51
|
Brisset U, Monpère C. Le réentraînement chez l’insuffisant cardiaque. Un point sur les différentes études et modalités pratiques de la rééducation. Sci Sports 2012. [DOI: 10.1016/j.scispo.2011.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
52
|
|
53
|
Fowler RM, Maiorana AJ, Jenkins SC, Gain KR, O'Driscoll G, Gabbay E. A comparison of the acute haemodynamic response to aerobic and resistance exercise in subjects with exercise-induced pulmonary arterial hypertension. Eur J Prev Cardiol 2012; 20:605-12. [PMID: 22505056 DOI: 10.1177/2047487312445424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exercise-induced pulmonary arterial hypertension (EIPAH) is associated with reduced exercise capacity and abnormal central haemodynamic responses to maximal aerobic exercise. Aerobic and resistance exercise training are commonly employed to treat reduced exercise capacity; however, the haemodynamic response to aerobic and resistance exercise, at training intensities, in subjects with EIPAH is unknown. METHODS Fourteen subjects (11 with scleroderma, 12 females) with EIPAH underwent cardiopulmonary exercise testing on a cycle ergometer, a one-repetition maximum (1RM) strength test and resistance exercise at 40% and 60% of maximum on a bilateral leg press machine. All tests were performed with a pulmonary artery catheter in situ. Haemodynamic and symptomatic responses to aerobic and resistance exercise, performed at 40% of peak oxygen consumption and 40% of 1RM, and at 60% of peak oxygen consumption and 60% of 1RM, were compared. For maximal exercise, the highest haemodynamic responses recorded during the cycling and 1RM tests were compared. RESULTS There were no differences in haemodynamic or symptomatic responses between the two modalities of submaximal exercise. At maximal exercise, all haemodynamic and symptomatic responses were lower during resistance compared with aerobic exercise (p < 0.05). CONCLUSIONS At the intensities studied, lower-limb resistance exercise was well tolerated and was mostly associated with similar or lower haemodynamic responses compared with aerobic exercise, in subjects with EIPAH.
Collapse
Affiliation(s)
- Robin M Fowler
- Advanced Lung Disease Program, Royal Perth Hospital, Perth, Australia.
| | | | | | | | | | | |
Collapse
|
54
|
Abstract
Thickening of the carotid artery wall has been adopted as a surrogate marker of pre-clinical atherosclerosis, which is strongly related to increased cardiovascular risk. The cardioprotective effects of exercise training, including direct effects on vascular function and lumen dimension, have been consistently reported in asymptomatic subjects and those with cardiovascular risk factors and diseases. In the present review, we summarize evidence pertaining to the impact of exercise and physical activity on arterial wall remodelling of the carotid artery and peripheral arteries in the upper and lower limbs. We consider the potential role of exercise intensity, duration and modality in the context of putative mechanisms involved in wall remodelling, including haemodynamic forces. Finally, we discuss the impact of exercise training in terms of primary prevention of wall thickening in healthy subjects and remodelling of arteries in subjects with existing cardiovascular disease and risk factors.
Collapse
|
55
|
Fowler R, Jenkins S, Maiorana A, Gain K, O'Driscoll G, Gabbay E. Australian perspective regarding recommendations for physical activity and exercise rehabilitation in pulmonary arterial hypertension. J Multidiscip Healthc 2011; 4:451-62. [PMID: 22247620 PMCID: PMC3256005 DOI: 10.2147/jmdh.s26617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIM To determine the opinion of health care professionals within Australia, regarding acceptable levels of exertion and symptoms, and referral for exercise rehabilitation in patients with pulmonary arterial hypertension (PAH). METHOD In 2010, 76 health care professionals at a specialist pulmonary hypertension meeting in Australia were surveyed using a self-administered questionnaire. The questionnaire included case studies of patients with PAH in World Health Organization (WHO) functional classes II-IV. For each case study, respondents were asked to report their opinion regarding the acceptable level of exertion and symptoms during daily activities, and whether they would refer the patient for exercise rehabilitation. Three additional questions asked about advice in relation to four specific physical activities. RESULTS The response rate was 70% (n = 53). Overall, 58% of respondents recommended patients undertake daily activities 'as tolerated'. There was no consensus regarding acceptable levels of breathlessness or fatigue, but the majority of respondents considered patients should have no chest pain (73%) and no more than mild light-headedness (92%) during daily activities. Overall, 63% of respondents would have referred patients for exercise rehabilitation. There was little difference in opinion regarding the acceptable level of exertion or symptoms, or referral for exercise rehabilitation, according to functional class. However, the patients' functional class did influence the advice given regarding the specific physical activities. CONCLUSION In 2010, there were inconsistencies between individual health care professionals within Australia regarding appropriate levels of physical exertion and acceptable symptoms during daily activities. Almost two-thirds of the respondents reported they would refer patients for exercise rehabilitation.
Collapse
Affiliation(s)
- Robin Fowler
- Advanced Lung Disease Program, Royal Perth Hospital
| | | | | | | | | | | |
Collapse
|
56
|
Mendes MDFA, Lopes WDS, Nogueira GÂ, Wilson A, Araújo SMD, Gomes ML. Exercício físico aeróbico em mulheres com doença de Chagas. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000400002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUÇÃO: A forma cardíaca da doença de Chagas causa modificações orgânicas e funcionais, sendo o exercício físico aeróbio uma alternativa de proposta terapêutica. OBJETIVO: avaliar o exercício físico aeróbio em mulheres com doença de Chagas crônica. MATERIAIS E MÉTODOS: Quatorze mulheres com doença de Chagas na faixa etária entre 40 e 60 anos, classe I da New York Heart Association (NYHA) foram divididas em dois grupos. Sete no G1 que realizaram exercício físico, com duas sessões diárias semanais por seis semanas e sete no G2 sem tal intervenção. O efeito do exercício físico foi avaliado por 27 variáveis fisioterapêuticas e ergoespirométricas no tempo zero (T0) e após seis semanas (T6). RESULTADO: No T6 em relação ao T0 a avaliação fisioterapêutica mostrou diferenças significativas na pressão arterial sistólica, no pico do fluxo expiratório, nas pressões inspiratória e expiratória máximas e na frequência cardíaca. Na ergoespirometria houve aumento significativo no DP máximo, no MET máximo, no estágio do protocolo de Bruce, no VO2 máximo, na duração do teste e na distância percorrida para as participantes de G1 e apenas na duração do teste para G2. Para G1 foi ainda observada em T6 uma diminuição significativa do duplo produto na intensidade moderada e alta na mesma carga de esforço. CONCLUSÃO: O treinamento aeróbio de curto período, de simples aplicação e com supervisão pode ser realizado com segurança, aumentando a tolerância ao exercício em pacientes com doença de Chagas crônica classe I da NYHA.
Collapse
|
57
|
Savage PD, Sanderson BK, Brown TM, Berra K, Ades PA. Clinical research in cardiac rehabilitation and secondary prevention: looking back and moving forward. J Cardiopulm Rehabil Prev 2011; 31:333-41. [PMID: 21946418 PMCID: PMC3219833 DOI: 10.1097/hcr.0b013e31822f0f79] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Cardiac rehabilitation/secondary prevention (CR/SP) programs are considered standard of care and provide critically important resources for optimizing the care of cardiac patients. The objective of this article is to briefly review the evolution of CR/SP programs from a singular exercise intervention to its current, more comprehensive multifaceted approach. In addition, we offer perspective on critical concerns and suggest future research considerations to optimize the effectiveness and utilization of CR/SP program interventions.
Collapse
Affiliation(s)
- Patrick D. Savage
- Division of Cardiology, Cardiac Rehabilitation & Prevention, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
| | | | - Todd M. Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Kathy Berra
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - Philip A. Ades
- Division of Cardiology, Cardiac Rehabilitation & Prevention, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT
| |
Collapse
|
58
|
Burniston JG, Hoffman EP. Proteomic responses of skeletal and cardiac muscle to exercise. Expert Rev Proteomics 2011; 8:361-77. [PMID: 21679117 DOI: 10.1586/epr.11.17] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Regular exercise is effective in the prevention of chronic diseases and confers a lower risk of death in individuals displaying risk factors such as hypertension and dyslipidemia. Thus, knowledge of the molecular responses to exercise provides a valuable contrast for interpreting investigations of disease and can highlight novel therapeutic targets. While exercise is an everyday experience and can be conceptualized in simple terms, it is also a complex physiological phenomenon and investigation of exercise responses requires sophisticated analytical techniques and careful standardization of the exercise stimulus. Proteomic investigation of exercise is in its infancy but the ability to link changes in function with comprehensive changes in protein expression and post-translational modification holds great promise for advancing physiology. This article highlights recent pioneering work investigating the effects of exercise in skeletal and cardiac muscle that has uncovered novel mechanisms underlying the benefits of physical activity.
