In recent studies found in the literature, patients with chronic heart failure have left ventricular systolic dysfunction, is there any guidelines for the exercise prescription for these patients? and what about patients with preserved left ventricular function?
Hi Nelson!
I Think this could help you...
http://www.health.qld.gov.au/heart_failure/pdf/guide_exercise_chf.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314201/pdf/11791816.pdf
Best regards!
Erick
Hi Nelson,
I hope that this will be handy
http://eurheartj.oxfordjournals.org/content/33/14/1787.full.pdf
(section 14)
further recommendation will be found in the American guidelines as well.
see the result of HF-ACTION study.
as for patients with preserved left ventricular function: I guess that a systemic training will decrease the sympathetic drive (RAS system) and in turn prevent or slow further deterioration of the diastolic dysfunction of the left ventricle beside many other mechanisms that the systemic training can trigger.
Best regards!
N.O
see also:
Working Group on Cardiac rehabilitation: Recommendations
for exercise training in chronic heart failure patients.
Eur Heart J 2001;22:125–35.
It looks like I am on the High Intensity Interval Training band wagon but it is especially helpful in increasing the ejection fraction. Of course High Intensity means High for the person's condition. I use a period of Steady State training where the client is able to talk while exercising but then when the client improves their condition we gradually work up to 17 on the Borg Scale. There is considerable peer reviewed articles to support this type of training. I use both aerobic equipment like the Rowing Ergometer and Resistance Training where multi-joint exercises, like squats, are used for the High Intensity work. For the rest pause light single joint exercises using the antagonist muscle is used to help with pumping blood back to the heart.
In adults, there is robust evidence that chronic heart failure patients who engage in exercise training increase their peak aerobic and maximal exercise capacity, mainly by reversing peripheral abnormalities, such as endothelial dysfunction, skeletal muscle wasting, and ventilator inefficiency [ Jessup 2009, Thomas 2010]. A recent met-analysis of randomized control trials showed that aerobic exercise training also favorably affects LV remodeling in clinically stable HF patients [Chen 2012]. Exercise training in adults with chronic stable HF was associated with modest significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality [O’Connor 2009].
Ref:
1. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, Konstam MA, Mancini DM, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 Focused Update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the ACCCF/AHA Task Force on Practice Guidelines: Developed in Collaboration with ISHLT. Circulation 2009;119:1977-2016.
2. Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J. AACVPR/ACCF/AHA 2010 update: performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services: a report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Clinical Performance Measures for Cardiac Rehabilitation). Circulation 2010;122:1342-50.
3. Chen YM, Li ZB, Zhu M, Cao YM. Effects of exercise training on left ventricular remodeling in heart failure patients: an updated meta- analysis of randomized control trials. Int J Clin Pract 2012;66:782-91.
4. O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg JL, Schulman KA, McKelvie RS, Zannad F, Piña IL; HF-ACTION Investigators. Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized Controlled Trial. JAMA. 2009;301:1439-50.
Obviously, patients with preserved left ventricular function will have better answers to the training program applied. However, even in those cases where there is left ventricular insufficiency like the left ventricular systolic dysfunction should be considered the aspects that involve improve of the functions of the muscular peripheral and respiratory systems, which promotes good modifications in functional capacity. The prescription of exercises and control of cardiorespiratory and metabolic functions during activities should be very strict to avoid side effects caused by errors in the exercise dosification.
Thank you all for your contribution. I decided to do, soon, one systematic review on this topic. I have a great scientific interest, and I think that more clinical trials are missing on this subject.
Best regards.
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