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Exercise in Heart Failure: Effectiveness Versus Safety

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Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Abstract

Exercise training in patients with heart failure has been shown to improve exercise tolerance and quality of life and reduce symptoms of heart failure. Recently, the first large-scale trial evaluating the effects of exercise training in heart failure, the Heart Failure – A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial, was presented. Although there was no improvement in the primary endpoint of all-cause mortality and hospitalization, there was a mortality benefit demonstrated for patients with clinical signs of increased mortality and for those that actually performed exercise training of at least 3 metabolic equivalent (MET) hours per week. This chapter reviews the results of this trial and the safety of exercise training for patients with chronic heart failure.

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References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler 3rd ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–292.

    Article  PubMed  Google Scholar 

  2. McDonald CD, Burch GE, Walsh JJ. Prolonged bed rest in the treatment of idiopathic cardiomyopathy. Am J Med. 1972;52:41–50.

    Article  CAS  PubMed  Google Scholar 

  3. Working Group on Cardiac Rehabilitation and Exercise Physiology and Working Group on Heart Failure of the European Society of Cardiology. Recommendations for exercise training in chronic heart failure patients. Eur Heart J. 2001;22:125–35.

    Article  Google Scholar 

  4. Oldridge NB, Guyatt GH, Rimm AA. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. JAMA. 1988;260:945–50.

    Article  CAS  PubMed  Google Scholar 

  5. Coats AJS, Adamopoulos S, Meyer TE, Conway J, Sleight P. Effects of physical training in chronic heart failure. Lancet. 1990;335:63–6.

    Article  CAS  PubMed  Google Scholar 

  6. Coats AJS, Adamopoulos S, Radaelli A, McCance A, Meyer TE, Bernardi L, Solda PL, Davey P, Ormerod O, Forfar C, Conway J, Sleight P. Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation. 1992;85:2119–31.

    Article  CAS  PubMed  Google Scholar 

  7. Koch M, Douard H, Broustet JP. The benefit of graded physical exercise in chronic heart failure. Chest. 1992;101:231S–5.

    Article  CAS  PubMed  Google Scholar 

  8. Belardinelli R, Georgiou D, Cianci G, Berman N, Ginzton L, Purcaro A. Exercise training improves left ventricular diastolic filling in patients with dilated cardiomyopathy. Clinical and prognostic implications. Circulation. 1995;91:2775–84.

    Article  CAS  PubMed  Google Scholar 

  9. Hambrecht R, Niebauer J, Fiehn E, Kalberer B, Offner B, Hauer K, Riede U, Schlierf G, Kubler W, Schuler G. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol. 1995;25:1239–49.

    Article  CAS  PubMed  Google Scholar 

  10. Kiilavuori K, Toivonen L, Naveri H, Leinonen H. Reversal of autonomic derangements by physical training in chronic heart failure assessed by heart rate variability. Eur Heart J. 1995;16:490–5.

    CAS  PubMed  Google Scholar 

  11. Keteyian SJ, Levine AB, Brawner CA, Kataoka T, Rogers FJ, Schairer JR, Stein PD, Levine TB, Goldstein S. Exercise training in patients with heart failure. A randomized, controlled trial. Ann Intern Med. 1996;124:1051–7.

    Article  CAS  PubMed  Google Scholar 

  12. Kiilavuori K, Sovijarvi A, Naveri H, Ikonen T, Leinonen H. Effect of physical training on exercise capacity and gas exchange in patients with chronic heart failure. Chest. 1996;111:985–91.

    Article  Google Scholar 

  13. Keteyian SJ, Brawner CA, Schairer JR, Levine TB, Levine AB, Rogers FJ, Goldstein S. Effects of exercise training on chronotropic incompetence in patients with heart failure. Am Heart J. 1999;138:233–40.

    Article  CAS  PubMed  Google Scholar 

  14. Willenheimer R, Erhardt L, Cline C, Rydberg E, Israelsson B. Exercise training in heart failure improves quality of life and exercise capacity. Eur Heart J. 1998;19:774–81.

    Article  CAS  PubMed  Google Scholar 

  15. Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome. Circulation. 1999;99:1173–82.