Collapse
Affiliation(s)
- Jatin G Burniston
- Muscle Physiology and Proteomics Laboratory, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| | | |
Collapse
|
59
|
Elahi M, Mahmood M, Shahbaz A, Malick N, Sajid J, Asopa S, Matata BM. Current concepts underlying benefits of exercise training in congestive heart failure patients. Curr Cardiol Rev 2011; 6:104-11. [PMID: 21532776 PMCID: PMC2892075 DOI: 10.2174/157340310791162640] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 01/09/2010] [Accepted: 02/01/2010] [Indexed: 01/14/2023] Open
Abstract
The pathophysiology of several conditions including heart failure is partly attributable to a failure of the cell energy metabolism. Studies have shown that exercise training (ET) improves quality of life (QOL) and is beneficial in terms of reduction of symptoms, mortality and duration of hospitalization. Increasingly, ET is now achieving acceptance as complimentary therapy in addition to routine clinical practice in patients with chronic heart failure (CHF). However, the mechanisms underlying the beneficial effects of ET are far less understood and need further evaluation. Evidence suggests that while CHF induces generalized metabolic energy depletion, ET largely enhances the overall function of the heart muscle. Hence, research efforts are now aiming to uncover why ET is beneficial as a complimentary treatment of CHF in the context of improving endothelial function and coronary perfusion, decreasing peripheral resistance, induction of cardiac and skeletal muscle cells remodeling, increasing oxygen uptake, substrate oxidation, and resistance to fatigue. Here we discuss the current evidence that suggest that there are beneficial effects of ET on cardiac and skeletal muscle cells oxidative metabolism and intracellular energy transfer in patients with CHF.
Collapse
Affiliation(s)
- Maqsood Elahi
- Wessex Cardiothoracic Centre, General/ BUPA, Chalybeate Close, Southampton, SO16 6UY, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
60
|
Anagnostakou V, Chatzimichail K, Dimopoulos S, Karatzanos E, Papazachou O, Tasoulis A, Anastasiou-Nana M, Roussos C, Nanas S. Effects of interval cycle training with or without strength training on vascular reactivity in heart failure patients. J Card Fail 2011; 17:585-91. [PMID: 21703531 DOI: 10.1016/j.cardfail.2011.02.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exercise training confers beneficial effects on vascular reactivity in patients with chronic heart failure (CHF). This randomized study compares the effects of interval cycle training combined with strength training versus interval training alone on vascular reactivity in CHF patients. METHODS Twenty-eight consecutive stable CHF patients (23 males, 53 ± 10 years, 28.4 ± 4.1 kg/m(2), left ventricular ejection fraction of 37 ± 12%) were randomly assigned to 3 times' weekly training sessions for 3 months, consisting of a) 40 minutes of interval cycle training (n = 14), versus b) 20 minutes of similar interval training plus 20 minutes of strength training of the quadriceps, hamstrings, muscles of the shoulder and biceps brachialis (n = 14). The work/recovery ratio of each session was 30/60 seconds. The intensity of interval training was set at 50% of the peak workload achieved at the steep ramp test (consisted of a 25-Watt increase on a cycle ergometer every 10 seconds until exhaustion). All patients underwent maximal, symptom-limited cardiopulmonary exercise testing and ultrasound evaluation of vascular reactivity by flow-mediated vasodilation (FMD) before and after the program. RESULTS A significant improvement in FMD was observed in the combined training group (P = 0.002), in contrast to the interval training alone group (P = NS); the improvement was significantly greater in the combined training than in the interval training alone group (P < .05). Peak oxygen uptake increased significantly and similarly in both groups, in the interval training group (P = .03), and in the combined training group (P = .006). No significant correlation was found between FMD improvement and cardiopulmonary exercise parameters. CONCLUSIONS A combined high-intensity, interval cycle exercise with strength training induces a greater beneficial effect on vascular reactivity rather than interval exercise training alone in CHF patients.
Collapse
Affiliation(s)
- Vania Anagnostakou
- 1(st) Critical Care Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, NKUA, Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
61
|
Ganderton L, Jenkins S, Gain K, Fowler R, Winship P, Lunt D, Gabbay E. Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial. BMC Pulm Med 2011; 11:25. [PMID: 21600062 PMCID: PMC3126789 DOI: 10.1186/1471-2466-11-25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 05/23/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Advances in the understanding and management of pulmonary arterial hypertension have enabled earlier diagnosis and improved prognosis. However, despite best available therapy, symptoms of exertional dyspnoea and fatigue are commonly reported and result in a reduced capacity to perform daily activities and impaired quality of life. Exercise training has demonstrated efficacy in individuals with other respiratory and cardiovascular diseases. Historically, however, exercise training has not been utilised as a form of therapy in pulmonary arterial hypertension due to the perceived risk of sudden cardiac death and the theoretical possibility that exercise would lead to worsening pulmonary vascular haemodynamics and deterioration in right heart function. Now, with the advances in pharmaceutical management, determining the safety and benefits of exercise training in this population has become more relevant. Only three studies of supervised exercise training in pulmonary arterial hypertension have been published. These studies demonstrated improvements in exercise capacity and quality of life, in the absence of adverse events or clinical deterioration. However, these studies have not utilised an outpatient-based, whole body exercise training program, the most common format for exercise programs within Australia. It is uncertain whether this form of training is beneficial and capable of producing sustained benefits in exercise capacity and quality of life in this population. DESIGN/METHODS This randomised controlled trial will determine whether a 12 week, outpatient-based, supervised, whole body exercise training program, followed by a home-based exercise program, is safe and improves exercise capacity and quality of life in individuals with pulmonary arterial hypertension. This study aims to recruit 34 subjects who will be randomly allocated to the exercise group (supervised exercise training 3 times a week for 12 weeks, followed by 3 sessions per week of home exercise for 12 weeks) or the control group (usual medical care). Subjects will be assessed at baseline, 12 weeks and 24 weeks. DISCUSSION This study will determine whether outpatient-based, whole body exercise training is beneficial and safe in individuals with pulmonary arterial hypertension. Additionally, this study will contribute to clinical practice guidelines for this patient population. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000502235.
Collapse
Affiliation(s)
- Louise Ganderton
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- Royal Perth Hospital, Perth, Australia
- Lung Institute of Western Australia, Centre for Asthma, Allergy and Respiratory Research, University of Western Australia
| | - Sue Jenkins
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- Lung Institute of Western Australia, Centre for Asthma, Allergy and Respiratory Research, University of Western Australia
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Kevin Gain
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- Royal Perth Hospital, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Robin Fowler
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- Royal Perth Hospital, Perth, Australia
- Lung Institute of Western Australia, Centre for Asthma, Allergy and Respiratory Research, University of Western Australia
| | | | | | - Eli Gabbay
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
- Royal Perth Hospital, Perth, Australia
- Lung Institute of Western Australia, Centre for Asthma, Allergy and Respiratory Research, University of Western Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| |
Collapse
|
62
|
Abstract
The volume of literature attesting to the clinical benefits of exercise training in patients with stable chronic heart failure (CHF) is substantial. Training can improve symptoms and exercise capacity, as well as reducing morbidity, mortality, and rates of emergency hospitalization. These benefits are apparent in all patients with stable CHF, irrespective of age or sex, or the etiology or severity of heart failure. Training regimens for patients with stable, systolic CHF should form part of a comprehensive heart-failure support effort and are best delivered using supervised in-hospital exercise combined with some training at home or in a group setting in community centers. In this Review, the modes and intensity of exercise training, selection of patients, duration of training effects, and other clinical guidance for using this treatment option are discussed.
