Physical training in patients with chronic heart failure
Abstract
Chronic heart failure (CHF) manifests in heart insufficiency and inadequate blood flow in various organs and tissues. One of the most important CHF symptoms is reduced physical stress (PS) tolerability, due to impaired central hemodynamics and various peripheral mechanisms. Physical training (PT) improves PS tolerability, quality of life and prognosis in CHF patients. While PT effectiveness in CHF has been proved, there are various approaches to PT methodology. In particular, two types of PT are used – PT with constant PS intensity and interval PT. This literature review summarizes the evidence on the mechanisms of PS tolerability in CHF and PT effects in these patients. PT methodology (start time after decompensation, length, and intensity) is also discussed.
About the Authors
A. V. Snytnikova
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
Cardiology Clinic
Moscow
D. A. Andreev
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
Cardiology Clinic
Moscow
A. A. Doletsky
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
Cardiology Clinic
Moscow
A. V. Svet
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
Cardiology Clinic
Moscow
A. V. Chaplygin
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
Cardiology Clinic
Moscow
References
1. Piña IL, Apstein CS, Balady GJ, et al. Exercise and Heart Failure: A Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation 2003; 107:1210-25.
2. Sullivan MJ, Cobb FR. Central hemodynamic response to exercise in patients with chronic heart failure. Chest 1992; 101 (5Suppl): 340S-6.
3. Duscha BD, Schulze PC, Robbins JL, et al. Implications of chronic heart failure on peripheral vasculature and skeletal muscle before and after exercise training. Heart Fail Rev 2008; 13: 21-37.
4. 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.
5. Drexler H, Banhardt U, Meinertz T, et al. Contrasting peripheral short-term and long-term effects of converting enzyme inhibition inpatients with congestive heart failure: a double blind, placebo-controlled trial. Circulation 1989; 79: 491-502.
6. McMurray JJ, Ray SG, Abdullah I, et al. Plasma endothelin in chronic heart failure. Circulation 1992; 85: 1374-9.
7. Longhurst J, Capone RJ, Zelis R. Evaluation of skeletal muscle capillary basement membrane thickness in congestive heart failure. Chest 1975; 67: 195-8.
8. Tagawa T, Imaizumi T, Endo T, et al. Role of nitric oxide in reactive hyperemia in human forearm vessels. Circulation 1994; 90: 2285-90.
9. Loscalzo J, Vita JA. Ischemia, hyperemia, exercise, and nitric oxide: complex physiology and complex molecular adaptations. Circulation 1994; 90: 2556-9.
10. Gilligan DM, Panza JA, Kilcoyne CM, et al. Contribution of endothelium-derived nitric oxide to exercise-induced vasodilation. Circulation 1994; 90: 2853-8.
11. Nakamura M, Ishikawa M, Funakoshi T, et al. Attenuated endotheliumdependent peripheral vasodilation and clinical characteristics in patients with chronic heart failure. Am Heart J 1994; 128: 1164-9.
12. Lipkin DP, Jones DA, Round JM, et al. Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol 1988; 18: 187-95.
13. Sullivan MJ, Green HJ, Cobb FR. Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation 1990; 81: 518-27.
14. Drexler H, Riede U, Munzel T, et al. Alterations of skeletal muscle in chronic heart failure. Circulation 1992; 85: 1751-9.
15. Sullivan MJ, Green HJ, Cobb FR. Altered skeletal muscle metabolic responses to exercise in chronic heart failure: relation to skeletal muscle aerobic enzyme activity. Circulation 1991; 84: 1597-607.
16. 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: 860-6.
17. Sullivan MJ, Knight JD, Higginbotham MB, et al. 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.
18. 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: 785-90.
19. Hambrecht R, Niebauer J, Fiehn E, et al. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscle. JACC 1995; 25: 1939-49.
20. Coats AJS. Exercise training in heart failure. Curr Control Trials Cardiovasc Med 2000; 1: 155-60.
21. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with severe left ventricular dysfunction: Hemodynamic and metabolic effects. Circulation 1988, 78: 506-15.
22. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance. Circulation 1989; 79: 324-9.
23. Coats AJS, Adamopoulos S, Meyer TE, et al. Effects of physical training in chronic heart failure. Lancet 1990; 335: 63-6.
24. Coats AJS, Adamopoulos S, Radaelli A, et al. Controlled trial of physical training in chronic heart failure: exercise performance, hemodynamics, ventilation and autonomic function. Circulation 1992; 85: 2119-31.
25. Piepoli MF, Davos C, Francis DP, et al. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 2004; 328: 189-92.
26. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29: 2388-442.
27. van Tol BA, Huijsmans RJ, Kroon DW, et al. 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 2006; 8: 841-50.
28. Belardinelli R, Georgiou D, Ginzton L, et al. Effects of moderate exercise training on thallium uptake and contractile response to low-dose dobutamine of dysfunctional myocardium in patients with ischemic cardiomyopathy. Circulation 1998; 97: 553-61.
29. Belardinelli R, Georgiou D, Cianci G, et al. 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.
30. Giannuzzi P, Temporelli PL, Corr 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 (ELVD-CHF) trial. Circulation 2003; 108: 554-9.
31. Giallauria F, Cirillo P, Lucci R, et al. Left ventricular remodeling in patients with moderate systolic dysfunction after myocardial infarction: favourable effects of exercise training and predictive role of N-terminal pro-brain natriuretic peptide. Eur J Cardiovasc Prev Rehabil 2008; 15: 113-8.
32. Wisløff U, Støylen A, Loennechen JP, et al. Superior Cardiovascular Effect of Aerobic Interval Training Versus Moderate Continuous Training in Heart Failure Patients: A Randomized Study. Circulation 2007; 115: 3086-94.
33. Papathanasiou G, Tsamis N, Georgiadou P, et al. Beneficial Effects of Physical Training and Methodology of Exercise Prescription in Patients with Heart Failure. Hellenic J Cardiol 2008; 49: 267-77.
34. 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: 3095-101.
35. Haykowsky MJ, Liang Y, Pechter D, et al. A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients. JACC 2007; 49: 2329-36.
36. Adamopoulos S, Parissis JT, Kremastinos DT. New aspects for the role of physical training in the management of patients with chronic heart failure. Int J Cardiol 2003; 90: 1-14.
37. Belardinelli R, Georgiou D, Scocco V, et al. Low intensity exercise training in patients with chronic heart failure. JACC 1995; 26: 975-82.
38. Piepoli MF, Flather M, Coats AJ. Overview of studies of exercise training in chronic heart failure: the need for a prospective randomized multicentre European trial. Eur Heart J 1998; 19: 830-41.
39. 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. JACC 1997; 29: 1067-73.
40. Bj rnstad HH, Bruvik J, Bj rnstad AB, et al. Exercise training decreases plasma levels of soluble CD40 ligand and P-selectin in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2008; 15: 43-8.
41. Adamopoulos S, Parissis J, Karatjas D, et al. Physical training modulates proinflammatory cytokines and the soluble Fas/ soluble Fas ligand system in patients with chronic heart failure. JACC 2002; 39: 653-63.
42. Hambrecht R, Schulze PC, Gielen S, et al. Effects of exercise training on insulin-like growth factor-I expression in the skeletal muscle of non-cachectic patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2005; 12: 401-6.
43. Negrao CE, Middlekauff HR. Adaptations in autonomic function during exercise training in heart failure. Heart Fail Rev 2008; 13: 51-60.
44. Belardinelli R. Exercise training in chronic heart failure: how to harmonize oxidative stress, sympathetic outflow, and angiotensin II. Circulation 2007; 115: 3042-4.
45. Klecha A, Kawecka-Jaszcza K, Baciora B, et al. Physical training in patients with chronic heart failure of ischemic origin: effect on exercise capacity and left ventricular remodelling. Eur J Cardiovasc Prev Rehabil 2007; 14: 85-91.
