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See doi:10.1016/j.ehj.2003.09.027for the article to which this editorial refers In the current issue of the journal Nuhr et al.1report a beneficial effect of chronic low-frequency stimulation (CLFS) to thigh and calf musculature on exercise performance and skeletal muscle histopathology in patients with severe congestive heart failure (CHF).Congestive heart failure is a clinical syndrome with a complex pathophysiology initiated by left ventricular dysfunction leading to systemic and pulmonary congestion and elevated peripheral vascular resistance. Fluid retention along with peripheral vasoconstriction and reduced skeletal muscle perfusion provides the pathophysiological basis for the symptoms. Coupled withinactivity the stage is set for deconditioning. Skeletal muscle atrophy, changes of fibre-composition (i.e. an increase of type II fibres which are mostly anaerobic, at the expense of aerobic type I fibres), reduced capillary density and reduced cytochrome oxidase activity characterize the condition.2Cross-talk between neurohumoral activation and the inflammatory response further aggravates the histopathology with redistribution and atrophy of muscle fibres.3Metabolic abnormalities in the skeletal muscles with early acidosis and accumulation of catabolites during exercise may be the trigger for a shift in the sensitivity of muscle afferent sensory nerves resulting in increased ventilation in response to exercise in these patients.4Elevated plasma levels and enhanced myocardial expression of proinflammatory cytokines have been documented in patients with CHF.5The cytokines directly contribute to skeletal muscle wasting, myocardial depression, left ventricular dilatation, left ventricular remodelling and cardiomyopathy by various mechanisms including changes … *Correspondence to: Dr A. I. Larsen, Central Hospital in Rogaland, Cardiology Division, P.O. Box 8100, N4001 Stavanger, Norway. Tel: +47 51 518000; Fax: +47 51 519905  E-mail address: al-i-lar{at}online.no

Can sedentary patients with heart failure achieve the beneficial effect of exercise training without moving?