Collapse
Affiliation(s)
- Andrew J Stewart Coats
- The Norwich Research Park, University of East Anglia, Colney Lane, Norwich, Norfolk NR4 7TJ, UK.
| |
Collapse
|
63
|
Maiorana AJ, Naylor LH, Exterkate A, Swart A, Thijssen DH, Lam K, O'Driscoll G, Green DJ. The Impact of Exercise Training on Conduit Artery Wall Thickness and Remodeling in Chronic Heart Failure Patients. Hypertension 2011; 57:56-62. [DOI: 10.1161/hypertensionaha.110.163022] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Exercise training is an important adjunct to medical therapy in chronic heart failure, but the extent to which exercise impacts on conduit artery remodeling is unknown. The aim of this study was to evaluate the impact of aerobic and resistance exercise training modalities on arterial remodeling in patients with chronic heart failure. We randomized 36 untrained subjects with chronic heart failure to resistance training (58.8±3.5 years), aerobic training (61.3±2.8 years), or an untrained control group (64.4±2.4 years). Peak oxygen consumption during cycle ergometry increased after 12 weeks in both the resistance and aerobic training (
P
<0.001) groups, but not in controls, whereas leg strength only increased after resistance training (
P
<0.05). Brachial artery wall thickness decreased in the resistance training group (475±10 versus 443±13 μm;
P
<0.01), whereas no changes were apparent in the aerobic or control groups. Brachial diameter increased by ≈6% and ≈5% in the aerobic training and resistance training groups (
P
<0.01), with no change evident in the control group. The wall:lumen ratio consequently declined in the resistance training group at 12 weeks (0.121±0.004 versus 0.107±0.004;
P
<0.01) and increased in the control group (0.111±0.006 versus 0.121±0.009;
P
<0.05). No wall:lumen change was evident in the aerobic training group. Our findings suggest that exercise has a systemic impact on remodeling of conduit arteries in humans and that resistance exercise training may be advantageous in subjects with chronic heart failure in this regard.
Collapse
Affiliation(s)
- Andrew J. Maiorana
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Louise H. Naylor
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Anne Exterkate
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Anne Swart
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Dick H.J. Thijssen
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Kaitlyn Lam
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Gerry O'Driscoll
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| | - Daniel J. Green
- From the Advanced Heart Failure and Cardiac Transplant Service (A.J.M., K.L., G.O.), Royal Perth Hospital, Perth, Western Australia, Australia; School of Physiotherapy and Curtin Health Innovation Research Institute (A.J.M.), Curtin University, Perth, Western Australia, Australia; School of Sport Science, Exercise, and Health (L.H.N., D.J.G.), University of Western Australia, Perth, Western Australia, Australia; Department of Physiology (A.E., A.S., D.H.J.T.), Radboud University Nijmegen Medical
| |
Collapse
|
64
|
FEIEREISEN PATRICK, VAILLANT MICHEL, EISCHEN DAISY, DELAGARDELLE CHARLES. Isokinetic versus One-Repetition Maximum Strength Assessment in Chronic Heart Failure. Med Sci Sports Exerc 2010; 42:2156-63. [DOI: 10.1249/mss.0b013e3181e3e2cb] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
65
|
Tasoulis A, Papazachou O, Dimopoulos S, Gerovasili V, Karatzanos E, Kyprianou T, Drakos S, Anastasiou-Nana M, Roussos C, Nanas S. Effects of interval exercise training on respiratory drive in patients with chronic heart failure. Respir Med 2010; 104:1557-65. [PMID: 20663654 DOI: 10.1016/j.rmed.2010.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 03/11/2010] [Accepted: 03/16/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) suffer from ventilatory abnormalities. This study examined the effects of interval exercise training on the respiratory drive in CHF patients. METHODS Forty-six clinically stable CHF patients (38 males/8 women, mean age = 53 +/- 11 years) participated in an exercise rehabilitation program (ERP) 3 times/week, for 12 weeks by interval training modality with or without the addition of resistance training. All patients underwent symptom-limited cardiopulmonary exercise testing (CPET), and measurements of mouth occlusion pressure at 100 ms (P(0.1)) and maximum inspiratory muscle strength (P(Imax)) before and after ERP. Respiratory drive was estimated by mouth occlusion pressure P(0.1) and P(0.1)/P(Imax) ratio at rest, and the ventilatory pattern by resting mean inspiratory flow (V(T)/T(I)) and by V(T)/T(I) at identical CPET workloads, before and after ERP. We also studied a control non exercising group of 11 patients (8 men and 3 women). RESULTS P(0.1) at rest decreased from 3.04 +/- 1.52 to 2.62 +/- 0.9 cmH(2)O (p = 0.015), P(0.1)/P(Imax) % at rest from 4.56 +/- 3.73 to 3.69 +/- 2.03 (p = 0.006), resting V(T)/T(I) from 0.44 +/- 0.10 to 0.41 +/- 0.10 l/s (p = 0.014), and V(T)/T(I) at identical work rate from 2.13 +/- 0.59 to 1.93 +/- 0.58 l/s (p = 0.001) after ERP. VO(2) at peak exercise increased from 16.3 +/- 4.8 to 18.5 +/- 5.3 ml/kg/min (p < 0.001) in the exercise group. No improvement was noted in the control group. CONCLUSIONS ERP by interval training improves the respiratory drive and ventilatory pattern at rest and during exercise in CHF patients.
Collapse
Affiliation(s)
- Athanasios Tasoulis
- Pulmonary & Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, National & Kapodistrian University of Athens, Papadiamantopoulou St, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Dobrosielski DA, Greenway FL, Welsh DA, Jazwinski SM, Welsch MA. Modification of vascular function after handgrip exercise training in 73- to 90-yr-old men. Med Sci Sports Exerc 2010; 41:1429-35. [PMID: 19516158 DOI: 10.1249/mss.0b013e318199bef4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine the influence of a unilateral exercise training protocol on brachial artery reactivity (BAR) in 12 men (aged 81 +/- 5 yr). METHODS Brachial artery diameters and blood flow parameters were assessed, in both arms, using high-resolution ultrasonography, before and after 5 min of forearm occlusion, before and at the end of each week of a 4-wk training program. Training consisted of a unilateral handgrip training protocol (nondominant arm) at 60% of maximal voluntary handgrip strength, performed for 4 wk, 4 d x wk(-1), 20 min per session, and a cadence of one contraction per 4 s. RESULTS After training, handgrip strength increased 6.2% (baseline = 32.4 +/- 7.0 kg vs week 4 = 34.4 +/- 6.7 kg) in the trained arm only but failed to reach statistical significance (P = 0.10). No statistical changes were observed for blood pressure or resting HR. In contrast, BAR increased 45% (Pre = 2.9% vs Post = 4.1%, P = 0.05) in the trained arm only. Improvements in BAR were observed after the second week of training, without significant changes in the main vasodilatory trigger, defined as the relevant shear stimulus after forearm occlusion (P > 0.05). CONCLUSIONS These data indicate that a localized short-term exercise program results in significant improvements in vascular function in the trained arm of elderly men compared with the control arm. Furthermore, the findings indicate a statistically significant increase in BAR at the end of the second week of training, despite a similar trigger for dilation versus before training.
Collapse
|
67
|
Alkarmi A, Thijssen DHJ, Albouaini K, Cable NT, Wright DJ, Green DJ, Dawson EA. Arterial prehabilitation: can exercise induce changes in artery size and function that decrease complications of catheterization? Sports Med 2010; 40:481-92. [PMID: 20524713 DOI: 10.2165/11531950-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary angiography and angioplasty are common invasive procedures in cardiovascular medicine, which involve placement of a sheath inside peripheral conduit arteries. Sheath placement and catheterization can be associated with arterial thrombosis, spasm and occlusion. In this paper we review the literature pertaining to the possible benefits of arterial 'prehabilitation'--the concept that interventions aimed at enhancing arterial function and size (i.e. remodelling) should be undertaken prior to cardiac catheterization or artery harvest during bypass graft surgery. The incidence of artery spasm, occlusion and damage is lower in larger arteries with preserved endothelial function. We conclude that the beneficial effects of exercise training on both artery size and function, which are particularly evident in individuals who possess cardiovascular diseases or risk factors, infer that exercise training may reduce complication rates following catheterization and enhance the success of arteries harvested as bypass grafts. Future research efforts should focus directly on examination of the 'prehabilitation' hypothesis and the efficacy of different interventions aimed at reducing clinical complications of common interventional procedures.
