Current Heart Failure Reports

, Volume 3, Issue 4, pp 189–196

Exercise training in heart failure

Article

Abstract

The reduction of exercise capacity with early occurrence of fatigue and dyspnea is a hallmark of heart failure syndrome. There are objective similarities between heart failure and muscular deconditioning. Deficiencies in peripheral blood flow and skeletal muscle function, morphology, metabolism, and function are present. The protective effects of physical activity have been elucidated in many recent studies: training improves ventilatory control, skeletal muscle metabolism, autonomic nervous system, central and peripheral circulation, and heart function. These provide the physiologic basis to explain the benefits in terms of survival and freedom from hospitalization demonstrated by physical training in heart failure.

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References and Recommended Reading

  1. 1.
    Coats AJS: Exercise rehabilitation in chronic heart failure. J Am Coll Cardiol 1993, 22:172A-177A.PubMedCrossRefGoogle Scholar
  2. 2.
    McDonald CD, Burch GE, Walsh JJ: Prolonged bed rest in the treatment of idiopathic cardiomyopathy. Am J Med 1972, 52:41–50.PubMedCrossRefGoogle Scholar
  3. 3.
    Sullivan MJ, Higginbotham MB, Cobb FR: Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects. Circulation 1988, 78:506–515.PubMedGoogle Scholar
  4. 4.
    Coats AJS, Adamopoulos S, Meyer TE, et al.: Effects of physical training in chronic heart failure. Lancet 1990, 335:63–66. The first randomized trial demonstrating the benefits in a controlled setting.PubMedCrossRefGoogle Scholar
  5. 5.
    Piepoli M: European Heart Failure Training Group. Experience from controlled trials of physical training in chronic heart failure: protocol and patient factors in effectiveness in the improvement in exercise tolerance. Eur Heart J 1998, 19:466–475.CrossRefGoogle Scholar
  6. 6.
    Davey P, Meyer T, Coats A, et al.: Ventilation in chronic heart failure: effects of physical training. Br Heart J 1992, 68:473–477.PubMedGoogle Scholar
  7. 7.
    Francis DP, Shamim W, Davies LC, et al.: Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO2 and peak VO2. Eur Heart J 2000, 21:154–161.PubMedCrossRefGoogle Scholar
  8. 8.
    Ponikowski P, Chua TP, Piepoli M, et al.: Augmented peripheral chemosensitivity as a potential input to barore-flex impairment and autonomic imbalance in chronic heart failure. Circulation 1997, 96:2586–2594.PubMedGoogle Scholar
  9. 9.
    Chua TP, Ponikowski P, Webb-Peploe K, et al.: Clinical characteristics of chronic heart failure patients with an augmented peripheral chemoreflex. Eur Heart J 1997, 18:480–486.PubMedGoogle Scholar
  10. 10.
    Guazzi M, Reina G, Tumminello G, Guazzi MD: Improvement of alveolar-capillary membrane diffusing capacity with exercise training in chronic heart failure. J Appl Physiol 2004, 97:1866–1873.PubMedCrossRefGoogle Scholar
  11. 11.
    Braith RW, Welsch MA, Feigenbaum MS, et al.: Neuroendocrine activation in heart failure is modified by endurance exercise training. J Am Coll Cardiol 1999, 34:1170–1175.PubMedCrossRefGoogle Scholar
  12. 12.
    Kiilavuori K, Naveri H, Leinonen H, et al.: The effect of physical training on hormonal status and exertional hormonal response in patients with chronic congestive heart failure. Eur Heart J 1999, 20:456–464.PubMedCrossRefGoogle Scholar
  13. 13.
    Hambrecht R, Gielen S, Linke A, et al.: Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial. JAMA 2000, 283:3095–3101.PubMedCrossRefGoogle Scholar
  14. 14.
    Adamopoulos S, Piepoli M, McCance A, et al.: Comparison of different methods for assessing sympathovagal balance in chronic congestive heart failure secondary to coronary artery disease. Am J Cardiol 1992, 70:1576–1582.PubMedCrossRefGoogle Scholar
  15. 15.
    Adamopoulos S, Ponikowski P, Cerquetani E, et al.: Circadian pattern of heart rate variability in chronic heart failure patients. Eur Heart J 1995, 16:1380–1386.PubMedGoogle Scholar
