Heart Failure in Cardiac Rehabilitation

Abstract

Exercise cardiac rehabilitation (CR) represents an evidence-based therapy for patients with heart failure with reduced ejection fraction (HFrEF) and this article provides a concise review of the relevant exercise testing and CR literature, including aspects unique to their care. Clinical Considerations: A hallmark feature of HFrEF is exercise intolerance (eg, early-onset fatigue). Drug therapies for HFrEF target neurohormonal pathways to blunt negative remodeling of the cardiac architecture and restore favorable loading conditions. Guideline drug therapy includes β-adrenergic blocking agents; blockade of the renin-angiotensin system; aldosterone antagonism; sodium-glucose cotransport inhibition; and diuretics, as needed. Exercise Testing and Training: Various assessments are used to quantify exercise capacity in patients with HFrEF, including peak oxygen uptake measured during an exercise test and 6-min walk distance. The mechanisms responsible for the exercise intolerance include abnormalities in (a) central transport (chronotropic response, stroke volume) and (b) the diffusion/ utilization of oxygen in skeletal muscles. Cardiac rehabilitation improves exercise capacity, intermediate physiologic measures (eg, endothelial function and sympathetic nervous system activity), health-related quality of life (HRQoL), and likely clinical outcomes. The prescription of exercise in patients with HFrEF is generally similar to that for other patients with cardiovascular disease; however, patients having undergone an advanced surgical therapy do present with features that require attention. Summary: Few patients with HFrEF enroll in CR and as such, many miss the derived benefits, including improved exercise capacity, a likely reduction in risk for subsequent clinical events (eg, rehospitalization), improved HRQoL, and adoption of disease management strategies.

An Index for Evaluating Exercise Capacity Improvement After Cardiac Rehabilitation in Patients After Myocardial Infarction

“…2,9 A large number of researchers have focused on estimates of exercise tolerance in patients with heart failure. [10][11][12][13] However, findings on the evaluation of exercise capacity after acute myocardial infarction (AMI) are still insufficient. 2 Nevertheless, commercially available CPX units record a variety of outcomes including exercise time and workload, blood pressure and heart rate responses, and gas analyses for oxygen and carbon dioxide at rest and during exercise, among others.…”

Not a One-Way Street

“…P articipation in exercise-based cardiac rehabilitation (CR) is recommended for adults in heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) since regular participation is likely to lead to improvements in functional status, exercise performance, and quality of life. 1,2 However, benefits received from CR depend on engagement, attendance rates, and compliance with prescribed programs, which all remain disappointingly low. Adherence is "the extent to which a person's behavior-taking medication, following a diet, and/or executing lifestyle changescorresponds with agreed recommendations from a health care provider."…”

Hemodynamic Tolerance of New Resistance Training Methods in Patients With Heart Failure and Coronary Artery Disease

“…Cardiovascular rehabilitation (CR) is recommended for the prevention and treatment of heart failure with reduced ejection fraction (HFrEF) and after myocardial revascularization 1,2. Participation in CR improves exercise capacity and quality of life, and reduces hospitalization rates for HFrEF 2–4. Cardiovascular rehabilitation also improves quality of life, reduces hospital admissions, and reduces cardiovascular mortality in people with coronary artery disease (CAD) 5.…”

“…1,2 Participation in CR improves exercise capacity and quality of life, and reduces hospitalization rates for HFrEF. [2][3][4] Cardiovascular rehabilitation also improves quality of life, reduces hospital admissions, and reduces cardiovascular mortality in people with coronary artery disease (CAD). 5 Resistance training (RT) involving the performance of one to three sets is recommended as part of CR 6 ; however, the most effective strategies of RT are debated.…”