Collapse
Affiliation(s)
- Amr Alkarmi
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | | | |
Collapse
|
68
|
Hwang CL, Chien CL, Wu YT. Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review. J Physiother 2010; 56:87-96. [PMID: 20482475 DOI: 10.1016/s1836-9553(10)70038-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
QUESTION Does resistance training, either alone or as an adjunct to aerobic training, improve cardiac function, exercise capacity and quality of life in people with chronic heart failure? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults with stable chronic heart failure. INTERVENTION Progressive resistance exercise training, alone or as an adjunct to aerobic training. OUTCOME MEASURES Cardiac function, exercise capacity and quality of life. RESULTS 241 participants from eight trials performed 2 to 6 months of moderate-intensity resistance training (50-75% of 1RM). Most programs consisted of 5 to 6 exercises for large limb and trunk muscles with two sets of 8 to 12 repetitions, three times a week. Resistance training significantly increased 6-minute walk distance (WMD 52 m, 95% CI 19 to 85) but not peak oxygen consumption (WMD 1.4 ml/kg/min, 95% CI -0.3 to 3.1). When used as an adjunct to aerobic training, resistance training did not significantly alter left ventricular ejection fraction (WMD -0.5%, 95% CI -4.3 to 3.3), peak oxygen consumption (WMD -0.7 ml/kg/min, 95% CI -2.3 to 1.0), or Minnesota Living with Heart Failure Questionnaire scores (WMD -0.9, 95% CI -5.4 to 3.7), compared with aerobic training alone. CONCLUSION Resistance training increased 6-minute walk distance compared to no training, but had no other benefits on cardiac function, exercise capacity, or quality of life if used alone or as an adjunct to aerobic training in people with chronic heart failure. However, further high quality, large scale, randomised trials are needed.
Collapse
|
69
|
Selig SE, Levinger I, Williams AD, Smart N, Holland DJ, Maiorana A, Green DJ, Hare DL. Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure. J Sci Med Sport 2010; 13:288-94. [DOI: 10.1016/j.jsams.2010.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 12/31/2022]
|
70
|
Thijssen DHJ, Maiorana AJ, O’Driscoll G, Cable NT, Hopman MTE, Green DJ. Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol 2010; 108:845-75. [PMID: 19943061 PMCID: PMC2829129 DOI: 10.1007/s00421-009-1260-x] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2009] [Indexed: 12/12/2022]
Abstract
The effects of inactivity and exercise training on established and novel cardiovascular risk factors are relatively modest and do not account for the impact of inactivity and exercise on vascular risk. We examine evidence that inactivity and exercise have direct effects on both vasculature function and structure in humans. Physical deconditioning is associated with enhanced vasoconstrictor tone and has profound and rapid effects on arterial remodelling in both large and smaller arteries. Evidence for an effect of deconditioning on vasodilator function is less consistent. Studies of the impact of exercise training suggest that both functional and structural remodelling adaptations occur and that the magnitude and time-course of these changes depends upon training duration and intensity and the vessel beds involved. Inactivity and exercise have direct "vascular deconditioning and conditioning" effects which likely modify cardiovascular risk.
Collapse
Affiliation(s)
- Dick H. J. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Andrew J. Maiorana
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Australia
- School of Physiotherapy, Curtin University of Technology, Perth, Australia
| | - Gerry O’Driscoll
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, Australia
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Nigel T. Cable
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
| | - Maria T. E. Hopman
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Daniel J. Green
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, 15–21 Webster Street, Liverpool, L3 2ET UK
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Australia
| |
Collapse
|
71
|
Resistance exercise training improves heart function and physical fitness in stable patients with heart failure. J Cardiopulm Rehabil Prev 2010; 29:294-8. [PMID: 19561521 DOI: 10.1097/hcr.0b013e3181ac784b] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study determined the effect of a structured isotonic strength training (ST) program on left ventricular (LV) function (ejection fraction, stroke volume, and end-diastolic and end-systolic volumes) and physical fitness (6-minute walk test, upper body strength, lower body strength, and body composition) in patients with New York Heart Association class II and III heart failure. METHODS Sixteen patients were randomized into 2 groups, ST and usual care. The ST group (10 patients) performed 24 ST exercise sessions (3 per week, 8 weeks), while the usual care (6 patients) group followed routine medical care. The structured isotonic ST program involved 12 different exercises on circuit weight machines. LV function (3D echocardiography) and physical fitness were assessed at baseline and 8 weeks. RESULTS Modest improvements (P < .05) in resting ejection fraction (0.32-0.37) and stroke volume (46 to 53 mL/beat), as well as in muscular strength and 6-minute walk distance, were found after training. CONCLUSIONS A short-term structured isotonic ST program appears to improve selected measures of resting LV function and fitness in patients with mild congestive heart failure. Additional studies utilizing larger numbers of subjects, including women, are needed.
Collapse
|
72
|
Lamotte M, Fleury F, Pirard M, Jamon A, Borne PVD. Acute cardiovascular response to resistance training during cardiac rehabilitation: effect of repetition speed and rest periods. ACTA ACUST UNITED AC 2010; 17:329-36. [DOI: 10.1097/hjr.0b013e328332efdd] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michel Lamotte
- Department of Cardiology, Erasme Hospital, Free University of Brussel, Belgium
| | - Fany Fleury
- Department of Cardiology, Erasme Hospital, Free University of Brussel, Belgium
| | - Melissa Pirard
- Department of Cardiology, Erasme Hospital, Free University of Brussel, Belgium
| | - Alexander Jamon
- Department of Cardiology, Erasme Hospital, Free University of Brussel, Belgium
| | | |
Collapse
|
73
|
Weiss CO, Hoenig HH, Varadhan R, Simonsick EM, Fried LP. Relationships of cardiac, pulmonary, and muscle reserves and frailty to exercise capacity in older women. J Gerontol A Biol Sci Med Sci 2009; 65:287-94. [PMID: 19822621 DOI: 10.1093/gerona/glp147] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A decline in exercise capacity (EC) is a characteristic of frailty. We hypothesized that decline is the effect of decrements in several physiological systems. We assessed whether the relationship of three main physiological systems-cardiac, pulmonary, and musculoskeletal-to EC is independent or interactive and whether their effect on EC varies with respect to frailty status. METHODS Observational study of 547 disabled women aged 65 years and older (Women's Health and Aging Study I) including 131 frail who participated in a test of EC. EC (seated step test), cardiac function (chronotropic index), pulmonary function (forced vital capacity, FVC), musculoskeletal function (quadriceps strength, QS), and frailty status were measured and interactive effects were modeled using linear regression and differentiation. RESULTS Each physiological system had a direct relationship with EC, which was lower in frail compared with nonfrail. The relationship between FVC and EC was positive and increased with increasing QS in nonfrail subjects. The effect of QS on EC was positive and increased with increasing FVC regardless of frailty. In subjects with low QS, frailty status was associated with lower EC and this effect became stronger with increasing FVC. Discussion Findings suggest but do not show that frailty status modifies the effects of physiological function in several systems on EC. Approaches to understanding emergent properties such as vulnerability to illness and death and clinical efforts to prevent and treat frailty should evaluate and possibly intervene on several physiological systems to be maximally effective.
Collapse
Affiliation(s)
- Carlos O Weiss
- Division of Geriatric Medicine & Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | |
Collapse
|
74
|
Evans ES, Battaglini CL, Groff DG, Hackney A. Aerobic Exercise Intensity in Breast Cancer Patients: A Preliminary Investigation. Integr Cancer Ther 2009; 8:139-47. [DOI: 10.1177/1534735409335506] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: This study compared the heart rate (HR), rate of perceived exertion (RPE), and blood lactate (BL) responses to aerobic exercise between posttreated breast cancer patients and apparently healthy, age-matched controls. Methods: Seven patients and 7 control subjects underwent a submaximal treadmill test for the estimation of Vo2max. Exercise intensities of 40%, 60%, and 70% of Vo2max were calculated from the treadmill test and randomly examined between groups during three 9-minute exercise bouts on 3 different days. Independent samples t tests were used to examine the HR, RPE, and BL responses at each intensity between groups. Results: No significant differences were observed between the control and patient groups for HR, RPE, and BL at 40% (101 ± 9 vs 101 ± 11 bpm, P = .979; 8 ± 1 vs 9 ± 3, P = .237; and 1.11 ± 0.73 vs 1.26 ± 0.64 mmol/L, P = .188, respectively) and 60% (127 ± 17 vs 117 ± 13 bpm, P = .523; 12 ± 2 vs 11 ± 3, P = .267, and 3.83 ± 2.48 vs 2.23 ± 1.65 mmol/L, P = .237, respectively) of Vo2max . At 70% of Vo2max, no significant differences were found for HR (151 ± 27 vs 135 ± 13 bpm, P = .704) and RPE (14 ± 1 vs 13 ± 3, P = .181), but lower BL responses were observed in the patient group (7.70 ± 1.62 vs 3.29 ± 1.08 mmol/L, P < .0005). Conclusions: The results suggest similar HR, RPE, and BL responses between patients and control subjects at 40%, 60%, and 70% of Vo2max , except for BL at 70% of Vo2max. The lower BL response in the patient group at 70% of Vo2max was somewhat unexpected. Further research is needed to confirm or refute the results of this study to allow for a clearer understanding of the physiological responses of breast cancer patients to aerobic exercise at moderate or higher intensities so that safer aerobic exercise prescriptions can be developed for this population.
