Heart Failure Reviews

, Volume 13, Issue 1, pp 3–11 | Cite as

Exercise training in patients with heart failure: clinical outcomes, safety, and indications

Article

Abstract

Heart failure (HF) patients are often counseled to limit their physical activity, however, this advice may not be appropriate. Data has accumulated supporting the effectiveness of exercise training to improve fitness levels and symptoms. There are also data suggesting that training may reduce mortality and morbidity in HF patients. Studies have demonstrated that exercise training can be performed safely in appropriately evaluated HF patients. The literature would support the prescribing of exercise training to NYHA II–III HF patients. Consideration could also be given to training stable NYHA IV HF patients who are not symptomatic at rest. This article reviews the effects of exercise training on clinical outcomes and addressing the safety of exercise training and the indications for training in HF patients.

Keywords

Heart failure Mortality and morbidity Exercise training Fitness Quality of life Indications for training 

References

  1. 1.
    McKelvie RS, McCartney N, Teo KK, Humen D, Montague T, Yusuf S (1995) Effects of exercise training in patients with congestive heart failure: a critical Review. J Am Coll Cardiol 25:789–796PubMedCrossRefGoogle Scholar
  2. 2.
    Pina IL, Apstein CS, Balady GJ et al (2003) A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 107:1210–1225PubMedCrossRefGoogle Scholar
  3. 3.
    Piepoli M, Clark AL, Volterrani M, Adamopoulos S, Sleight P, Coats A (1996) Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure. Effects of physical training. Circulation 93:940–952PubMedGoogle Scholar
  4. 4.
    Ponikowski P, Chua TP, Francis DP, Capucci A, Coats AJ, Piepoli MF et al (2001) Muscle ergoreceptor overactivity reflects deterioration in clinical status and cardiorespiratory reflex control in chronic heart failure. Circulation 104:2324–2330PubMedCrossRefGoogle Scholar
  5. 5.
    Scott A, Wensel R, Davos CH, Kemp M, Kaczmarek A, Hooper J et al (2002) Chemical mediators of the muscle ergoreflex in chronic heart failure: a putative role for prostaglandins in reflex ventilatory control. Circulation 106:214–220PubMedCrossRefGoogle Scholar
  6. 6.
    Belardinelli R, Georgiou D, Cianci G et al (1999) Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome. Circulation 99:1173–1182PubMedGoogle Scholar
  7. 7.
    Lloyd-Williams F, Mair FS, Leitner M (2002) Exercise training and heart failure: a systematic review of current evidence. Br J Gen Pract 52:47–55PubMedGoogle Scholar
  8. 8.
    McKelvie RS, Teo KK, Roberts R, McCartney N, Humen D, Montague T et al (2002) Effects of exercise training in patients with heart failure: The Exercise Rehabilitation Trial (EXERT). Am Heart J 144:23–30PubMedCrossRefGoogle Scholar
  9. 9.
    Smart N, Marwick TH (2004) Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med 116:693–706PubMedCrossRefGoogle Scholar
  10. 10.
    Piepoli MF, Davos C, Francis DP, Coats AJS (2004) Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 328:189–191PubMedCrossRefGoogle Scholar
  11. 11.
    Gianuzzi P, Tavazzi L, Meyer K, Drexler H, Dubach P, Meyers J et al (2001) Recommendations for exercising training in chronic heart failure patients. Eur Heart J 22:125–135CrossRefGoogle Scholar
  12. 12.
    Keteyian SJ, Levine AB, Brawner CA, Katacha T, Rogers FJ, Schairer JR et al (1996) Exercise training in patients with heart failure. A randomized controlled trial. Ann Int Med 124:1051–1057PubMedGoogle Scholar
  13. 13.
    Hambrecht R, Offner B, Schuler G, Niebauer J, Fiehn E, Kalberer B et al (1995) Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol 25:1239–1249PubMedCrossRefGoogle Scholar
