Skip to main content

Advertisement

Log in

Preventing Heart Failure with Exercise Training

  • Heart Failure Prevention (W Tang, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Within the past few decades, the syndrome of heart failure (HF) was recognized as an emerging epidemic and in recent investigations has been distinguished as a major public health problem. Alarming epidemiological data further expound the important need for HF prevention research and programs. There has been recent interest regarding the utility of exercise training in the prevention and treatment of risk factors associated with HF development and progression, such as hypertension (HTN), coronary heart disease (CHD)/myocardial infarction (MI), and obesity. Physical fitness (PF), including muscular fitness and, especially, cardiorespiratory fitness, have recently been shown to promote overall cardiovascular (CV) health, improve quality of life, reduce depression, reduce CV diseases (CVD), and reduce CVD- and all-cause mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Braunwald E. Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med. 1997;337:1360–9.

    Article  CAS  PubMed  Google Scholar 

  2. Roger V. Epidemiology of heart failure. Circ Res. 2013;113:646–59.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO. Impact of obesity and the obesity paradox on prevalence and prognosis of in heart failure. J Am Coll Cardiol HF. 2013;1:93–102.

    Google Scholar 

  4. Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the American Heart Association. Circulation. 2013;127:652–62.

    Article  PubMed  Google Scholar 

  5. Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O’Keefe JH, et al. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J. 2013;77:281–92.

    Article  PubMed  Google Scholar 

  6. Downing J, Balady GJ. The role of exercise training in heart failure. J Am Coll Cardiol. 2011;58:561–9.

    Article  PubMed  Google Scholar 

  7. Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, et al. Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2 slope and peak VO2. Eur Heart J. 2000;21:154–61.

    Article  CAS  PubMed  Google Scholar 

  8. McElroy PA, Janicki JS, Weber KT. Cardiopulmonary exercise testing in congestive heart failure. Am J Cardiol. 1988;62(2):35A.

    Article  CAS  PubMed  Google Scholar 

  9. Yasaka Y, Yamabe H, Yokoyama M. Dependence of peak oxygen uptake on oxygen transport capacity in chronic heart failure: comparison of graded protocol and fixed protocol. Int J Cardiol. 1997;59:149–56.

    Article  CAS  PubMed  Google Scholar 

  10. Lavie CJ, Berra K, Arena R. Formal cardiac rehabilitation and exercise training programs in heart failure—evidence for substantial clinical benefits. JCRP. 2013;33:209–11.

    PubMed  Google Scholar 

  11. Keteyan SJ. Exercise training in congestive heart failure: risks and benefits. Prog Cardiovasc Dis. 2011;53:119–28.

    Google Scholar 

  12. Smart N, Marwick TH. Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med. 2004;116:693–706.

    Article  PubMed  Google Scholar 

  13. Piepoli MF, Davos C, Francis DP, Coats AJ, ExTraMATCH Collaborative. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 2004;328:189.

    Article  CAS  PubMed  Google Scholar 

  14. Sullivan MJ, Knight B, Higginbotham MB, Cobb FR. Relation between central and peripheral hemodynamics during exercise in patients with severe heart failure. Circulation. 1989;80:769–81.

    Article  CAS  PubMed  Google Scholar 

  15. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAJA. 2009;301:1439–50.

    Article  Google Scholar 

  16. Keteyian SJ, Leifer ES, Houston-Miller N, Kraus WE, Brawner CA, O’Connor CM, et al. Relation between volume of exercise and clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2012;601:1899–905.

    Article  Google Scholar 

  17. Berry JD, Pandey A, Gao A, Leonard D, Farzaneh-Far R, Ayers C, et al. Physical fitness and risk for heart failure and coronary artery disease. Circ Heart Fail. 2013;6:627–34.

    Article  PubMed  Google Scholar 

  18. Lavie CJ, Ventura HO, Milani RV, Arena R. Critical impact of fitness in the prevention and treatment of heart failure. AHJ. 2014;169:194–6. This paper provides considerable evidence suggesting that poor CRF is a strong overall CV risk factor.

    Article  PubMed  Google Scholar 

  19. Pandey A, Patel M, Goa A, Willis BL, Das SR, Leonard D, et al. Changes in mid-life fitness predicts heart failure risk at a later age independent of interval development of cardiac and noncardiac risk factors: the Cooper Center Longitudinal Study. AHJ. 2015;169:290–7. This paper provides evidence that fitness during mid-life is an independent and modifiable risk factor for HF hospitalization later on in life.

    Article  PubMed  Google Scholar 

  20. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.