Collapse
Affiliation(s)
- Elizabeth S. Evans
- Department of Exercise and Sport Science, , University of North Carolina at Chapel Hill, North Carolina,
| | - Claudio L. Battaglini
- Department of Exercise and Sport Science, , University of North Carolina at Chapel Hill, North Carolina, Lineberger Comprehensive Cancer Center, , University of North Carolina at Chapel Hill, North Carolina
| | - Diane G. Groff
- Department of Exercise and Sport Science, , University of North Carolina at Chapel Hill, North Carolina
| | - A.C. Hackney
- Department of Exercise and Sport Science, , University of North Carolina at Chapel Hill, North Carolina, Department of Nutrition, University of North Carolina at Chapel Hill, North Carolina
| |
Collapse
|
75
|
Mandic S, Tymchak W, Kim D, Daub B, Quinney HA, Taylor D, Al-Kurtass S, Haykowsky MJ. Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: a randomized controlled pilot trial. Clin Rehabil 2009; 23:207-16. [PMID: 19218296 DOI: 10.1177/0269215508095362] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examined the effects of different training modalities on exercise capacity (Vo( 2peak)), systolic function, muscular strength and endurance and quality of life in heart failure patients. DESIGN Randomized controlled trial. SETTING Cardiac rehabilitation centre in Canada. SUBJECTS Forty-two individuals with heart failure (62 +/- 12 years; New York Heart Association (NYHA) classes I-III). INTERVENTIONS Aerobic training (n = 14), combined aerobic and resistance training (n = 15) or usual care (n = 13) three times per week for 12 weeks. MAIN MEASURES (1) Vo( 2peak) measured by symptom-limited graded exercise test on cycle ergometer; (2) systolic function assessed by two-dimensional echocardiography; (3) muscular strength and muscular endurance measured by one-repetition maximum procedure; and (4) quality of life assessed by questionnaires. RESULTS In the intention-to-treat analysis, neither aerobic nor combined aerobic and resistance training significantly improved Vo(2peak), systolic function or quality of life compared with usual care. However, combined aerobic and resistance training significantly improved upper extremity strength (40.7 (14.0)-48.5 (16.0) kg, P<0.05) and muscular endurance (5.7 (2.7)-11.6 (7.6) reps, P<0.05) compared with aerobic training or usual care. In compliant participants (exercise adherence 80%), Vo(2peak) increased in the aerobic group (16.9 (6.0)-19.0 (6.8), P= 0.026) and tended to increase in the combined training group (15.9 (5.0)-17.6 (5.6), P= 0.058) compared with usual care. Quality of life was improved in the aerobic group only. CONCLUSIONS Both aerobic and combined aerobic and resistance training are effective interventions to improve Vo(2peak) in compliant heart failure patients. Combined training may be more effective in improving muscle strength and endurance.
Collapse
Affiliation(s)
- Sandra Mandic
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
76
|
Bacurau AVN, Jardim MA, Ferreira JCB, Bechara LRG, Bueno CR, Alba-Loureiro TC, Negrao CE, Casarini DE, Curi R, Ramires PR, Moriscot AS, Brum PC. Sympathetic hyperactivity differentially affects skeletal muscle mass in developing heart failure: role of exercise training. J Appl Physiol (1985) 2009; 106:1631-40. [PMID: 19179649 DOI: 10.1152/japplphysiol.91067.2008] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Sympathetic hyperactivity (SH) is a hallmark of heart failure (HF), and several lines of evidence suggest that SH contributes to HF-induced skeletal myopathy. However, little is known about the influence of SH on skeletal muscle morphology and metabolism in a setting of developing HF, taking into consideration muscles with different fiber compositions. The contribution of SH on exercise tolerance and skeletal muscle morphology and biochemistry was investigated in 3- and 7-mo-old mice lacking both alpha(2A)- and alpha(2C)-adrenergic receptor subtypes (alpha(2A)/alpha(2C)ARKO mice) that present SH with evidence of HF by 7 mo. To verify whether exercise training (ET) would prevent skeletal muscle myopathy in advanced-stage HF, alpha(2A)/alpha(2C)ARKO mice were exercised from 5 to 7 mo of age. At 3 mo, alpha(2A)/alpha(2C)ARKO mice showed no signs of HF and preserved exercise tolerance and muscular norepinephrine with no changes in soleus morphology. In contrast, plantaris muscle of alpha(2A)/alpha(2C)ARKO mice displayed hypertrophy and fiber type shift (IIA --> IIX) paralleled by capillary rarefaction, increased hexokinase activity, and oxidative stress. At 7 mo, alpha(2A)/alpha(2C)ARKO mice displayed exercise intolerance and increased muscular norepinephrine, muscular atrophy, capillary rarefaction, and increased oxidative stress. ET reestablished alpha(2A)/alpha(2C)ARKO mouse exercise tolerance to 7-mo-old wild-type levels and prevented muscular atrophy and capillary rarefaction associated with reduced oxidative stress. Collectively, these data provide direct evidence that SH is a major factor contributing to skeletal muscle morphological changes in a setting of developing HF. ET prevented skeletal muscle myopathy in alpha(2A)/alpha(2C)ARKO mice, which highlights its importance as a therapeutic tool for HF.
Collapse
Affiliation(s)
- Aline V N Bacurau
- Escola de Educação Física e Esporte da Universidade de São Paulo, Departamento de Biodinâmica do Movimento do Corpo Humano, Av. Professor Mello Moraes, 65, Butantã, São Paulo 05508-900, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
77
|
Brentano MA, Cadore EL, Da Silva EM, Ambrosini AB, Coertjens M, Petkowicz R, Viero I, Kruel LFM. Physiological Adaptations to Strength and Circuit Training in Postmenopausal Women With Bone Loss. J Strength Cond Res 2008; 22:1816-25. [DOI: 10.1519/jsc.0b013e31817ae3f1] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
78
|
The 12-week progressive quadriceps resistance training improves muscle strength, exercise capacity and quality of life in patients with stable chronic heart failure. Int J Cardiol 2008; 130:36-43. [DOI: 10.1016/j.ijcard.2007.07.158] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 05/16/2007] [Accepted: 07/20/2007] [Indexed: 12/21/2022]
|
79
|
Bocalini DS, dos Santos L, Serra AJ. Physical exercise improves the functional capacity and quality of life in patients with heart failure. Clinics (Sao Paulo) 2008; 63:437-42. [PMID: 18719752 PMCID: PMC2664117 DOI: 10.1590/s1807-59322008000400005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 04/14/2008] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of physical exercise on the functional capacity and quality of life in heart failure patients. METHODS Forty-two patients of both sexes with heart failure of NYHA class II and III with different etiologies were randomly divided into untrained or trained groups. The six-month exercise program consisted of aerobic training, muscle strength training, agility and joint flexibility activities. Physical fitness was evaluated by testing the performance on these trained components. Quality of life was evaluated by scored answers to a standardized questionnaire involving multiple domains. RESULTS Baseline values did not differ between groups. Improvement in the trained group was identified in all components of functional capacity when compared to the untrained group (p<0.001). Quality of life improved in the trained patients concerning physical, psychological, social and environmental domains (p<0.001), whereas no significant change was found in the untrained patients. CONCLUSIONS Guided and monitored physical exercise is safe and has the potential to improve functional capacity and quality of life in heart failure patients with multiple etiologies.