  14. 14.
    Belardinelli R, Georgiou D, Scocco V, Barstow TJ, Purcaro A (1995) Low intensity exercise training in patients with chronic heart failure. J Am Coll Cardiol 26:975–982PubMedCrossRefGoogle Scholar
  15. 15.
    Dubach P, Meyers J, Dziekan G, Goebbels U, Reinhart W, Moller P et al (1997) Effect of high intensity exercise training on central hemodynamic responses to exercise in man with reduced left ventricular function. J Am Coll Cardiol 29:1591–1598PubMedCrossRefGoogle Scholar
  16. 16.
    Dubach P, Myers J, Dziekan G, Goebbels U, Reinhart W, Vogt P et al (1997) Effect of exercise training on myocardial remodeling in patients with reduced left ventricular function after myocardial infarction: application of magnetic resonance imaging. Circulation 95:2060–2067PubMedGoogle Scholar
  17. 17.
    Kiilavuory K, Sovijarvi A, Navery H, Ikonen T, Leinonen H (1996) Effect of physical training on exercise capacity and gas exchange in patients with chronic heart failure. Chest 110:985–991Google Scholar
  18. 18.
    Belardinelli R, Georgiou D, Cianci G, Purcaro A (1996) Effects of exercise training on left ventricular filling at rest and during exercise in patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction. Am Heart J 132:61–70PubMedCrossRefGoogle Scholar
  19. 19.
    Sullivan MJ, Higginbotham MB, Cobb F (1988) Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects. Circulation 78:506–515PubMedGoogle Scholar
  20. 20.
    Hornig B, Maier V, Drexler H (1996) Physical training improves endothelial function in patients with chronic heart failure. Circulation 93:210–214PubMedGoogle Scholar
  21. 21.
    Hambrecht R, Fiehn E, Weigl C, Gielen S, Hamann C, Kaiser R et al (1998) Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 98:2709–2715PubMedGoogle Scholar
  22. 22.
    Katz A, Yuen J, Bijou R (1997) Training improves endothelium-dependent vasodilation in resistance vessels of patients with heart failure. J Appl Physiol 82:1488–1492PubMedCrossRefGoogle Scholar
  23. 23.
    Hambrecht R, Adams V, Erbs S, Linke A, Krankel N, Shu Y et al (2003) Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 107:3152–3158PubMedCrossRefGoogle Scholar
  24. 24.
    Fisher D, Rossa S, Landmesser U, Spiekermann S, Engberding N, Horning B et al (2005) Endothelial dysfunction in patients with chronic heart failure is independently associated with increased incidence of hospitalization, cardiac transplantation, or death. Eur Heart J 26:65–69CrossRefGoogle Scholar
  25. 25.
    Katz S, Hryniewicz K, Hriljac I, Balidemaj K, Dimayuga C, Hudaihed A et al (2005) Vascular endothelial dysfunction and mortality risk in patients with chronic heart failure. Circulation 111(3):310–314PubMedCrossRefGoogle Scholar
  26. 26.
    Minotti JR, Johnson EC, Hudson TL, Zuroske G, Murata G, Fukushina E et al (1990) Skeletal muscle response to exercise training in congestive heart failure. J Clin Invest 86:751–758PubMedCrossRefGoogle Scholar
  27. 27.
    Hambrecht R, Fiehn E, Jiangtao Y, Niebauer J, Weigl C, Hilbrich L et al (1997) Effects of endurance training on mitochondrial ultra structure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol 29:1067–1073PubMedCrossRefGoogle Scholar
  28. 28.
    Coats AJS, Adamopoulos S, Radaelli A et al (1992) Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation 85:2119–2131PubMedGoogle Scholar
  29. 29.
    Kiilavuori K, Toivonen L, Naveri H et al (1995) Reversal of autonomic derangements by physical training in chronic heart failure assessed by heart rate variability. Eur Heart J 16:490–495PubMedGoogle Scholar
  30. 30.
    Roveda F, Middlekauff HR, Urbana M et al (2003) The effects of exercise training on sympathetic neural activation in advanced heart failure. J Am Coll Cardiol 42:854–860PubMedCrossRefGoogle Scholar
