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Principles of exercise prescription for patients with chronic heart failure

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Abstract

Chronic heart failure (CHF) is a common and debilitating condition characterized by reduced exercise tolerance. While exercise training was once thought to be contraindicated for patients with CHF, a substantial body of data has been published over the last two decades to support the use of exercise programs for these patients. Improvements in exercise capacity, quality of life, and mortality have been demonstrated among patients with CHF who have participated in formal exercise programs. Exercise prescription is a means of assessing and interpreting clinical information and applying the principles of training to develop an appropriate regimen so that these benefits are achieved. The major principles of the exercise prescription are the mode, frequency, duration, and intensity. Importantly, safe and effective exercise prescription for patients with CHF requires more than the application of these principles; it also requires careful consideration of the individual patients’ functional status, comorbid conditions, medications, contraindications, and personal goals and preferences. Recent studies have demonstrated that a wide spectrum of patients with CHF benefit from appropriately applied exercise training, including those with both systolic and diastolic dysfunction, atrial fibrillation, pacemakers, implantable cardioversion devices, and post-cardiac transplantation. Increasingly, the principles of exercise prescription are included as a component of comprehensive CHF management programs. Evidence has accumulated that CHF patients who participate in rehabilitation programs have better health outcomes in terms of reduced morbidity and mortality, as well as lower hospitalization rates and lower overall health care costs.

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References

  1. Pina IL, Apstein CS, Balady GJ, Bellardinelli R, Chaitman B, Duscha BD, Fletcher BJ, Fleg JL, Myers JN, Sullivan MJ (2003) Exercise and heart failure: a statement from the American heart association committee on exercise, rehabilitation, and prevention. Circulation 107(8):1210–1225

    Article  PubMed  Google Scholar 

  2. Myers J, Froelicher VF (1991) Hemodynamic determinants of exercise capacity in chronic heart failure. Ann Intern Med 115:377–386

    PubMed  CAS  Google Scholar 

  3. Kitzman DW (2005) Exercise intolerance. Prog Cardiovasc Dis 47:367–379

    Article  PubMed  Google Scholar 

  4. Drexler H, Coats AJS (1996) Explaining fatigue in congestive heart failure. Annu Rev Med 47:241–256

    Article  PubMed  CAS  Google Scholar 

  5. Larsen AI, Dickstein K (2005) Exercise training in congestive heart failure. A review of the current status. Minerva Cardioangiol 53:275–286

    PubMed  CAS  Google Scholar 

  6. Franklin BA (2005) Cardiovascular events associated with exercise. The risk-protection paradox. J Cardiopulm Rehabil 25:189–195

    Article  PubMed  Google Scholar 

  7. Franklin BA (2003) Myocardial infarction. In: Durstine JL Moore GE (eds) ACSMs Exercise Management for Persons with Chronic Diseases and Disabilities, 2nd edn. Human Kinetics, Champaign pp 24–31

    Google Scholar 

  8. Myers JN, Brubaker PH (2003) Chronic Heart Failure. In: Durstine JL, Moore GE (eds) ACSMs exercise management for persons with chronic diseases and disabilities, 2nd edn. Human Kinetics, Champaign, pp 64–69

    Google Scholar 

  9. Haykowsky MJ, Ezekowitz JA, Armstrong PW (2004) Therapeutic exercise for individuals with heart failure: special attention to older women with heart failure. J Cardiac Fail 10:165–173

    Article  CAS  Google Scholar 

  10. Myers J, Salleh A, Buchanan N et al (1992) Ventilatory mechanisms of exercise intolerance in chronic heart failure. Am Heart J 124:710–729

    Article  PubMed  CAS  Google Scholar 

  11. Recommendations for exercise training in chronic heart failure patients (2001) Working group on cardiac rehabilitation & exercise physiology and working group on heart failure of the European society of cardiology. Eur Heart J 22:125–135

    Article  Google Scholar 

  12. Myers J (2000) Effects of exercise training on abnormal ventilatory responses to exercise in patients with chronic heart failure. Congest Heart Fail 6:243–249

    Article  PubMed  Google Scholar 

  13. Piepoli MF, Cavos C, Francis DP et al (2004) Exercise training meta-analysis of trials in patients with chroinic heart failure (ExTraMATCH). BMJ 328:711

    Article  Google Scholar 

  14. Olson TP, Snyder EM, Johnson BD (2006) Exercise-disordered breathing in chronic heart failure. Exerc Sport Sci Rev 34:194–201

    Article  PubMed  Google Scholar 

  15. Arena R, Guazzi M, Myers J (2007) Ventilatory abnormalities during exercise in heart failure: a mini review. Current Respiratory Med Rev 3:179–187

    Article  Google Scholar 

  16. Clark AL, Poole-Wilson PA, Coats AJ (1996) Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol 28:1092–1102

    Article  PubMed  CAS  Google Scholar 

  17. Defoor J, Schepers D, Reybrouck T et al (2006) Oxygen uptake efficiency slope in coronary artery disease: clinical use and response to training. Int J Sports Med 27:730–737

    Article  PubMed  CAS  Google Scholar 

  18. Goebbels U, Myers J, Dziekan G et al (1998) A randomized comparison of exercise training in patients with normal vs. reduced ventricular function. Chest 113:1387–1393

    PubMed  CAS  Google Scholar 

  19. Wenger NK, Froelicher ES, Smith LK et al (1995) Cardiac rehabilitation: clinical practice guidelines. Agency for health care policy and research and the national heart, lung and blood institute, Rockville, MD

    Google Scholar 

  20. Kennedy MD, Haykowsky M, Humphrey R (2003) Function, eligibility, outcomes, and exercise capacity associated with left ventricular assist devices: exercise rehabilitation and training for patients with ventricular assist devices. J Cardiopulm Rehabil 23:208–217