Collapse
Affiliation(s)
- Danilo Sales Bocalini
- Division of Internal Medicine, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.
| | | | | |
Collapse
|
80
|
Beckers PJ, Denollet J, Possemiers NM, Wuyts FL, Vrints CJ, Conraads VM. Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: a prospective randomized study. Eur Heart J 2008; 29:1858-66. [DOI: 10.1093/eurheartj/ehn222] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
81
|
Group-based aerobic interval training in patients with chronic heart failure: Norwegian Ullevaal Model. Phys Ther 2008; 88:523-35. [PMID: 18258768 DOI: 10.2522/ptj.20060374] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this case report is to describe the responses of 4 patients with chronic heart failure (CHF) to a novel rehabilitation program: a group-based, high-intensity, interval-training program that includes aerobic, resistance, flexibility, and balance activities. CASE DESCRIPTION Four patients (55-71 years of age) with CHF (New York Heart Association class III) participated in the rehabilitation program twice per week for 16 weeks. Outcome measures included a 6-minute walk test (6MWT), a cycle ergometer test (aerobic capacity), and a quality-of-life questionnaire. OUTCOMES Patients 1, 2, and 3 increased their aerobic capacity (17%, 25%, and 52%, respectively). Patient 4 did not complete the cycle ergometer test because of limitations associated with his pacemaker. All patients increased their 6MWT distance (117, 66, 135, and 143 m for patients 1, 2, 3, and 4, respectively). No adverse events were reported. DISCUSSION The Norwegian Ullevaal Model of cardiac rehabilitation is a novel high-intensity, interval-training program. The 4 patients with CHF in this case series who participated in this program experienced improvements in physical capacity and quality of life and had no adverse events. These results are consistent with recent evidence supporting the efficacy of high-intensity interval training in people with CHF. Randomized clinical trials are needed to evaluate the clinical efficacy of this group-based, high-intensity, aerobic interval-training program for patients with CHF.
Collapse
|
82
|
Implications of chronic heart failure on peripheral vasculature and skeletal muscle before and after exercise training. Heart Fail Rev 2008; 13:21-37. [PMID: 17955365 DOI: 10.1007/s10741-007-9056-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The pathophysiology of chronic heart failure (CHF) is typically conceptualized in terms of cardiac dysfunction. However, alterations in peripheral blood flow and intrinsic skeletal muscle properties are also now recognized as mechanisms for exercise intolerance that can be modified by therapeutic exercise. This overview focuses on blood delivery, oxygen extraction and utilization that result from heart failure. Related features of inflammation, changes in skeletal muscle signaling pathways, and vulnerability to skeletal muscle atrophy are discussed. Specific focus is given to the ways in which perfusion and skeletal muscle properties affect exercise intolerance and how peripheral improvements following exercise training increase aerobic capacity. We also identify gaps in the literature that may constitute priorities for further investigation.
Collapse
|
83
|
Medeiros A, Rolim NPL, Oliveira RSF, Rosa KT, Mattos KC, Casarini DE, Irigoyen MC, Krieger EM, Krieger JE, Negrão CE, Brum PC. Exercise training delays cardiac dysfunction and prevents calcium handling abnormalities in sympathetic hyperactivity-induced heart failure mice. J Appl Physiol (1985) 2008; 104:103-9. [DOI: 10.1152/japplphysiol.00493.2007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise training (ET) is a coadjuvant therapy in preventive cardiology. It delays cardiac dysfunction and exercise intolerance in heart failure (HF); however, the molecular mechanisms underlying its cardioprotection are poorly understood. We tested the hypothesis that ET would prevent Ca2+ handling abnormalities and ventricular dysfunction in sympathetic hyperactivity-induced HF mice. A cohort of male wild-type (WT) and congenic α2A/α2C-adrenoceptor knockout (α2A/α2CARKO) mice with C57BL6/J genetic background (3–5 mo of age) were randomly assigned into untrained and exercise-trained groups. ET consisted of 8-wk swimming session, 60 min, 5 days/wk. Fractional shortening (FS) was assessed by two-dimensional guided M-mode echocardiography. The protein expression of ryanodine receptor (RyR), phospho-Ser2809-RyR, sarcoplasmic reticulum Ca2+ ATPase (SERCA2), Na+/Ca2+ exchanger (NCX), phospholamban (PLN), phospho-Ser16-PLN, and phospho-Thr17-PLN were analyzed by Western blotting. At 3 mo of age, no significant difference in FS and exercise tolerance was observed between WT and α2A/α2CARKO mice. At 5 mo, when cardiac dysfunction is associated with lung edema and increased plasma norepinephrine levels, α2A/α2CARKO mice presented reduced FS paralleled by decreased SERCA2 (26%) and NCX (34%). Conversely, α2A/α2CARKO mice displayed increased phospho-Ser16-PLN (76%) and phospho-Ser2809-RyR (49%). ET in α2A/α2CARKO mice prevented exercise intolerance, ventricular dysfunction, and decreased plasma norepinephrine. ET significantly increased the expression of SERCA2 (58%) and phospho-Ser16-PLN (30%) while it restored the expression of phospho-Ser2809-RyR to WT levels. Collectively, we provide evidence that improved net balance of Ca2+ handling proteins paralleled by a decreased sympathetic activity on ET are, at least in part, compensatory mechanisms against deteriorating ventricular function in HF.
Collapse
|
84
|
Abstract
Exercise intolerance is one of the hallmark symptoms of heart failure (HF). Exercise training in this condition was not explored as a therapeutic modality until the past two decades. In fact, bed rest was promoted as a treatment for certain forms of HF in the 1970s. Over the past two decades, however, data have shown convincingly that exercise training can be implemented safely in patients who have HF, with significant improvement in functional capacity, various other physiologic variables, and quality of life. This article reviews the accumulated literature in this area, with specific emphasis on the effects of exercise training in older patients who have HF, a subset that may have the most to gain from such training.
Collapse
Affiliation(s)
- Jerome L Fleg
- Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, Bethesda, MD 20892-7936, USA.
| |
Collapse
|
85
|
Dracup K, Evangelista LS, Hamilton MA, Erickson V, Hage A, Moriguchi J, Canary C, MacLellan WR, Fonarow GC. Effects of a home-based exercise program on clinical outcomes in heart failure. Am Heart J 2007; 154:877-83. [PMID: 17967593 DOI: 10.1016/j.ahj.2007.07.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 07/24/2007] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to determine the effects of a home-based exercise program on clinical outcomes. Exercise training improves exercise capacity in patients with heart failure (HF) but the long-term effects on clinical outcomes remain unknown. METHODS We randomized 173 patients with systolic HF to control (n = 87) or home-based exercise (n = 86). The primary end point was a composite of all-cause hospitalizations, emergency department admissions, urgent transplantation, and death at 12 months. Functional performance (as assessed by cardiopulmonary exercise testing and the 6-minute walk test), quality of life, and psychological states were measured at baseline, 3 months, and 6 months. RESULTS There was no significant difference between experimental and control groups in the combined clinical end point at 12 months and in functional status, quality of life, or psychological states over 6 months. Patients in the exercise group had a lower incidence of multiple (2 or more) hospitalizations compared with the control group: 12.8% versus 26.6%, respectively (P = .018). CONCLUSIONS A home-based walking program that incorporated aerobic and resistance exercise did not result in improved clinical outcomes at 1-year follow-up in this cohort of patients with systolic HF. However, the exercise program resulted in reduced rehospitalization rates.
Collapse
|
86
|
FEIEREISEN PATRICK, DELAGARDELLE CHARLES, VAILLANT MICHEL, LASAR YVES, BEISSEL JEAN. Is Strength Training the More Efficient Training Modality in Chronic Heart Failure? Med Sci Sports Exerc 2007; 39:1910-7. [DOI: 10.1249/mss.0b013e31814fb545] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
87
|
Izawa KP, Watanabe S, Yokoyama H, Hiraki K, Morio Y, Oka K, Osada N, Omiya K. Muscle Strength in Relation to Disease Severity in Patients with Congestive Heart Failure. Am J Phys Med Rehabil 2007; 86:893-900. [PMID: 17873824 DOI: 10.1097/phm.0b013e318154b592] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Indices of exercise capacity such as peak oxygen uptake (VO2peak) and muscle strength are important in association with reduced mortality. The present study compared differences in VO2peak and muscle strength indices (grip strength and knee extensor and flexor muscle strength) with disease severity and investigated the relation of these variables in congestive heart failure (CHF) patients. DESIGN The study comprised 102 patients with stable CHF (93 men, age 61.4 +/- 10.2 yrs) with left ventricular ejection fraction (LVEF) <40% by echocardiography. We used New York Heart Association (NYHA) functional class to index disease severity. VO2peak, grip strength, knee extensor, and flexor muscle strength were determined. Patients were divided into three groups by NYHA class: class I (n = 39), class II (n = 49), and class III (n = 14). RESULTS Age, sex, and LVEF did not differ according to NYHA class. VO2peak and all muscle strength indices decreased with increases in NYHA class (P < 0.05). VO2peak correlated positively with all muscle strengths (P < 0.05). Stepwise linear regression analysis revealed that grip and knee extensor strength were important in predicting VO2peak. CONCLUSIONS Exercise capacity and disease severity in CHF patients may be influenced not only by lower-limb but also upper-limb muscle strength.