  31. 31.
    Conraads VM, Beckers P, Vaes J, Martin M, Van Hoof V, DeMaeyer C et al (2004) Combined endurance/resistance training reduces NT proBNP levels in patients with chronic heart failure. Eur Heart J 25:1797–1805PubMedCrossRefGoogle Scholar
  32. 32.
    Levine B, Kalman J, Mayer L, Fillit HM, Packer M (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–244PubMedCrossRefGoogle Scholar
  33. 33.
    Adamopoulos S, Parissis J, Karatzas D, Kroupis C, Georgiadis M, Karavolias G et al (2002) Physical training modulates proinflammatory cytokines and the soluble Fas/soluble Faslingand system in patients with chronic heart failure. J Am Coll Cardiol 39:653–663PubMedCrossRefGoogle Scholar
  34. 34.
    Whellan DJ, O’Connor CM, Lee KL et al (2007) Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Am Heart J 153:201–211PubMedCrossRefGoogle Scholar
  35. 35.
    European Heart Failure Training Group (1998) Experience from controlled treats of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. Eur Heart J 19:466–475CrossRefGoogle Scholar
  36. 36.
    Van Tol BAF, Huijsmans RJ, Kroon DW et al (2006) Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. Eur J Heart Fail 8:841–850PubMedCrossRefGoogle Scholar
  37. 37.
    Parnell MM, Holst DP, Kaye DM (2002) Exercise training increases arterial compliance in patients with congestive heart failure. Clin Sci 102:1–7PubMedCrossRefGoogle Scholar
  38. 38.
    Tyni-Lenne R, Gordon A, Sylven C (1996) Improved quality of life in chronic heart failure patients following local endurance training with leg muscles. J Card Fail 2:111–117PubMedCrossRefGoogle Scholar
  39. 39.
    Giannuzzi P, Temporelli PL, Corra U et al (2003) Antiremodeling effect of long term exercise training in patients with stable chronic heart failure. Results of the ELVD-CHF Trial. Circulation 108:554–559PubMedCrossRefGoogle Scholar
  40. 40.
    Koch M, Douard H, Broustet JP (1992) The benefit of graded physical exercise in chronic heart failure. Chest 101:231–235CrossRefGoogle Scholar
  41. 41.
    Oka RK, De Marco T, Haskell WL et al (2000) Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. Am J Cardiol 85:365–369PubMedCrossRefGoogle Scholar
  42. 42.
    Wielenga RP, Erdman RAM, Huisveld IA et al (1998) Effect of exercise training on quality of life in patients with chronic heart failure. J Psychosom Res 45:459–464PubMedCrossRefGoogle Scholar
  43. 43.
    Koukouvou G, Kouidi E, Iacovides A et al (2004) Quality of life, psychological and physiological changes following exercise training in patients with chronic heart failure. J Rehabil Med 36:36–41PubMedCrossRefGoogle Scholar
  44. 44.
    Keteyian SJ, Brawner CA, Schairer JR et al (1999) Effects of exercise training on chronotropic incompetence in patients with heart failure. Am heart J 138:233–240PubMedCrossRefGoogle Scholar
  45. 45.
    Quittan M, Sturm B, Wiesinger GF et al (1999) Quality of life in patients with chronic heart failure: a randomized controlled trial of changes induced by a regular exercise program. Scand J Rehabil Med 31:223–228PubMedCrossRefGoogle Scholar
  46. 46.
    Owen A, Croucher L (2000) Effect of an exercise programme for elderly patients with heart failure. Eur J Heart Fail 2:65–70PubMedCrossRefGoogle Scholar
  47. 47.
    Hambrecht R, Gielen S, Linke A et al (2000) Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure. A randomized trial. JAMA 283:3095–3101PubMedCrossRefGoogle Scholar
  48. 48.
    Fletcher GF, Balady GJ, Amsterdam EA et al (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740PubMedCrossRefGoogle Scholar
  49. 49.
    Haskell WL (1994) The efficacy and safety of exercise programs in cardiac rehabilitation. Med Sci Sports Exerc 26:815–823PubMedGoogle Scholar