  16. 16.
    Ali A, Mehra MR, Malik FS, et al.: Effects of aerobic exercise training on indices of ventricular repolarization in patients with chronic heart failure. Chest 1999, 116:83–87.PubMedCrossRefGoogle Scholar
  17. 17.
    Jugdutt BI, Michorowski BL, Kappadoga CT: Exercise training after anterior Q wave myocardial infarction: importance of regional left ventricular function and topography. J Am Coll Cardiol 1988, 12:362–372.PubMedCrossRefGoogle Scholar
  18. 18.
    Dubach P, Myers J, Dziekan G, et al.: Effect of exercise training on myocardial remodeling in patients with reduced left ventricular function after myocardial infarction. Circulation 1997, 95:2060–2067.PubMedGoogle Scholar
  19. 19.
    Ehsani AA, Miller TR, Miller TA, et al.: Comparison of adaptations to a 12-month exercise program and late outcome in patients with healed myocardial infarction and ejection fraction < 45% and 50%. Am J Cardiol 1997, 79:1258–1260.PubMedCrossRefGoogle Scholar
  20. 20.
    Belardinelli R, Georgiou D, Cianci G, Purcaro A: 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 1996, 132:61–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Demopoulos L, Bijou R, Fergus I, et al.: Exercise training in patients with severe congestive heart failure: enhancing peak aerobic capacity while minimizing the increase in ventricular wall stress. J Am Coll Cardiol 1997, 29:597–603.PubMedCrossRefGoogle Scholar
  22. 22.
    Hambrecht R, Wolf A, Gielen S, et al.: Effect of exercise on coronary endothelial function in patients with coronary artery disease. New Engl J Med 2000, 342:454–460. Exercise training improves endothelium-dependent vasodilatation both in epicardial coronary vessels and in resistance vessels.PubMedCrossRefGoogle Scholar
  23. 23.
    Belardinelli R, Georgiou D, Purcaro A: Low dose dobutamine echocardiography predicts improvement in functional capacity after exercise training in patients with ischemic cardiomyopathy: prognostic implication. J Am Coll Cardiol 1998, 31:1027–1034. Presence of hibernating myocardium does not preclude the benefit of exercise training.PubMedCrossRefGoogle Scholar
  24. 24.
    Giannuzzi P, Temporelli PL, Corra U, et al.: Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVDCHF) Trial. Circulation 2003, 108:554–559. Large multicenter study investigated the long-term effect of moderate ET on LV remodeling, work capacity, and quality of life.PubMedCrossRefGoogle Scholar
  25. 25.
    Wang J, Yi GH, Knecht M, et al.: Physical training alters the pathogenesis of pacing-induced heart failure through endothelium-mediated mechanisms in awake dogs. Circulation 1997, 96:2683–2692.PubMedGoogle Scholar
  26. 26.
    Hambrecht R, Fiehn E, Yu J, et al.: Effects of endurance training on mitochondrial ultrastructure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol 1997, 29:1067–1073.PubMedCrossRefGoogle Scholar
  27. 27.
    Belardinelli R, Georgiou D, Scocco V, et al.: Low intensity exercise training in patients with chronic heart failure. J Am Coll Cardiol 1995, 26:975–982.PubMedCrossRefGoogle Scholar
  28. 28.
    Gordon A, Tyni-Lenne R, Persson H, et al.: Markedly improved skeletal muscle function with local muscle training in patients with chronic heart failure. Clin Cardiol 1996, 19:568–574.PubMedGoogle Scholar
  29. 29.
    Scarpelli M, Belardinelli R, Tulli D, Provinciali L: Quantitative analysis of changes occurring in muscle vastus lateralis in patients with heart failure after low-intensity training. Anal Quant Cytol Histol 1999, 21:374–380.PubMedGoogle Scholar
  30. 30.
    Hornig B, Maier V, Drexler H: Physical training improves endothelial function in patients with chronic heart failure. Circulation 1996, 93:210–214.PubMedGoogle Scholar
  31. 31.
    Varin R, Mulder P, Richard V, et al.: Exercise improves flow-mediated vasodilatation of skeletal muscle arteries in rats with chronic heart failure. Role of nitric oxide, prostanoids, and oxidant stress. Circulation 1999, 99:2951–2957.PubMedGoogle Scholar