    Article  CAS  PubMed  Google Scholar 

  16. Hambrecht R, Gielen S, Linke A, Fiehn E, Yu J, Walther C, Schoene N, Schuler G. Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure. JAMA. 2000;283:3095–101.

    Article  CAS  PubMed  Google Scholar 

  17. McKelvie RS, Teo KK, Roberts R, McCartney N, Humen D, Montague T, Hendrican K, Yusuf S. Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT). Am Heart J. 2002;144:23–30.

    Article  PubMed  Google Scholar 

  18. Nilsson BB, Westheim A, Risberg MA. Long-term effects of a group-based high-intensity aerobic interval-training program in patients with chronic heart failure. Am J Cardiol. 2008;102:1220–4.

    Article  PubMed  Google Scholar 

  19. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, Piña IL, HF-ACTION Investigators. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1439–50.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Keteyian SJ, Leifer ES, Houston-Miller N, Kraus WE, Brawner CA, O’Connor CM, Whellan DJ, Cooper LS, Fleg JL, Kitzman DW, Cohen-Solal A, Blumenthal JA, Rendall DS, Piña IL, HF-ACTION Investigators. Relation between volume of exercise and clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2012;60:1899–905.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Sullivan MJ, Knight JD, Higginbotham MB, Cobb FR. Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure: muscle blood flow is reduced with maintenance of arterial perfusion pressure. Circulation. 1989;80:769–81.

    Article  CAS  PubMed  Google Scholar 

  22. Sullivan MJ, Cobb FR. Dynamic regulation of leg vasomotor tone in patients with chronic heart failure. J Appl Physiol. 1991;71:1070–5.

    CAS  PubMed  Google Scholar 

  23. Sullivan MJ, Cobb FR. Central hemodynamic response to exercise in patients with chronic heart failure. Chest. 1992;101:340S–6.

    Article  CAS  PubMed  Google Scholar 

  24. Maskin CS, Forman R, Sonnenblick EH, Frishman WH, LeJemtel TH. Failure of dobutamine to increase exercise capacity despite hemodynamic improvement in severe chronic heart failure. Am J Cardiol. 1983;51:177–82.

    Article  CAS  PubMed  Google Scholar 

  25. Wilson JR, Martin JL, Ferraro N, Weber KT. Effect of hydralazine on perfusion and metabolism in the leg during upright bicycle exercise in patients with heart failure. Circulation. 1983;68:425–32.

    Article  CAS  PubMed  Google Scholar 

  26. Wilson JR, Martin JL, Ferraro N. Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol. 1984;53:1308–15.

    Article  CAS  PubMed  Google Scholar 

  27. Duscha BD, Schulze PC, Robbins JL, Forman DE. Implications of chronic heart failure on peripheral vasculature and skeletal muscle before and after exercise training. Heart Fail Rev. 2008;13:21–37.

    Article  PubMed  Google Scholar 

  28. Crimi E, Ignarro LJ, Cacciatore F, Napoli C. Mechanisms by which exercise training benefits patients with heart failure. Nat Rev Cardiol. 2009;6:292–300.

    Article  PubMed  Google Scholar 

  29. Whellan DJ, O’Connor CM, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Houston-Miller N, Fleg JL, Schulman KA, Piña IL, HF-ACTION Trial Investigators. Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Am Heart J. 2007;153:201–11.

    Article  PubMed  Google Scholar 

  30. Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol. 2012;60:1521–8.

    Article  PubMed  Google Scholar 

  31. Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, Canby RC, Schroeder JS, Liem LB, Hall S, Wheelan K, Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE ICD) Trial Investigators. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003;289:2685–94.

    Article  PubMed  Google Scholar 

  32. Flynn KE, Piña IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O’Connor CM, Weinfurt KP, HF-ACTION Investigators. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1451–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Awan NA, Evenson MK, Needham KE, Win A, Mason DT. Efficacy of oral angiotensin-converting enzyme inhibition with captopril therapy in severe chronic normotensive congestive heart failure. Am Heart J. 1981;101:22–31.