  50. 50.
    van Camp SP, Peterson RA (1986) Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 256:1160–1163PubMedCrossRefGoogle Scholar
  51. 51.
    Vongvanich P, Paul-Labrador MJ, Merz CN (1996) Safety of medically supervised exercise in a cardiac rehabilitation centre. Am J Cardiol 77:1383–1385PubMedCrossRefGoogle Scholar
  52. 52.
    Mittleman MA, MaClure M, Tofler GH et al (1993) Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 329:1677–1683PubMedCrossRefGoogle Scholar
  53. 53.
    Willich SN, Lewis M, Lowel H et al (1993) Physical exertion as a trigger of acute myocardial infarction: Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med 329:1684–1690PubMedCrossRefGoogle Scholar
  54. 54.
    Burke AP, Farb A, Malcom GT et al (1999) Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 281:921–926PubMedCrossRefGoogle Scholar
  55. 55.
    Berlin JA, Colditz GA (1990) A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 132:612–628PubMedGoogle Scholar
  56. 56.
    Oldridge NB, Guyatt GH, Fischer MS, Rimm AA (1988) Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA 260:945–950PubMedCrossRefGoogle Scholar
  57. 57.
    O’Connor GT, Buring JE, Yusuf S et al (1989) An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 80:234–244PubMedGoogle Scholar
  58. 58.
    Lakka TA, Venalainen MD, Rauramaa R et al (1994) Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men. N Engl J Med 330:1549–1554PubMedCrossRefGoogle Scholar
  59. 59.
    Tristani FE, Hughes CV, Archibald DG, Sheldahl LM, Cohn JN, Fletcher R (1987) Safety of graded symptom-limited exercise testing in patients with congestive heart failure. Circulation 76(Suppl 6):54–58Google Scholar
  60. 60.
    Jugdutt BI, Michorowski BL, Kappagoda CT (1988) Exercise training after anterior Q wave myocardial infarction: importance of regional function and topography. J Am Coll Cardiol 12:362–372PubMedCrossRefGoogle Scholar
  61. 61.
    Giannuzzi P, Tavazzi L, Temporelli PL, Corra U, Imparato A, Gattone M et al (1993) Long term physical training and left ventricular remodeling after anterior myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) Study Group. J Am Coll Cardiol 22:1821–1829PubMedGoogle Scholar
  62. 62.
    Belardinelli R, Georgiou D, Cianci G, Purcaro A (1999) Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome. Circulation 99:1173–1182PubMedGoogle Scholar
  63. 63.
    Kobashigawa JA, Leaf DA, Lee N et al (1999) A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 340:272–277PubMedCrossRefGoogle Scholar
  64. 64.
    Braith RW, Limarcher MC, Leggett SH et al (1993) Skeletal muscle strength in heart transplant recipients. J Heart Lung Transplant 12:1018–1023PubMedGoogle Scholar
  65. 65.
    Cahalin LP, Semigran MJ, Dec GW (1997) Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplatiation: results of a pilot clinical trial. Phys Ther 77:830–838PubMedGoogle Scholar
  66. 66.
    Kavanagh T, Yacoub MH, Mertens DJ et al (1988) Cardiorespiratory responses to exercise training after orthopic cardiac transplantation. Circulation 77:162–171PubMedGoogle Scholar
  67. 67.
    Jaski BE, Kim J, Maly RS et al (1997) Effects of exercise during long-term support with a left ventricular assist device: results of the experience with left ventricular assist device with exercise (EVADE) pilot trial. Circulation 95:2401–2406PubMedGoogle Scholar
  68. 68.
    Morrone TM, Buck LA, Catanese KA et al (1996) Early progressive mobilization of patients with left ventricular assist devices is safe and optimizes recover before heart transplantation. J Heart Lung Transplant 15:423–429PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Hamilton Health Sciences Corporation – General SiteHamiltonCanada

Personalised recommendations