  32. 32.
    Gielen S, Adams V, Mobius-Winkler S, et al.: Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol 2003, 42:854–860.CrossRefGoogle Scholar
  33. 33.
    Adamopoulos S, Coats AJ, Brunotte F, et al.: Physical training improves skeletal muscle metabolism in patients with chronic heart failure. J Am Coll Cardiol 1993, 21:1101–1106.PubMedCrossRefGoogle Scholar
  34. 34.
    Stratton JR, Dunn JF, Adamopoulos S, et al.: Training partially reverses skeletal muscle metabolic abnormalities during exercise in heart failure. J Appl Physiol 1994, 76:1575–1572.PubMedGoogle Scholar
  35. 35.
    Magnusson G, Gordon A, Kaijser L, et al.: High intensity knee extensor training, in patients with chronic heart failure. Major skeletal muscle improvement. Eur Heart J 1996, 17:1048–1055.PubMedGoogle Scholar
  36. 36.
    Kao FF: An experimental study of the pathways involved in exercise hyperpnea employing cross-circulation technique. In The Regulation of Human Respiration. Edited by Cunningham DJC, Lloyd BB. Oxford: Blackwell Scientific Publications; 1963: 461–502.Google Scholar
  37. 37.
    McCloskey DI, Mitchell JH: Reflex cardiovascular and respiratory responses originating in exercising muscle. J Physiol (London) 1972, 224:173–186.Google Scholar
  38. 38.
    Scott AC, Wensel R, Davos CH, et al.: Skeletal muscle reflex in heart failure patients: role of hydrogen. Circulation 2003, 107:300–306.PubMedCrossRefGoogle Scholar
  39. 39.
    Scott AC, Wensel R, Davos CH, et al.: Putative contribution of prostaglandin and bradykinin to muscle reflex hyperactivity in patients on Ace-inhibitor therapy for chronic heart failure. Eur Heart J 2004, 25:1806–1813.PubMedCrossRefGoogle Scholar
  40. 40.
    Coats A, Clark A, Piepoli M, et al.: Symptoms and quality of life in heart failure: the muscle hypothesis. Br Heart J 1994, 72:S36-S39.PubMedGoogle Scholar
  41. 41.
    Piepoli M, Volterrani M, Clark AL, et al.: Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure. Effects of physical training. Circulation 1996, 93:940–952. Evidence for the ergoreflex role on the responses to exercise in HF than in control subjects. And that training may reduce this exaggerated ergoreflex activity, thereby improving the responses to exercise.PubMedGoogle Scholar
  42. 42.
    Piepoli M, Ponikowski P, Clark A, et al.: A neural link to explain the "muscle hypothesis" of exercise intolerance in chronic heart failure. Am Heart J 1999, 137:1050–1056.PubMedCrossRefGoogle Scholar
  43. 43.
    Tyni-Lenné R, Gordon A, Jensen-Urstad M, et al.: Aerobic training involving a minor muscle mass shows greater efficiency than training involving a major muscle mass in chronic heart failure patients. J Cardiac Fail 1999, 5:300–307.CrossRefGoogle Scholar
  44. 44.
    Piepoli MF, Davos C, Francis DP, et al.: Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 2004, 328:189–196. Properly supervised medical training programs reduce mortality and the combined endpoint of mortality and hospitalization.PubMedCrossRefGoogle Scholar
  45. 45.
    Belardinelli R, Georgiou D, Cianci D, 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, 99:1173–1182.PubMedGoogle Scholar
  46. 46.
    Meyer TE, Casadei B, Coats AJ, et al.: Angiotensin-converting enzyme inhibition and physical training in heart failure. J Intern Med 1991, 230:407–413.PubMedCrossRefGoogle Scholar
  47. 47.
    Forissier JF, Vernochet P, Bertrand P, et al.: Influence of carvedilol on the benefits of physical training in patients with moderate chronic heart failure. Eur J Heart Fail 2001, 3:335–342.PubMedCrossRefGoogle Scholar
  48. 48.
    US Department of Health and Human Services: Agency for Health Care Policy and Research. Clinical Practice Guideline No. 17: Cardiac Rehabilitation. Washington, DC: Agency for Health Care Policy and Research, Octo: AHCPR Publication No. 96-0672.Google Scholar
  49. 49.
