Exercise-based Cardiac Rehabilitation in Congestive Heart Failure With Coexisting Knee Osteoarthritis

February 23, 2026 updated by: Riphah International University

Effects of Exercise-based Cardiac Rehabilitation in Patient With Congestive Heart Failure and Coexisting Knee Osteoarthritis

Exercise-based cardiac rehabilitation (CR) has been shown to significantly improve cardiovascular health and overall well-being in patients with congestive heart failure (CHF). However, a substantial number of CHF patients also suffer from comorbid conditions, such as knee osteoarthritis (OA), which can impede their ability to engage in physical activity and, consequently, derive full benefits from CR. Knee OA is characterized by pain, stiffness, and reduced joint mobility, which can significantly limit exercise capacity and adherence to CR programs. This dual burden poses a unique challenge, necessitating tailored rehabilitation approaches that accommodate both cardiovascular and musculoskeletal limitations. This study aims to evaluate the effectiveness of an exercise-based CR program specifically adapted for patients with CHF and coexisting knee OA, focusing on improvements in cardiovascular function, joint mobility, pain management, and overall quality of life.

This study will employ a randomized controlled trial (RCT) design involving 100 patients diagnosed with both CHF and knee OA. Participants will be randomly assigned to either an intervention group or a control group. The intervention group will undergo a 12-week exercise-based CR program tailored to accommodate their knee OA, incorporating low-impact aerobic exercises, strength training, and flexibility exercises specifically designed to minimize knee joint stress. The control group will receive standard medical care without the structured exercise program. Primary outcomes will include changes in cardiovascular fitness, assessed by peak oxygen uptake (VO2 peak), and knee function, measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes will assess pain levels, quality of life using the SF-36 questionnaire, and adherence rates to the rehabilitation program. Data will be collected at baseline, post-intervention (12 weeks), and at a 6-month follow-up to evaluate both immediate and long-term effects. Statistical analyses will be conducted to compare the outcomes between the two groups and determine the efficacy of the tailored CR program.

Keywords: Exercised-based cardiac rehabilitation, Congestive heart failure, knee osteoarthritis, low impact aerobic exercise, strength training

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

94

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 42000
        • 1. Behria International Hospital 2. Punjab Institute of Cardiology

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Patients with a confirmed diagnosis of CHF, classified according to the New York Heart Association (NYHA) functional classification II-III.
  • Radiographically confirmed diagnosis of knee OA, based on the Kellgren-Lawrence grading system (grade II-III).
  • Adults aged 40-80 years
  • Left ventricular ejection fraction (LVEF) ≤ 40% as measured by echocardiography within the last 6 months.
  • Patients must be on stable pharmacologic therapy for CHF for at least 4 weeks prior to enrollment.

Exclusion Criteria:

  • Presence of severe comorbid conditions that could interfere with the study protocol or pose a risk to the patient, such as severe pulmonary disease, advanced renal or liver disease, or active malignancy.
  • Kellgren-Lawrence grade IV knee OA or recent knee surgery within the last 6 months.
  • Presence of inflammatory arthritis, such as rheumatoid arthritis or gout
  • Recent myocardial infarction (within the past 3 months), unstable angina, or recent coronary artery bypass graft surgery.
  • Any condition that contraindicates exercise participation, such as severe hypertension (BP > 180/110 mmHg), uncontrolled arrhythmias, or severe aortic stenosis.
  • Significant cognitive impairment or psychiatric disorder that would interfere with adherence to the exercise protocol.
  • Patients already participating in regular, structured exercise programs exceeding moderate intensity (>150 minutes per week)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Intervention Group
Other: Exercise Based Cardiac Rehabilitation

Exercise Prescription:

Aerobic Exercise: walking, stationary cycling, Resistance / strength training, Flxibility and Range of motion, Balance and proprioception

Strength Training: Lower limb strengthening focus: Quadriceps, Hamstrings, Gluteals Upper body Shoulders, Arms (light resistance) Exercises using Thera Bands, light dumbbells, or body weight Isometric exercises initially if active movement is painful

Type: Resistance exercises focusing on major muscle groups, especially lower extremities to support knee function,e.g. Quadriceps, Hamstrings, Gluteal muscles, Hip adductors, abductors and Calf muscles using weights, resistance bands, or machines.