    Article  PubMed  Google Scholar 

  21. Edelmann F, Gelbrich G, Dungen H, Frohling S, Wachter R, Stahrenberg R, et al. Exercise training in diastolic heart failure—pilot study: a prospective, randomized, controlled study to determine the effects of physical training on exercise capacity and quality of life [Ex-DHF-P]. J Am Coll Cardiol. 2011;58:1780–91.

    Article  PubMed  Google Scholar 

  22. Pandey A, Parashar A, Kumbani D, Agarwal S, Garg J, Kitzman D, et al. Exercise training in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2015;8:33–40. This study suggests that exercise training in HFpEF patients is associated with improved QoL and CRF without significantly affecting LV systolic or diastolic function.

    Article  PubMed  Google Scholar 

  23. Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation. 2007;116:637–47.

    Article  PubMed  Google Scholar 

  24. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, et al. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med. 2008;359:2456–67.

    Article  CAS  PubMed  Google Scholar 

  25. Ahmed A, Rich MW, Fleg JL, Zile MR, Young JB, Kitzmann DW, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation. 2006;114:397–403.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Suchy C, Massen L, Rognmo O, Van Craenenbroeck EM, Beckers P, Kraigher-Krainer E, et al. Optimising exercise training in prevention and treatment of diastolic heart failure (OptimEx-CLIN): rationale and design of a prospective, randomized, controlled trial. Eur J Prev Cardiol. 2014;21(2 Suppl):18–25. This study will help define the optimal dose and method of exercise training in patients with HFpEF.

    Article  PubMed  Google Scholar 

  27. Kannel WB. Incidence and epidemiology of heart failure. Heart Fail Rev. 2000;5:167–73.

    Article  CAS  PubMed  Google Scholar 

  28. Park YM, Sui X, Liu J, Zhou H, Kokkinos PF, Lavie CJ, et al. The effect of cardiorespiratory fitness on age-related lipids and lipoproteins. J Am Coll Cardiol. 2015;65(19):2091–100. This paper highlights that higher CRF levels may delay the development of dyslipidemia.

    Article  CAS  PubMed  Google Scholar 

  29. Cullen P. Evidence that triglycerides are an independent coronary heart disease risk factor. Am J Cardiol. 2000;86:943–9.

    Article  CAS  PubMed  Google Scholar 

  30. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2960–84.

    Article  PubMed  Google Scholar 

  31. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, et al. Trends in serum lipids and lipoproteins of adults, 1960–2002. JAMA. 2005;294:1773–81.

    Article  CAS  PubMed  Google Scholar 

  32. Schubert CM, Rogers NL, Remsberg EK, Sun SS, Chumlea WC, Demerath EW, et al. Lipids, lipoproteins, lifestyle, adiposity and fat free mass during middle age: the Fels Longitudinal Study. Int J Obes (Lond). 2006;30:251–60.

    Article  CAS  Google Scholar 

  33. Wilson PWF, Anderson KM, Harri T, Kannel WB, Castelli WP. Determinants of change in total cholesterol and HDL-C with age: the Framingham Study. J Gerontol. 1994;49:M252–7.

    Article  CAS  PubMed  Google Scholar 

  34. Garry PJ, Hunt WC, Koehler KM, Vanderjagt DJ, Vellas BJ. Longitudinal study of dietary intakes and plasma lipids in healthy elderly men and women. Am J Clin Nutr. 1992;55:682–8.

    CAS  PubMed  Google Scholar 

  35. Ferrara A, Barrett-Connor E, Shan J. Total, LDL, and HDL cholesterol decrease with age in older men and women. The Ranch Bernardo Study 1984–1994. Circulation. 1997;96:37–43.

    Article  CAS  PubMed  Google Scholar 

  36. Liu J, Sui X, Lavie CJ, Zhou H, Park YM, Cai B, et al. Effects of cardiorespiratory fitness on blood pressure trajectory with aging in a cohort of healthy men. J Am Coll Cardiol. 2014;64:1245–53. This paper suggests that higher fitness levels delay the development of hypertension.

    Article  PubMed  Google Scholar 

  37. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the join national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

    Article  CAS  PubMed  Google Scholar 

  38. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16–22.

    Article  CAS  PubMed  Google Scholar 

  39. Cheng S, Xanthakis V, Sullivan LM, Vasan RS. Blood pressure tracking over the adult life course: patterns and correlates in the Framingham Heart Study. Hypertension. 2012;60:1393–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Franklin SS, Gustin IV W, Wong ND, Larson MG, Weber MA, Kannel WB, et al. The Framingham Heart Study. Hemodynamic patterns of age-related changes in blood pressure. Circulation. 1997;96:308–15.