    Working Group on Cardiac Rehabilitation & 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, 22:125–135. Practical guideline from the European Society of Cardiology with very comprehensive recommendations.CrossRefGoogle Scholar
  50. 50.
    Pina IL, Apstein CS, Balady GJ, et al.: American Heart Association Committee on exercise, rehabilitation, and prevention. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 2003, 107:1210–1225. Practical guideline from the American Heart Association with physiologic items.PubMedCrossRefGoogle Scholar
  51. 51.
    HF-ACTION. Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training. http://www.hfaction.org/.Google Scholar
  52. 52.
    Sullivan MJ, Cobb FR: Central hemodynamic response to exercise in patients with chronic heart failure. Chest 1992, 101(5 Suppl):340S-346S.PubMedGoogle Scholar
  53. 53.
    Stevenson LW, Brunken RC, Belil D, et al.: Afterload reduction with vasodilator and diuretics decreases mitral regurgitation during upright exercise in advanced heart failure. J Am Coll Cardiol 1990, 15:174–180.PubMedCrossRefGoogle Scholar
  54. 54.
    Guazzi M: Alveolar capillary membrane dysfunction in chronic heart failure: pathophysiology and therapeutic implications. Clin Sci 2000, 98:633–641.PubMedCrossRefGoogle Scholar
  55. 55.
    Mancini DM, Henson D, LaManca J, Levine S: Evidence of reduced respiratory muscle endurance in patients with heart failure. J Am Coll Cardiol 1994, 24:972–981.PubMedCrossRefGoogle Scholar
  56. 56.
    Zelis R, Longhurst J, Capone RJ, et al.: A comparison of regional blood flow and oxygen utilization during dynamic forearm exercise in normal subjects and patients with congestive heart failure. Circulation 1974, 50:137–143.PubMedGoogle Scholar
  57. 57.
    Drexler H, Lu W: Endothelial dysfunction of hindquarter resistance vessels in experimental heart failure. Am J Physiol 1992, 262:H1640-H1645.PubMedGoogle Scholar
  58. 58.
    Floras JS: Clinical aspects of sympathetic activation and parasympathetic withdrawal in heart failure. J Am Coll Cardiol 1993, 22:72A-84A. Clear review of the physiologic mechanisms behind neurohormonal activation.PubMedCrossRefGoogle Scholar
  59. 59.
    Massie BM, et al.: Skeletal muscle metabolism in patients with congestive heart failure: relation to clinical severity and blood flow. Circulation 1987, 76:1009–1019.PubMedGoogle Scholar
  60. 60.
    Drexler H, Riede U, Munzel T, et al.: Alterations of skeletal muscle in chronic heart failure. Circulation 1992, 85:1751–1759.PubMedGoogle Scholar
  61. 61.
    Sullivan MJ, Duscha BD, Klitgaard H, et al.: Altered expression of myosin heavy chain in human skeletal muscle in chronic heart failure. Med Sci Sports Exerc 1997, 29:860–866.PubMedGoogle Scholar
  62. 62.
    Sullivan MJ, Green HJ, Cobb FR: Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation 1990, 81:518–527.PubMedGoogle Scholar
  63. 63.
    Vescovo G, Volterrani M, Zennaro R, et al.: Apoptosis in the skeletal muscle of patients with heart failure: investigation of clinical and biochemical changes. Heart 2000, 84:431–437.PubMedCrossRefGoogle Scholar
  64. 64.
    Wada O, Asanoi H, Miyagi K: Quantitative evaluation of blood flow distribution to exercising and resting skeletal muscles in patients with cardiac dysfunction using whole-body thallium-201 scintigraphy. Clin Cardiol 1997, 20:785–790.PubMedCrossRefGoogle Scholar
  65. 65.
    Guazzi M: Alveolar capillary membrane dysfunction in chronic heart failure: pathophysiology and therapeutic implications. Clin Sci 2000, 98:633–641.PubMedCrossRefGoogle Scholar
  66. 66.
    Mancini DM, Henson D, LaManca J, Levine S: Evidence of reduced respiratory muscle endurance in patients with heart failure. J Am Coll Cardiol 1994, 24:972–981.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2006

Authors and Affiliations

  1. 1.Heart Failure Unit, Cardiology DepartmentG. da Saliceto Polichirurgico HospitalPiacenzaItaly

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