You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure.
Abstract 1:
AIMS Patients with chronic heart failure ( CHF ) exhibit detrimental changes in skeletal muscle that contribute to their impaired physical performance . This study investigates the possibility of counteracting these changes by chronic low-frequency electrical stimulation ( CLFS ) of left and right thigh muscles . METHODS AND RESULTS ( mean+/-SD ) 32 CHF patients ( 53+/-10 years ) with an LVEF of 22+/-5 % , NYHA II-IV , undergoing optimized drug therapy , were r and omized in a CLFS group ( CLFSG ) or a control group ( controls ) . The groups differed in terms of the intensity of stimulation , which elicited strong muscle contractions only in the CLFSG , whereas the controls received current input up to the sensory threshold without muscle contractions . Functional capacity was assessed by peak VO(2 ) , work capacity , and a 6-min-walk ( 6-MW ) . Muscle biopsies were analyzed for myosin heavy chain ( MHC ) isoforms , citrate synthase ( CS ) and glyceraldehydephosphate dehydrogenase ( GAPDH ) activities . Peak VO(2)(mlmin(-1)kg -1 ) increased from 9.6+/-3.5 to 11.6+/-2.8 ( P<0.001 ) in the CLFSG , and decreased from 10.6+/-2.8 to 9.4+/-3.2 ( P<0.05 ) in the controls . The increase in the CLFSG was paralleled by increases in maximal workload ( P<0.05 ) and oxygen uptake at the anaerobic threshold ( P<0.01 ) . The corresponding values of the controls were unchanged , as also the 6-MW values , the MHC isoform distribution , and both CS and GAPDH activities . In the CLFSG , the 6-MW values increased ( P<0.001 ) , CS activity was elevated ( P<0.05 ) , GAPDH activity decreased ( P<0.01 ) , and the MHC isoforms were shifted in the slow direction with increases in MHCI at the expense of MHCIId/x ( P<0.01 ) . CONCLUSIONS Our results suggest that CLFS is a suitable treatment to counteract detrimental changes in skeletal muscle and to increase exercise capacity in patients with severe CHF


Title 2:
The flow-mediated dilation response to acute exercise in overweight active and inactive men.
Abstract 2:
OBJECTIVE Inflammation has been found to play a role in the etiology of cardiovascular disease as well as provoke endothelial dysfunction . Inflammatory cytokines associated with endothelial function are interleukin-6 ( IL-6 ) and tumor necrosis factor-alpha ( TNF-alpha ) . IL-6 is exercise intensity dependent and has been shown to inhibit TNF-alpha expression directly . The aim of this study was to investigate the interaction of IL-6 and TNF-alpha on endothelial function in response to acute exercise in overweight men exhibiting different physical activity profiles . METHODS AND PROCEDURES Using a r and omized mixed factorial design , 16 overweight men ( 8 active , maximal exercise capacity ( VO(2)peak ) = 34.2 + /- 1.7 , BMI = 27.4 + /- 0.7 and 8 inactive , VO(2)peak = 30.9 + /- 1.2 , BMI = 29.3 + /- 1.0 ) performed three different intensity acute exercise treatments .  Brachial artery flow-mediated dilation ( FMD ) and subsequent blood sample s were taken pre-exercise and 1 h following the cessation of exercise . RESULTS Independent of exercise intensity , the active group displayed a 24 % increase ( P = 0.034 ) in FMD following acute exercise compared to a 32 % decrease ( P = 0.010 ) in the inactive group . Elevated ( P < 0.001 ) concentrations of IL-6 following moderate ( 50 % VO(2 ) ) and high ( 75 % VO(2 ) ) intensity acute exercise were observed in both groups ; however , concentrations of TNF-alpha were unchanged in response to acute exercise ( P = 0.584 ) . DISCUSSION The FMD response to acute exercise is enhanced in active men who are overweight , whereas inactive men who are overweight exhibit an attenuated response . The interaction of IL-6 and TNF-alpha did not provide insight into the physiological mechanisms associated with the disparity of FMD observed between groups
In addition to the patients with comorbidities , it is unlikely that AMI patients suffering from cardiac instability , who are obliged to have bed rest , will perform conventional exercise training .
Nevertheless , even low-intensity resistance muscle training could be a burden for patients with cardiovascular instability .
Functional electrical stimulation or neuromuscular electrical stimulation ( NMES ) of muscles is expected to be an alternative mode of rehabilitation for AMI patients who are intolerant to conventional exercise training .
A meta- analysis of r and omized , controlled trials in CHF patients comparing NMES with conventional exercise training showed that conventional cycle training produced superior improvements in exercise capacity to that of NMES .
Also , compared with NMES therapy , conventional exercise training is more simple and practical in that no special apparatus is needed .
Therefore , the introduction of NMES is expected to raise the implementation rate of CR in patients who are intolerant of exercise training .