    Article  CAS  PubMed  Google Scholar 

  41. Newhouse A, Jiang W. Co-morbidities in heart failure: heart failure and depression. Heart Fail Clin. 2014;10(2):295–304.

    Article  PubMed  Google Scholar 

  42. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527–37.

    Article  PubMed  Google Scholar 

  43. Van den Broek KC, de Filippi CR, Christenson RH, Seliger SL, Gottdiener JS, Kop WJ. Predictive value of depressive symptoms and B-type natriuretic peptide for new-onset heart failure and mortality. Am J Cardiol. 2011;107(5):723–9.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Jiang W, Alexander J, Christopher E, Kuchibhatla M, Gaulden LH, Cuffe MS, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001;161(15):1849–56.

    Article  CAS  PubMed  Google Scholar 

  45. Blumenthal JA, Babyak MA, O’Connor C, Keteyian S, Landzberg J, Howlett J, et al. Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA. 2012;308(5):465–74.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA. Exercise for depression. Cochrane Database Syst Rev. 2009;3:CD004366.

    PubMed  Google Scholar 

  47. Mentz RJ, Babyak MA, Bittner V, Fleg JL, Keteyian SJ, Swank AM, et al. Prognostic significance of depression in African Americans with heart failure: insights from HF-ACTION. Circ Heart Fail. 2015. doi:10.1161/CIRCHEARTFAILURE.114.001995. This paper presents the association between African-Americans that have HF and depression who are at increased risk for all-cause mortality/hospitalization.

    Google Scholar 

  48. Hoffman BM, Babyak MA, Craighead WE, Sherwood A, Doraiswamy PM, Coons MJ, et al. Exercise and pharmacotherapy in patients with major depression: one year follow-up of the SMILE study. Psychosom Med. 2011;73(2):127–33.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Lavie CJ, Milani RV. Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation. Arch Intern Med. 2006;166:1878–83.

    Article  PubMed  Google Scholar 

  50. Lavie CJ, Milani RV, O’Keefe J, Lavie TJ. Impact of exercise training on psychological risk factors. Prog Cardiovasc Dis. 2011;53:464–70.

    Article  PubMed  Google Scholar 

  51. Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med. 2007;120:799–806.

    Article  PubMed  Google Scholar 

  52. Milani RV, Lavie CJ. Reducing psychosocial stress: a novel mechanism of improving survival from exercise training. Am J Med. 2009;122:931–8.

    Article  PubMed  Google Scholar 

  53. Milani RV, Lavie CJ, Mehra MR, Ventura HO. Impact of exercise training and depression on survival in failure due to coronary heart disease. Am J Cardiol. 2011;107:64–8.

    Article  PubMed  Google Scholar 

  54. Kenchaiah S, Evan JC, Levy D. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.

    Article  PubMed  Google Scholar 

  55. Lavie CJ, Cahalin LP, Chase P, Myers J, Bensimhon D, Peberdy MA, et al. Impact of cardiorespiratory fitness on the obesity paradox in patients with heart failure. Mayo Clin Proc. 2013;88:251–8.

    Article  PubMed  Google Scholar 

  56. McAuley PA, Artero EG, Sui X, Lee D, Church TS, Lavie CJ, et al. The obesity paradox, cardiorespiratory fitness, and coronary heart disease. Mayo Clin Proc. 2012;87(5):443–51.

    Article  PubMed Central  PubMed  Google Scholar 

  57. DeSchutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease—the obesity paradox. PCAD. 2014;56:401–8.

    Google Scholar 

  58. Clark AL, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heart failure. PCAD. 2014;56:409–14. This paper reviews the relationship between the obesity paradox and CRF, while suggesting explanations for the obesity paradox and evidence for intentional weight loss in HF.

    Google Scholar 

  59. Lavie CJ, DeSchutter A, Milani RV. Body composition and the obesity paradox in coronary heart disease—can heavier really be healthier? Heart. 2015; In Press. This paper highlights the key findings of the obesity paradox in the context of CHD.

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Carl Lavie, Ross Arena, Hector Ventura, and Parham Parto have no relevant disclosures to report.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carl J. Lavie.

Additional information

This article is part of the Topical Collection on Heart Failure Prevention

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parto, P., J. Lavie, C., Arena, R. et al. Preventing Heart Failure with Exercise Training. Curr Cardiovasc Risk Rep 9, 44 (2015). https://doi.org/10.1007/s12170-015-0472-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12170-015-0472-3

Keywords

Navigation