun Chen
Wei Jiang
Xiaoli Lin
Cecilia Stålsby Lundborg
Zehuai Wen
Weihui Lu
Gaetano Marrone
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-018-2531-9

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