Collapse
Affiliation(s)
- Kazuhiro P Izawa
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
| | | | | | | | | | | | | | | |
Collapse
|
88
|
Braith RW, Beck DT. Resistance exercise: training adaptations and developing a safe exercise prescription. Heart Fail Rev 2007; 13:69-79. [DOI: 10.1007/s10741-007-9055-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
89
|
Degache F, Garet M, Calmels P, Costes F, Bathélémy JC, Roche F. Enhancement of isokinetic muscle strength with a combined training programme in chronic heart failure. Clin Physiol Funct Imaging 2007; 27:225-30. [PMID: 17564671 DOI: 10.1111/j.1475-097x.2007.00741.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with congestive heart failure (CHF) exhibit an impaired exercised tolerance that dramatically limits their functional capacity and alters their quality of life. DESIGN The aim of this study was to compare the effects of two types of training programmes on isokinetic muscle strength and aerobic capacities in patients with CHF. METHODS A group of 23 stable CHF patients included consecutively followed an exercise training programme, 3 days a week for 8 weeks. The first group (P1, n=11) exercised on a cycloergometer for 45 min at 65% of peak VO2. The second group (P2, n=12) followed a 45-min combined bicycle and quadricipital strength training. Strength training consisted of 10 series of 10 repetitions at 70% of maximal voluntary force. Incremental maximal cardiopulmonary exercise tests as well as an isokinetic quadricipital dynamometry evaluation were performed before and after training. RESULTS AND CONCLUSIONS In P1, peak VO2 increased by 20% (22.3+/-4.9 versus 17.8+/-4.5 ml min(-1) kg(-1); P<0.05) without any significant change in isokinetic muscle strength. In P2, peak VO2 improved within the same range (20.5+/-2.8 versus 18.6+/-3.7 ml min(-1) kg(-1); P<0.01). This last rehabilitation programme significantly increased isokinetic muscle strength at each angular velocities (+10.5+/-13.5%, P<0.04; +5.6+/-7.0%, P<0.03; for 180 degrees s(-1) and 60 degrees s(-1) respectively). Only the combined endurance/strength training programme was associated with an improvement in both peak VO2 and peripheral muscle strength, two significant parameters of outcome and quality of life in CHF.
Collapse
Affiliation(s)
- Francis Degache
- Service de Physiologie Clinique et de l'Exercice - Groupe PPEH, CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France
| | | | | | | | | | | |
Collapse
|
90
|
Gao L, Wang W, Liu D, Zucker IH. Exercise Training Normalizes Sympathetic Outflow by Central Antioxidant Mechanisms in Rabbits With Pacing-Induced Chronic Heart Failure. Circulation 2007; 115:3095-102. [PMID: 17548725 DOI: 10.1161/circulationaha.106.677989] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In a recent study, we demonstrated that an increase in oxidative stress in the rostral ventrolateral medulla plays a critical role in the sympathoexcitation observed in chronic heart failure (CHF). Growing evidence indicates that exercise training evokes an antioxidative effect in CHF. In the present study, we therefore hypothesized that long-term exercise exerts its beneficial effect on autonomic activity in CHF via central antioxidative mechanisms. METHODS AND RESULTS Experiments were performed on New Zealand White rabbits. All rabbits were instrumented to measure mean arterial pressure, heart rate, and renal sympathetic nerve activity and to test baroreflex sensitivity. Exercise training significantly decreased baseline renal sympathetic nerve activity (65.8+/-5.2% to 41.3+/-3.9% of Max [where "Max" is the maximum renal sympathetic nerve activity induced by a 50-mL puff of smoke directed to the external nares of the rabbit], P<0.05) and increased the maximal gain of the baroreflex curves for heart rate (2.2+/-0.2 to 4.6+/-0.7 bpm per mm Hg, P<0.01) and renal sympathetic nerve activity (1.9+/-0.2% to 4.5+/-0.4% of Max per mm Hg, P<0.01) in CHF rabbits. Exercise training increased expression of CuZn superoxide dismutase (0.3+/-0.1 to 1.5+/-0.3 [ratio of CuZn superoxide dismutase to tubulin], P<0.01) and decreased NAD(P)H oxidase subunit gp91(phox) protein expression (1.9+/-0.2 to 1.2+/-0.1 [ratio of gp91(phox) to tubulin], P<0.05) in the rostral ventrolateral medulla of CHF rabbits. Central overexpression of CuZn superoxide dismutase dose-dependently decreased baseline renal sympathetic nerve activity (control, 68.5+/-7.1% of Max; 10(10) particles of adenovirus, 53.2+/-4.4% of Max; and 10(11) particles of adenovirus, 33.7+/-3.5% of Max; P<0.05) in CHF rabbits. CONCLUSIONS These results suggest that an upregulation in central antioxidative mechanisms and suppressed central prooxidant mechanisms may contribute to the exercise training-induced beneficial effects on autonomic activity in CHF.
Collapse
Affiliation(s)
- Lie Gao
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA.
| | | | | | | |
Collapse
|
91
|
Abstract
Exercise intolerance is one of the hallmark symptoms of heart failure (HF). Exercise training in this condition was not explored as a therapeutic modality until the past two decades. In fact, bed rest was promoted as a treatment for certain forms of HF in the 1970s. Over the past two decades, however, data have shown convincingly that exercise training can be implemented safely in patients who have HF, with significant improvement in functional capacity, various other physiologic variables, and quality of life. This article reviews the accumulated literature in this area, with specific emphasis on the effects of exercise training in older patients who have HF, a subset that may have the most to gain from such training.
Collapse
Affiliation(s)
- Jerome L Fleg
- Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Room 8126, Bethesda, MD 20892-7936, USA.
| |
Collapse
|
92
|
Maria Sarullo F, Gristina T, Brusca I, Milia S, Raimondi R, Sajeva M, Maria La Chiusa S, Serio G, Paterna S, Di Pasquale P, Castello A. Effect of physical training on exercise capacity, gas exchange and N-terminal pro-brain natriuretic peptide levels in patients with chronic heart failure. ACTA ACUST UNITED AC 2007; 13:812-7. [PMID: 17001223 DOI: 10.1097/01.hjr.0000238396.42718.61] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decreased exercise capacity is the main factor restricting the daily life of patients with chronic heart failure. N-terminal pro-brain natriuretic peptide (NT pro-BNP) is strongly related to the severity of and is an independent predictor of outcome in chronic heart failure. DESIGN The study aimed to evaluate the effect of exercise training on functional capacity and on changes in NT pro-BNP levels and to assess the effect of exercise training on quality of life. MATERIALS AND METHODS Sixty patients (45 men/15 women, mean age 52.7 years; +/-5.3 SD), with stable heart failure (45 ischaemic/hypertensive and 15 idiopathic patients), in New York Heart Association (NYHA) functional class II (n=35) to III (n=25), with an ejection fraction less than 40%, were randomly assigned to a training (n=30) and a control group (n=30). The training group (30 patients) performed 3 months of supervised physical training programme using a bicycle ergometer for 30 min three times a week at a load corresponding to 60-70% of their oxygen consumption (VO2) peak. The control group did not change their previous physical activity. A graded maximal exercise test with respiratory gas analysis and an endurance test with constant workload corresponding to 85% of the peak oxygen load at the baseline and after 3 months were performed, and at the same times NT pro-BNP levels were measured. RESULTS The exercise capacity increased from 15.8 (+/-2.3 SD) to 29.9 (+/-2.1 SD) min (P<0.0001) and the peak VO2 tended to improve from 14.5 (+/-1.4 SD) to 17.7 (+/-2.6 SD) ml/kg per min (P<0.0001) during the supervised training period. VO2 at the anaerobic threshold increased from 12.9 (+/-1.0 SD) to 15.5 (+/-1.7 SD) ml/kg per min (P<0.0001). NT pro-BNP levels decreased from 3376 (+/-3133 SD) to 1434 (+/-1673 SD) pg/ml (P=0.043). The positive training effects were associated with an improvement in the NYHA functional class. CONCLUSION Physical training of moderate intensity significantly improves the exercise capacity and neurohormonal modulation in patients with chronic heart failure. This is associated with an alleviation of symptoms and improvement in quality of life.