    Article  CAS  PubMed  Google Scholar 

  34. Piccini JP, Hellkamp AS, Whellan DJ, Ellis SJ, Keteyian SJ, Kraus WE, Hernandez AF, Daubert JP, Piña lL, O’Connor CM, HF-ACTION Investigators. Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure: results from HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing). JACC Heart Fail. 2013;1:142–8.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Grünig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, Halank M, Fischer C, Seyfarth HJ, Klose H, Meyer A, Sorichter S, Wilkens H, Rosenkranz S, Opitz C, Leuchte H, Karger G, Speich R, Nagel C. Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J. 2012;40:84–92.

    Article  PubMed  Google Scholar 

  36. Mancini DM, Eisen H, Kussmaul x, Mull R, Edmunds LH, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991;83:778–86.

    Article  CAS  PubMed  Google Scholar 

  37. Chua TP, Ponikowski P, Harrington D, Anker SD, Webb-Peploe K, Clark AL, Poole-Wilson PA, Coats AJS. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol. 1997;29:1585–90.

    Article  CAS  PubMed  Google Scholar 

  38. Robbins M, Francis G, Pashkow RJ, Snader CE, Hoercher K, Young JB, Lauer MS. Ventilatory and heart rate responses to exercise. Better predictors of heart failure mortality than peak oxygen consumption. Circulation. 1999;100:2411–7.

    Article  CAS  PubMed  Google Scholar 

  39. Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, Coats AJS. 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 

  40. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M, Schneider S, Schwarz A, Senges J. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation. 2002;106:3079–84.

    Article  PubMed  Google Scholar 

  41. Arena R, Humphrey R. Comparison of ventilatory expired gas parameters used to predict hospitalization in patients with heart failure. Am Heart J. 2002;143:427–32.

    Article  PubMed  Google Scholar 

  42. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and Ve/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J. 2004;147:354–60.

    Article  PubMed  Google Scholar 

  43. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2–3:92–8.

    Google Scholar 

  44. Balady GJ, Berra KA, Golding LA, Gordon NF, Mahler DA, Myers JN, Sheldahl LM. General principles of exercise prescription. In: Franklin BA, Whaley MH, Howley ET, editors. ACSM’s guidelines for exercise testing and prescription. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 137–64.

    Google Scholar 

  45. Gary R. Exercise self-efficacy in older women with diastolic heart failure: results of a walking program and education intervention. J Gerontol Nurs. 2006;32:31–9.

    PubMed  Google Scholar 

  46. Kitzman DW, Hundley WG, Brubaker PH, Morgan TM, Moore JB, Stewart KP, Little WC. A randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction: effects on exercise tolerance and arterial distensibility. Circ Heart Fail. 2010;3:659–67.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Edelmann F, Gelbrich G, Düngen HD, Fröhling S, Wachter R, Stahrenberg R, Binder L, Töpper A, Lashki DJ, Schwarz S, Herrmann-Lingen C, Löffler M, Hasenfuss G, Halle M, Pieske B. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol. 2011;58:1780–91.

    Article  PubMed  Google Scholar 

  48. Alves AJ, Ribeiro F, Goldhammer E, Rivlin Y, Rosenschein U, Viana JL, Duarte JA, Sagiv M, Oliveira J. Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc. 2012;44:776–85.

    Article  PubMed  Google Scholar 

  49. Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, Abdelhamed A, Haykowsky MJ. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013;62:584–92.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7125, Baltimore, MD, 21287, USA

    Stuart D. Russell MD

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  1. Stuart D. Russell MD
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Correspondence to Stuart D. Russell MD .

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Editors and Affiliations

  1. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Gowraganahalli Jagadeesh

  2. Pharmacology Unit, AIMST University, Bedong, Malaysia

    Pitchai Balakumar

  3. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Khin Maung-U

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Russell, S.D. (2015). Exercise in Heart Failure: Effectiveness Versus Safety. In: Jagadeesh, G., Balakumar, P., Maung-U, K. (eds) Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Adis, Cham. https://doi.org/10.1007/978-3-319-15961-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-15961-4_9

  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-15960-7

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