Flexibility and Balance Exercises: Static stretching of major lower limb muscle groups:

Quadriceps, Hamstrings, Calf muscles, Hip flexors, Gentle knee range of motion exercises within pain-free limits
Other: Controlled Group
Other: Controlled Group
Education and Counseling consisting of Regular sessions on disease education, self-management strategies, nutrition, and adherence to medication.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
6 MWT functional capacity
Time Frame: 8 weeks
The 6-minute walk test (6MWT) serves as a valuable and widely used data collection tool in research, particularly in studies assessing functional capacity, exercise tolerance, and overall physical performance. it was used to collect data pre-post exercise
8 weeks
ECHO (left ventricle Ejection fraction)
Time Frame: 8 weeks
Left Ventricular Ejection Fraction (LVEF) is a key measurement used in echocardiography (ECHO) to assess the heart's function, particularly its ability to pump blood. LVEF represents the percentage of blood that is ejected from the left ventricle (the heart's main pumping chamber) with each heartbeat. pre-post data was collected
8 weeks
WOMAC Questionnaire
Time Frame: 8 weeks
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a widely used, validated questionnaire designed to evaluate the condition of patients with osteoarthritis (OA) of the knee and hip. Developed in the 1980s, the WOMAC is specifically tailored to measure three key dimensions: pain, stiffness, and physical function. The questionnaire comprises 24 items divided into three subscales: 5 items for pain, 2 items for stiffness, and 17 items for physical function. pre-post data was collected
8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: MUHAMMAD USAMA IQBAL, MS-PT(CPPT), Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • Kamiya K, Sato Y, Takahashi T, Tsuchihashi-Makaya M, Kotooka N, Ikegame T, et al. Multidisciplinary cardiac rehabilitation and long-term prognosis in patients with heart failure. 2020;13(10):e006798.
  • Cattadori G, Segurini C, Picozzi A, Padeletti L, Anzà C. Exercise and heart failure: an update. ESC heart failure. 2018;5(2):222-32.
  • Tegegne TK, Rawstorn JC, Nourse RA, Kibret KT, Ahmed KY, Maddison R. Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis. 2022;9(1):e001949
  • Xie S-H, Wang Q, Wang L-Q, Zhu S-Y, Li Y, He C-QJM. The feasibility and effectiveness of internet-based rehabilitation for patients with knee osteoarthritis: a study protocol of randomized controlled trial in the community setting. 2020;99(44):e22961.
  • Paneroni M, Scalvini S, Corrà U, Lovagnini M, Maestri R, Mazza A, et al. The impact of cardiac rehabilitation on activities of daily life in elderly patients with heart failure. 2022;12:785501.
  • King L, Marshall D, Jones C, Woodhouse L, Ravi B, Faris P, et al. Are medical comorbidities contributing to the use of opioid analgesics in patients with knee osteoarthritis? 2020;28(8):1030-7.
  • Edelmann F, Wachter R, Duvinage A, Mueller S, Fegers-Wustrow I, Schwarz S, et al. Combined endurance and resistance exercise training in heart failure with preserved ejection fraction: a randomized controlled trial. Nat Med. 2025;31(1):306-14.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 30, 2024

Primary Completion (Actual)

June 30, 2025

Study Completion (Actual)

August 17, 2025

Study Registration Dates

First Submitted

February 23, 2026

First Submitted That Met QC Criteria

February 23, 2026

First Posted (Actual)

February 27, 2026

Study Record Updates

Last Update Posted (Actual)

February 27, 2026

Last Update Submitted That Met QC Criteria

February 23, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/RCR/&AHS/24/0325

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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