A Study Investigating the Impact of IMT With CR On Exercise Responses In HF

Inclusion criteria

• HFrEF Patients: (≥18 yrs) receiving guideline directed pharmacologic medical therapy for \>6 weeks (those with contraindications to medical therapy will meet inclusion criteria), NYHA symptoms I-III, no hospitalizations in the \>3 months, have a body mass index ≤45 kg/m2, currently be non-smokers with \<30 pack year history and be able to exercise (i.e. without significant orthopedic limitations or musculoskeletal disorders limiting their ability to exercise).

Exclusion criteria

• sustained ventricular tachycardia and/or ventricular fibrillation within 21 days of visit 1;
• second or third degree heart block;
• body mass index \>45 kg/m2;
• current smokers and/or smoking history \>30 pack years;
• pregnant women (testing will be done by research team if requested);
• glomerular filtration rate of \<30 mL/min/1.73m2 (initial screen via clinical record within the past 6 months and this will be assessed on Visit 1);
• individuals who are not able to engage in exercise;
• symptomatic peripheral artery disease;
• asthmatic patients with a low symptom perception and suffer frequency, severe exacerbations or with an abnormally low perception of dyspnea;
• ruptured eardrum or any other condition of the ear;
• history of spontaneous pneumothorax or osteoporosis with a history of rib fractures;
• history of lung disease.
• For individuals agreeing to undergo dual energy x-ray absorptiometry (DEXA) scanning for measurement of body composition as part of their study visit, additional exclusion criteria apply: recently administered gastrointestinal contrast or radionuclides; severe degenerative changes or fracture deformity in measurement areas; or inability to attain correct position and/or remain motionless for the measurement period.