Herz

, Volume 38, Issue 6, pp 578–586

Körperliches Training bei Herzinsuffizienz

Schwerpunkt
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Zusammenfassung

Zusätzlich zu verschiedenen pharmakologischen und nichtpharmakologischen Behandlungskonzepten ist körperliches Training bei stabiler chronischer Herzinsuffizienz eine in den aktuellen Leitlinien empfohlene und besonders bei eingeschränkter LV-Funktion (HFrEF) breit akzeptierte Therapieoption. Die pathophysiologischen Ursachen, die für die Belastungsintoleranz bei Herzinsuffizienzpatienten verantwortlich sind, sind vielfältig. Neben zentral hämodynamischen und vaskulären Komponenten sind auch ventilatorische, peripher muskuläre sowie neurohumorale und inflammatorische Ursachen zu finden. Eine Vielzahl von randomisierten Studien zu körperlichem Training bei HFrEF und eine wachsende Zahl von Studien zu Herzinsuffizienz mit erhaltener LV-Funktion (HFpEF) belegen, dass Belastungstoleranz, Symptomatik und Lebensqualität signifikant verbessert werden können. Gründe hierfür sind durch körperliches Training induzierte Verbesserungen der zentralen Hämodynamik, der Endothelfunktion, der Inflammation, der neurohumoralen Aktivierung, aber auch des Skelettmuskelmetabolismus und der peripher muskulären Struktur. Im Gegensatz zu einer wegweisenden Metaanalyse zeigte die randomisierte HF-ACTION-Studie für Patienten mit HFrEF lediglich einen gering positiven Effekt auf Mortalität und Hospitalisierungen jeglicher Ursache. Prognostische Untersuchungen fehlen bislang für HFpEF. Unabhängig davon ist die Wirksamkeit von körperlichem Training auch durch die gewählte Trainingsintensität und -modalität beeinflusst. So scheinen eine höhere Intensität und ein zusätzlich zum aeroben Ausdauertraining durchgeführtes Krafttraining vorteilhaft zu sein. Trotz der zunehmenden Evidenz zur Durchführung von körperlichem Training bei Herzinsuffizienz bleiben relevante Herausforderungen bei dessen täglicher therapeutischer Umsetzung bestehen. Das interaktive Management der Patienten ist aufwändig und die Finanzierung der Programme ungenügend. Außerdem fehlen individualisierte Konzepte zur Aufrechterhaltung der Compliance.

Schlüsselwörter

Linksventrikuläre Funktion Belastungsintoleranz Ausdauertraining Krafttraining Therapie 

Exercise training in heart failure

Abstract

In patients with chronic but stable heart failure (HF) exercise training is a recommended and widely accepted adjunct to an evidence-based management involving pharmacological and non-pharmacological therapies. Various pathophysiological mechanisms, such as central hemodynamics, vasculature, ventilation, skeletal muscle function as well as neurohormonal activation and inflammation are responsible for exercise intolerance described in HF patients. There is sufficient and growing evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) is effective in improving exercise capacity, HF symptoms and quality of life. The positive effects of exercise training in HF are mediated by an improvement of central hemodynamics, endothelial function, inflammatory markers, neurohumoral activation, as well as skeletal muscle structure and function. In contrast to convincing data from a large meta-analysis, the large HF-ACTION study (Heart Failure-A Controlled Trial Investigating Outcomes of exercise TraiNing) only demonstrated a modest improvement of all cause mortality and hospitalizations in HFrEF. Outcome data in HFpEF are lacking. Whether interval training incorporating variable and higher intensities or the addition of resistance exercise to a standard aerobic prescription is superior in improving clinical status of HF patients is currently being examined. Despite increasing validation of the potential of exercise training in chronic HF, challenges remain in the routine therapeutic application, including interdisciplinary management, financing of long-term exercise programs and the need to improve short-term and long-term adherence to exercise training.

Keywords

Left ventricular function Exercise intolerance Endurance training Strength training Therapy 

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Copyright information

© Urban & Vogel 2013

Authors and Affiliations

  1. 1.Abteilung für Kardiologie und PulmologieUniversität GöttingenGöttingenDeutschland
  2. 2.Abteilung für KardiologieMedizinische Universität GrazGrazÖsterreich

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