Collapse
Affiliation(s)
- Filippo Maria Sarullo
- Division of Cardiology bClinical Pathology Service, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
93
|
Boudreau M, Genovese J. Cardiac Rehabilitation: A Comprehensive Program for the Management of Heart Failure. ACTA ACUST UNITED AC 2007; 22:88-92. [PMID: 17541318 DOI: 10.1111/j.0889-7204.2007.05242.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heart failure is one of the major health problems found in the United States today. Medical and interventional therapies play an important role in the treatment of this chronic condition, but they create a huge economic burden on the health care system. Nonpharmacologic interventions need further exploration. This article reviews research that examined the relationship between exercise and heart failure. A variety of exercise modalities measured outcomes of functional capacity and quality of life in both supervised and nonsupervised settings. Many investigators found exercise training to be safe and to confer benefits, especially on functional capacity, quality of life, and survival. The most favorable outcomes were observed in supervised settings. Cardiac rehabilitation provides an ideal environment for safe exercise and management of the health care needs of patients with heart failure. The multidisciplinary staff is adept at providing a paced approach to activity based on individualized exercise prescriptions, education, and management of this population's many comorbidities.
Collapse
|
94
|
Freimark D, Shechter M, Schwamenthal E, Tanne D, Elmaleh E, Shemesh Y, Motro M, Adler Y. Improved exercise tolerance and cardiac function in severe chronic heart failure patients undergoing a supervised exercise program. Int J Cardiol 2007; 116:309-14. [PMID: 17275110 DOI: 10.1016/j.ijcard.2006.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 12/24/2005] [Accepted: 03/11/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exercise intolerance is a widespread and serious problem in chronic heart failure (CHF) patients. However, the impact of a supervised exercise and rehabilitation program on exercise tolerance and cardiac performance in severe CHF patients has not yet been fully investigated. METHODS Of 56 consecutive patients with severe CHF (New York Heart Association functional class III, Stage D) 44 underwent a hospital-based supervised 18-week, cardiac exercise and rehabilitation program (exercise group), and 12 did not (control group). Cardiac performance was assessed by a 6-minute walk test, peak exercise VO(2), exercise duration time, resting and immediate post peak exercise stroke index (SI), cardiac index (CI) and systemic vascular resistance (SVR), before and after exercise. RESULTS Both groups were comparable regarding baseline clinical characteristics. Post exercise training, functional and hemodynamic parameters improved significantly in the exercise group compared to controls. A highly significant interaction between the groups and change was found in the 6-minute walk test (p<0.001), exercise test duration (p<0.001), METs during exercise (p<0.001), immediate post peak exercise CI (0.016), delta peak VO(2) (p=0.028), and immediate post peak exercise SVR (p=0.045). CONCLUSIONS A hospital-based supervised exercise and rehabilitation program significantly improves functional and hemodynamic parameters in severe CHF patients, and may partially contribute to better physical conditioning detected in these patients after exercise training.
Collapse
Affiliation(s)
- Dov Freimark
- Heart Failure Center, Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | | | | | | | |
Collapse
|
95
|
Benton MJ. Safety and Efficacy of Resistance Training in Patients With Chronic Heart Failure: Research‐Based Evidence. ACTA ACUST UNITED AC 2007; 20:17-23. [PMID: 15785166 DOI: 10.1111/j.0889-7204.2005.03888.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although a rich body of research exists regarding the safety and efficacy of resistance training, health care providers continue to caution patients with heart failure not to engage in this type of exercise. Research studies utilizing resistance training demonstrate improvements in muscular strength and endurance, New York Heart Association functional class, and quality of life. Despite the hemodynamic changes which occur during resistance exercise, no negative outcomes have been reported. The purpose of this paper is to review the most current research regarding the use of resistance training with heart failure patients to provide assistance to clinicians and enable them to provide education and appropriate recommendations to their patients.
Collapse
Affiliation(s)
- Melissa J Benton
- Department of Exercise and Wellness, Arizona State University East, 7350 East Unity, Mesa, AZ 85212, USA.
| |
Collapse
|
96
|
Tenenbaum A, Freimark D, Ahron E, Koren-Morag N, Schwamenthal E, Fisman EZ, Shechter M, Tanne D, Kachlon D, Motro M, Adler Y. Long-term versus intermediate-term supervised exercise training in advanced heart failure: Effects on exercise tolerance and mortality. Int J Cardiol 2006; 113:364-70. [PMID: 16707174 DOI: 10.1016/j.ijcard.2005.11.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 10/10/2005] [Accepted: 11/17/2005] [Indexed: 11/23/2022]
Abstract
AIM To date there have been no studies exploring the effects of long-term versus intermediate-term and short-term supervised exercise training program in patients with severe chronic heart failure (CHF) on optimal medical therapy. We assessed exercise tolerance and mortality in CHF patients undergoing long- versus intermediate-term exercise training (ET). METHODS Forty-two consecutive severe CHF patients (New York Heart Association functional class III) were referred for a supervised exercise and cardiac rehabilitation program and were followed-up for 3 years: 20/42 (48%) patients discontinued ET after intermediate-term period of 1.6+/-0.8 years (Group A, intermediate-term ET), and 22/42 (52%) remained on the ET program for 3.0+/-0.3 years (Group B, long-term ET). Exercise duration, 6-min walked distance and metabolic equivalents (METs) assessed by modified Bruce protocol were recorded before, 4.5 months after, and 3 years after initiation of ET. RESULTS Both groups were comparable regarding age, gender, prevalence of ischemic etiology, mean ejection fraction and medications. Risk factors for ischemic heart disease were similar, except for the prevalence of diabetes, which was higher in Group A compared to Group B (11/20 versus 5/22, p=0.03). Significantly more Group A patients died after ET discontinuation (4/20 versus 0/22, p=0.01). At the end of follow-up a significant improvement could be seen in Group B patients compared to A in exercise duration, 6-min walked distance and metabolic equivalents (p<0.01 for all). CONCLUSIONS Higher survival rate was observed in severe CHF patients undergoing long-term versus intermediate-term exercise training. Long-term supervised exercise training is safe and improves exercise tolerance in these patients.
Collapse
Affiliation(s)
- Alexander Tenenbaum
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
97
|
Yu DSF, Lee DTF, Woo J, Hui E. Non-Pharmacological Interventions in Older People with Heart Failure: Effects of Exercise Training and Relaxation Therapy. Gerontology 2006; 53:74-81. [PMID: 17057393 DOI: 10.1159/000096427] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 08/24/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. OBJECTIVE To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. METHODS Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general 'greetings'. RESULTS The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). CONCLUSION Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program.
Collapse
Affiliation(s)
- Doris S F Yu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | | | | | | |
Collapse
|
98
|
Gunn E, Smith KM, McKelvie RS, Arthur HM. Exercise and the heart failure patient: aerobic vs strength training--is there a need for both? ACTA ACUST UNITED AC 2006; 21:146-50. [PMID: 16957461 DOI: 10.1111/j.0889-7204.2006.04678.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart failure (HF) is characterized by general muscular weakness, muscle atrophy, and exercise intolerance that lead to reductions in functional capacity, ability to perform activities of daily living, and health-related quality of life. Until recently, exercise programs for patients with HF were centered on aerobic exercise training alone. Although many activities of daily living require significant muscle strength, the role of strength training for HF patients, either alone or in combination with aerobic exercise, has not been well studied. There is suggestive evidence that combined strength-aerobic exercise training may offer additional benefits in terms of health-related quality of life and functional capacity. Strength training can be targeted to reduce muscle atrophy to a greater extent than aerobic training. Further research is required to isolate the specific role of strength training regarding improvements in prognosis, HF-related morbidity and hospitalization, and health-related quality of life for patients with HF.
Collapse
Affiliation(s)
- Elizabeth Gunn
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | | | | |
Collapse
|
99
|
Abstract
Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.
Collapse
Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases, Copenhagen, Denmark.
| | | |
Collapse
|
100
|
Kao A. The role of exercise therapy in the treatment of patients with systolic heart failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:310-24. [PMID: 17038271 DOI: 10.1007/s11936-006-0052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The predominant benefits of exercise training in systolic heart failure have been seen with aerobic training, although some information exists for the beneficial effects of resistive training as well. Although men clearly benefit from exercise training, the effects of exercise in women are less clear. Most of the studies have used supervised training 3 to 5 days a week for 8 weeks to 6 months, with 30 to 60 minutes of exercise per session. However, home exercise has been reported in a few studies, and appears to be safe and possibly efficacious. The effects of training on mortality are unknown at this time, although no study has demonstrated increased adverse events associated with training. Exercise training should be recommended for patients with stable New York Heart Association class II to III heart failure.
Collapse
Affiliation(s)
- Andrew Kao
- Cardiovascular Consultants, Mid-America Heart Institute, 4330 Wornall Road, Suite 2000, Kansas City, MO 64111, USA.
| |
Collapse
|