Background-It is still a matter of debate whether exercise training (ET) is a beneficial treatment in chronic heart failure (CHF). Methods and Results-To determine whether long-term moderate ET improves functional capacity and quality of life in patients with CHF and whether these effects translate into a favorable outcome, 110 patients with stable CHF were initially recruited, and 99 (59±14 years of age; 88 men and 11 women) were randomized into 2 groups. One group (group T, n=50) underwent ET at 60% of peak VO 2 , initially 3 times a week for 8 weeks, then twice a week for I year. Another group (group NT, n=49) did not exercise. At baseline and at months 2 and 14, all patients underwent a cardiopulmonary exercise test, while 74 patients (37 in group T and 37 in group NT) with ischemic heart disease underwent myocardial scintigraphy. Quality of life was assessed by questionnaire. Ninety-four patients completed the protocol (48 in group T and 46 in group NT). Changes were observed only in patients in group T. Both peak VO 2 and thallium activity score improved at 2 months (18% and 24%, respectively; P<0.001 for both) and did not change further after 1 year. Quality of life also improved and paralleled peak VO 2 , Exercise training was associated both with lower mortality (n =9 versus n=20 for those with training versus those without; relative risk (RR)=0.37; 95% CI, 0.17 to 0.84; P=0.01) and hospital readmission for heart failure (5 versus 14; RR=0.29; 95% CI, 0.11 to 0.88; P=0.02). Independent predictors of events were ventilatory threshold at baseline (β-coefficient=0.378) and posttraining thallium activity score (β-coefficient -0.165). Conclusions-Long-term moderate ET determines a sustained improvement in functional capacity and quality of life in patients with CHF. This benefit seems to translate into a favorable outcome.

Randomized, Controlled, Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure: Effects on Functional Capacity, Quality of Life and Clinical Outcome

We conducted a three-week randomized trial comparing the improvement of functional capacity by exercise training in chronic heart failure by the steady-state (EF 27.3%, n = 20) and the interval modus (EF 29.3%, n = 20) with a control group (EF = 26.6%, n = 10). Minimal EF was 10%, the lowest maximal oxygen consumption was 9.3 ml/kg/min and the lowest cardiac output was 1.9 l/min; 9 patients had been evaluated for HTX. VO2 at the anaerobic threshold and at maximal exercise increased in the continuous exercise group by 1.4 or 1.6 ml/kg/min, respectively, corresponding to an increase of 13.7% (p < 0.05) and 9.3% (p < 0.05). In the interval training group the increase was 1.3 and 1.5 ml/kg/min corresponding to 14% (p < 0.05) and 8.1% (p < 0.05). Continuous short-term exercise had no impact to central hemodynamics as pulmonary artery pressure (PA), capillary wedge pressure (pc), cardiac index (CI) or stroke volume index (SVI), whereas after interval training a significant increase at maximal exercise could be seen in CI (p < 0.05) and SVI (p < 0.01) with a concomitant drop in systemic peripheral resistance (p < 0.05) compared to the steady-state modus. Interval training was further characterized by a higher short-term but lower mean work load with a significantly smaller increase in lactate. Quality of life was improved according to the SF-36 questionnaire in both training groups but the psychologic sum factor was three times as high, increasing to 24.2% in the steady-state exercise group. It can be concluded that clinically stable patients with heart failure and even those already having been evaluated for cardiac transplantation profit from short-term physical training. Both training modalities seem equally suited to improve functional capacity. However interval training leads to more pronounced improvement in hemodynamics compared to the steady-state exercise, whereas the later had a greater impact on psychological well-being and quality of life. Patients with heart failure and severe peripheral deconditioning tolerate higher workloads with more peripheral stress by an interval training modus. Long-term training modalities need to be established to further improve and stabilize functional status.

[Physical training as interval or continuous training in chronic heart failure for improving functional capacity, hemodynamics and quality of life--a controlled study].

A B S T R A C T Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.

/pdf/programas-de-rehabilitacion-cardiaca-y-calidad-de-vida-3zjtqunf0l.pdf

Programas de rehabilitación cardiaca y calidad de vida relacionada con la salud. Situación actual

Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.

Cardiac Rehabilitation Programs and Health-Related Quality of Life. State of the Art

Die Leitsymptome bei chronischer Herzinsuffizienz sind Dyspnoe und eingeschrankte korperliche Belastbarkeit. Die pathologischen Herzveranderungen allein konnen die Symptomatik der Patienten nicht ausreichend erklaren, vielmehr bestehen zusatzlich Veranderungen der peripheren Durchblutung, der respiratorischen Funktion, der Skelettmuskulatur und des neuroendokrinen Systems. Einschrankung der korperlichen Aktivitat bis hin zur Bettruhe, bei akuter Herzinsuffizienz gunstig und erforderlich, fuhrt im chronischen Stadium zu einer weiteren Verschlechterung der Symptomatik. Im Gegensatz dazu kann korperliches Training die Belastbarkeit der Patienten mit chronischer Herzinsuffizienz deutlich verbessern, wie sich seit den 80er Jahren in zahlreichen Studien zeigen lies. Die kardiale Funktion andert sich dabei nur gering (es kommt aber auch nicht zu der initial befurchteten Verschlechterung), die Verbesserung tritt hauptsachlich durch die Beeinflussung der extrakardialen Veranderungen bei Herzinsuffizienz ein. Nicht zuletzt wird die Lebensqualitat der Patienten signifikant besser. Ob die Prognose hinsichtlich Mortalitat gunstig beeinflusst werden kann, ist derzeit noch unklar, wenngleich eine rezente Arbeit erste Hinweise darauf gibt. Schon zu diesem Zeitpunkt zeigt sich, dass korperliches Training fur ausgewahlte Patienten mit Herzinsuffizienz empfohlen werden kann, eine ausreichende Supervision muss allerdings gewahrleistet sein.

K. K. Teo

Papers

Randomized controlled trial of exercise training in patients with congestive heart failure