Herz

, Volume 37, Issue 5, pp 486–492

Trainingstherapie bei kardiologischen Patienten (Sportkardiologie)

Schwerpunkt

Zusammenfassung

Körperliches Training hat sich in den letzten Jahren zu einer evidenzbasierten Therapieoption bei kardiologischen Erkrankungen, insbesondere bei koronarer Herzkrankheit (KHK) und chronischer Herzinsuffizienz, entwickelt. Bei der KHK wurde durch regelmäßige körperliche Aktivität eine partielle Korrektur der Endotheldysfunktion und eine Ökonomisierung der mechanischen Herzarbeit nachgewiesen. In Metaanalysen konnten durch körperliches Training eine Verminderung der Angina-Pectoris-Symptomatik und eine Reduktion der Gesamt- wie auch der kardiovaskulären Mortalität gezeigt werden. Körperliches Training bei chronischer Herzinsuffizienz führt über eine Korrektur der peripheren Endotheldysfunktion zu einer Nachlastsenkung, die sich wiederum günstig auf die linksventrikuläre Funktion auswirkt. Ferner konnte nachgewiesen werden, dass körperliches Training die neurohumorale Aktivierung und Stimulation des Renin-Angiotensin-Aldosteron-Systems bei Herzinsuffizienz vermindert und positive Effekte auf den Skelettmuskelmetabolismus und die Skelettmuskelfunktion (inflammationsbedingte Schädigungen, oxidativer Stress) hat. Eine ärztlich überwachte Trainingstherapie bei chronischer Herzinsuffizienz ist sicher und führt in klinischen Studien zu einer Morbiditätsverbesserung. Aerobes körperliches Training ist somit eine wichtige Komponente der Therapie der stabilen KHK und der chronischen Herzinsuffizienz, für die in den Leitlinien eine Klasse-Ia-Empfehlung ausgesprochen wird.

Schlüsselwörter

Koronare Herzkrankheit Chronische Herzinsuffizienz Endotheldysfunktion Trainingstherapie 

Physical exercise training for cardiovascular diseases

Abstract

Clinical application of physical exercise has developed into an evidence-based therapeutic option for cardiovascular diseases, especially coronary artery disease (CAD) and chronic heart failure (CHF). In CAD regular physical exercise training partially corrects endothelial dysfunction and leads to an economization of left ventricular function. Meta-analyses have shown a reduction of angina pectoris symptoms and a decrease of total and cardiovascular mortality by regular aerobic exercise training. Endurance training for CHF reduces cardiac afterload by correcting peripheral endothelial dysfunction und leads to a better left ventricular function. In addition exercise training reduces the adrenergic tone and the stimulation of the renin-angiotensin-aldosterone system in CHF. Exercise training provides positive effects on the metabolism and function of skeletal muscle (e.g. reduced inflammation and oxidative stress). Supervised regular physical exercise training in CHF is safe and has improved the morbidity in clinical studies. Thus aerobic exercise training is an important component of therapeutic management of stable CAD and CHF with a class 1a recommendation in the current guidelines.

Keywords

Coronary artery disease Chronic heart failure Endothelial dysfunction Physical training 

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Copyright information

© Urban & Vogel, Muenchen 2012

Authors and Affiliations

  1. 1.Klinik für Kardiologie und AngiologieKlinikum Links der Weser gGmbHBremenDeutschland

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