Title : Chronic heart failure and exercise: Update and tips
Heart failure is a complex syndrome characterized by progressive deterioration of ventricular function. Consequently, there is a significant decrease in cardiac output, dyspnea at relatively low workloads, and diminished physical work capacity. In addition to limitations in the functional capacity, the 5-year survival for patients with heart failure is only 24% for men and 31% for women. The prevalence of heart failure has increased by 70%in the last decade.
Recent advances in medical treatment of myocardial infarction and the increasing number of Americans >70years of age have in part attributed to this rise. For years conventional wisdom imposed that physical activity may exacerbate symptoms and lead to progressive deterioration of cardiac function in patients with heart failure. Thus, patients were advised to avoid physical exertion. However, this conservative viewpoint has been challenged by a number of studies showing that patients with heart failure need not avoid physical activity. On the contrary, an individually tailored exercise program is tolerated well by patients with heart failure and yields positive adaptation. Over the past two decades, numerous clinical studies have demonstrated the beneficial impact of exercise training on skeletal muscle energy metabolism, vascular function, and ventilatory capacity, which correlate with measures of exercise tolerance, improvements in hospitalization rates and quality of life of patients with heart failure. In accordance with recent guidelines set forth by the leading cardiology societies in the United States and Europe, physicians are urged to emphasize exercise training for all clinically stable patients with heart failure using individualized protocols that feature early mobilization after acute exacerbations of disease and gradual increases in intensity.