46. McKelvie RS, Teo KK, Roberts R, et al. Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT). Am Heart J 2002; 144: 23-30.
47. Ventura-Clapier R, Mettauer B, Bigard X. Beneficial effects of endurance training on cardiac and skeletal muscle energy metabolism in heart failure. Cardiovasc Res 2007; 73: 10-8.
48. Smart N, Haluska B, Jeffries L, et al. Exercise training in systolic and diastolic dysfunction: Effects on cardiac function, functional capacity, and quality of life. Am Heart J 2007; 153: 530-6.
49. Austin J, Williams WR, Ross L, et al. Five-year follow-up findings from a randomized controlled trial of cardiac rehabilitation for heart failure. Eur J Cardiovasc Prev Rehabil 2008; 15: 162-7.
50. Whellan DJ, O’Connor CM, Lee KL, et al. Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Am Heart J 2007; 153: 201-11.
51. O’Connor CM, Whellan DJ, Lee KL, et al. Efficasy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized Controlled Trial. JAMA 2009; 301(14): 1439-50.
52. Dubach P, Myers J, Dziekan G, et al. Effect of High Intensity Exercise Training on Central Hemodynamic Responses to Exercise in Men With Reduced Left Ventricular Function. JACC 1997; 29(7): 1591-8.
53. Meyer K, Schwaibold M, Westbrook S, et al. Effects of ShortTerm Exercise Training and Activity Restriction on Functional Capacity in Patients With Severe Chronic Congestive Heart Failure. Am J Cardiol 1996; 78:1017-22.
54. Meyer K, Samek L, Schwaibold M, et al. Interval training in patients with severe chronic heart failure: analysis and recommendations for exercise procedures. Med Sci Sport Exerc 1997; 29(3): 306-12.
55. 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.
56. American College of Sports Medicine. ACSM’S Guidelines for exercise testing and prescription. Williams & Wilkings; Baltimore, Philadelphia 1995.
57. Adamopoulos S, Coats AJ, Brunotte F, et al. Physical training improves skeletal muscle metabolism in patients with chronic heart failure. JACC 1993; 21: 1101-6.
58. Hasenfuss G, Holubarsch C, Hermann HP, et al. Influence of the force-frequency relationship on haemodynamics and left ventricular function in patients with non-failing hearts and in patients with dilated cardiomyopathy. Eur Heart J 1994; 15: 16470.
59. Andersson B, Strömblad SO, Lomsky M, et al. Heart rate dependency of cardiac performance in heart failure patients treated with metoprolol. Eur Heart J 1999; 20: 575-83.
60. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377-81.
61. Pollock ML, Wilmore JH. Exercise in Health and Disease: Evaluation and prescription for prevention and rehabilitation, 2nd edn. Philadelphia: W.B. Saunders, 1990.
62. Keteyian SJ, Levine AB, Brawner CA, et al. Exercise training in patients with heart failure. A randomized, controlled trial. Ann Intern Med 1996; 124: 1051-7.
63. Kavanagh T, Myers MG, Baigrie RS, et al. Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 month’s aerobic training. Heart 1996; 75: 42-9.
64. Meyer K, Samek L, Schwaibold M, et al. Physical responses to different modes of interval exercise in patients with chronic heart failure – application to exercise training. Eur Heart J 1996; 17(7): 1040-7.
65. Meyer K, Schwaibold M, Westbrook S, et al. Effects of exercise training and activity restriction on 6-minute walking test performance in patients with chronic heart failure. Am Heart J 1997; 133: 447-53.
Review
For citations:
Snytnikova A.V., Andreev D.A., Doletsky A.A., Svet A.V., Chaplygin A.V. Physical training in patients with chronic heart failure. Cardiovascular Therapy and Prevention. 2009;8(8):108-118. (In Russ.)
Views:
4495
Email this article 