    Article  PubMed  Google Scholar 

  21. Belardinelli R, Capestro F, Misiani A et al (2006) Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. Eur J Cardiovasc Prev Rehabil 13:818–825

    Article  PubMed  Google Scholar 

  22. Kamke W, Dovifat C, Schranz M et al (2003) Cardiac rehabilitation in patients with implantable defibrillators. Feasibility and complications. Z Kardiol 92:869–875

    Article  PubMed  CAS  Google Scholar 

  23. Vanhees L, Kornaat M, Defoor J et al (2004) Effect of exercise training in patients with an implantable cardioverter defibrillator. Eur Heart J 25:1120–1126

    Article  PubMed  Google Scholar 

  24. Parmley WW (1986) Position report on cardiac rehabilitation. Recommendations of the American college of cardiology. J Am Coll Cardiol 7(2):451–453

    Article  PubMed  CAS  Google Scholar 

  25. Pollock ML, Gaesser GA, Butcher JD et al (1998) The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 30:975–991

    Article  Google Scholar 

  26. Meyer T, Gorge G, Schwaab B et al (2005) An alternative approach for exercise prescription and efficacy testing in patients with chronic heart failure: a randomized controlled training study. Am Heart J 149:e1–e7

    Article  PubMed  Google Scholar 

  27. Curnier D, Galinier M, Pathak A et al (2001) Rehabilitation of patients with congestive heart failure with or without beta-blockade therapy. J Card Fail 7:241–248

    Article  PubMed  CAS  Google Scholar 

  28. Meyer K, Samek L, Schwaibold M et al (1996) Physical responses to different modes of interval exercise in patients with chronic heart failure—application to exercise training. Eur Heart J 17:1040–1047

    PubMed  CAS  Google Scholar 

  29. Keteyian SJ, Levine AB, Brawner CA et al (1996) Exercise training in patients with heart failure. A randomized, controlled trail. Ann Intern Med 124:1051–1057

    PubMed  CAS  Google Scholar 

  30. Schuchert A (2005) Atrial fibrillation and heart failure comorbidity. Minerva Cardioangiol 53:299–311

    PubMed  CAS  Google Scholar 

  31. Volaklis KA, Tokmakidis SP (2005) Resistance exercise training in patients with heart failure. Sports Med 35:1085–1093

    Article  PubMed  Google Scholar 

  32. Benton MJ (2005) Safety and efficacy of resistance training in patients with chronic heart failure: research-based evidence. Prog Cardiovasc Nurs 20:17–23

    Article  PubMed  Google Scholar 

  33. Meyer K (2006) Resistance exercise in chronic heart failure—landmark studies and implications for practice. Clin Invest Med 29:166–169

    PubMed  Google Scholar 

  34. Braith RW (1998) Exercise training in patients with CHF and heart transplant recipients. Med Sci Sports Exerc 30(10 Suppl):S367–S378

    PubMed  CAS  Google Scholar 

  35. Mattauer B, Levy F, Richard R et al (2005) Exercising with a denervated heart after cardiac transplantation. Ann Transplant 10:35–42

    Google Scholar 

  36. Kavanagh T (1996) Physical training in heart transplant recipients. J Cardiovasc Risk 3:154–159

    Article  PubMed  CAS  Google Scholar 

  37. Kobashigawa JA, Leaf DA, Lee N et al (1999) A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 340:272–277

    Article  PubMed  CAS  Google Scholar 

  38. Braith RW, Magyari PM, Fulton MN et al (2006) Comparison of calcitonin versus calcitonin + resistance exercise as prophylaxis for osteoporosis in heart transplant recipients. Transplantation 81:1191–1195

    Article  PubMed  CAS  Google Scholar 

  39. Braith RW, Magyari PM (2001) Resistance training in organ transplant recipients. In: Graves JE, Franklin BA (eds) Resistance training for health and rehabilitation. Human Kinetics, Champaign, pp 253–273

    Google Scholar 

  40. Ades PA, Balady GJ, Berra K (2001) Transforming exercise-based cardiac rehabilitation programs into secondary prevention centers: a national imperative. J Cardiopulm Rehabil 21:263–272

    Article  PubMed  CAS  Google Scholar 

  41. Ahmed A (2002) Quality and outcomes of heart failure care in older adults: role of multidisciplinary disease-management programs. J Am Geriatr Soc 50:1590–1593

    Article  PubMed  Google Scholar 

  42. Whellan DJ, Hasselblad V, Peterson E et al (2005) Meta-analysis and review of heart failure disease management randomized controlled clinical trails. Am Heart J 149:722–729

    Article  PubMed  Google Scholar 

  43. Roccaforte R, Demers C, Baldassarre F et al (2005) Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. a meta-analysis. Eur J Heart Fail 7:1077–1078

    Article  Google Scholar 

  44. Krumholz HM, Amatruda J, Smith GL et al (2002) Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol 39:83–89

    Article  PubMed  Google Scholar 

  45. Blair SN, LaMonte MJ, Nichman MZ (2004) The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr 79:913S–920S

    PubMed  CAS  Google Scholar 

  46. Brooks GA, Butte NF, Rand WM, Flatt JP, Caballero B (2004) Chronicle of the institute of medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr 79:921S–930S

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiology Division (111C), VA Palo Alto Health Care System, Stanford University, 3801 Miranda Ave., Palo Alto, CA, 94304, USA

    Jonathan Myers

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  1. Jonathan Myers
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Correspondence to Jonathan Myers.

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Myers, J. Principles of exercise prescription for patients with chronic heart failure. Heart Fail Rev 13, 61–68 (2008). https://doi.org/10.1007/s10741-007-9051-0

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