Principles of exercise prescription for patients with chronic heart failure

Myers, Jonathan

doi:10.1007/s10741-007-9051-0

Cited by 85 publications

(93 citation statements)

References 39 publications

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“…The training programmes were well tolerated by the patients. Similar training programmes have beneficial effects in other cardiac diseases, such as chronic HF 173 .…”

Section: Calorific Restriction and Exercisementioning

confidence: 99%

Proteostasis in cardiac health and disease

Henning

Brundel²

2017

Nat Rev Cardiol

144

126

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The worldwide increase in life expectancy gives rise to an increasing prevalence of cardiac diseases, which remain the leading cause of disability and death in the developed world [1][2][3] . Currently, the mechanisms under lying how ageing contributes to the initiation or acceler ation of cardiac diseases are essentially unresolved. Prevailing theories of ageing centre on gradual derail ment of cellular protein homeostasis -proteostasis -either by design (genetically) or by 'wear and tear' (environmentally) 3 . Central to the role of proteostasis derailment as a major factor in ageing is the observation that protein function declines over time.Proteins are the most versatile and complex macro molecules and are involved in the proper functioning of every biological process 4 . After synthesis as a poly peptide chain from the genetic code, proper function of a protein relies heavily on its correct folding into a 3D native state and on various post translational modifi cations, mostly involving the addition of chem ical groups (including phosphate, acetate, and carbo hydrate). Protein maturation, transport, and ultimately breakdown is monitored and supported by various classes of proteins, collectively called 'protein quality control' (PQC) [3][4][5] . Balanced proteostasis, therefore, depends on proper PQC and is crucial for cellular and organismal health 6 . The intricate network making up the PQC involves numerous proteins, of which the main players are the chaperones and their regula tors 4,7-9 (assisting in folding and refolding of proteins) and the pathways that clear irreversibly misfolded and aggregation prone proteins (the ubiquitin-proteasome system [UPS] and autophagy systems) 9-11 . With ageing, the gradual accumulation of misfolded or damaged pro teins, together with concomitant failure of PQC, results in proteotoxic stress and compromised defence against reactive oxygen species (ROS) 10 , a process that is likely to be accelerated in various age related diseases includ ing neurodegenerative diseases 12,13 , type 2 diabetes mel litus 14 , cancer 15 , and cardiac diseases [16][17][18][19][20] . In addition to the accumulation of misfolded proteins, ageing is accompanied by an imbalance in the proteome, as indi cated by lowered expression of chaperone, proteaso mal, ribosomal, and mitochondrial proteins, whereas proteins related to oxidative stress are upregulated 21,22 . Although mild impairment of proteostasis extends lifespan in Caenorhabditis elegans, referred to as hormesis, sustained impairment is accompanied by loss of PQC to neutralize this effect 3,5 . Importantly, evidence indicates that the amount of soluble, aggregate prone protein oligomers, rather than the abundance of pro tein aggregates, correlates with disease severity 23,24 . Therefore, protein aggregates, which contain both misfolded proteins and elevated levels of chaper ones, constitute an adequate PQC response, aimed at sequestering potentially harmful protein oligomers, rather than embodying the ultimate cellular threat 25 . This ...

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“…The training programmes were well tolerated by the patients. Similar training programmes have beneficial effects in other cardiac diseases, such as chronic HF 173 .…”

Section: Calorific Restriction and Exercisementioning

confidence: 99%

Proteostasis in cardiac health and disease

Henning

Brundel²

2017

Nat Rev Cardiol

144

126

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“…In addition to characterizing patients' limitations, prerehabilitation exercise testing is used to screen for adverse effects of exercise such as ischemia, arrhythmia, or hypoxemia and to develop a training prescription. 4,91 Although these goals do not necessarily require measurement of gas exchange, CPX can be uniquely helpful in designing training regimens that are effective and…”

Section: Cardiac and Pulmonary Rehabilitationmentioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Clinical Evaluation of Patients With Heart and Lung Disease

2011

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Exercise tests are commonly used in clinical practice for both functional and diagnostic assessments. Many exercise tests are designed to produce a single measurement relevant to a specific clinical setting such as a timed walking distance as a measure of functional capacity in rehabilitation candidates or the presence of ECG changes consistent with myocardial ischemia in patients with chest pain. Cardiopulmonary exercise testing (CPX) measures a broader range of variables related to cardiorespiratory function, including expiratory ventilation (VE) and pulmonary gas exchange (oxygen uptake [VO 2 ] and carbon dioxide output [VCO 2 ]), along with the ECG and blood pressure, with the goal of quantitatively linking metabolic, cardiovascular, and pulmonary responses to exercise. [1][2][3] With increased availability of instruments for the facile measurement of exercise gas exchange, experience with CPX has expanded from clinical research applications to a broad range of clinical practice settings. 4 Interpretation of CPX for clinical purposes includes comparison of data from individual patients with those from healthy and disease populations. Substantial data are available characterizing exercise responses of patients with certain common heart and lung diseases, providing a basis for using CPX to compare individual patients' impairment relative to others from the same populations. Diagnostic applications of CPX, eg, for evaluating unexplained dyspnea or exercise intolerance, also rely on a comparison of patients' data with those of patients with known diagnoses. In clinical practice, in contrast to much of the research related to specific disorders, patients frequently have multiple medical problems, confounding the assessment of impairment or the attribution of symptoms to one or another condition. Although there are few systematic analyses of the effects of coexistent conditions on exercise responses, an advantage of CPX compared with other forms of testing is the potential for gaining insight into these interactions. This review highlights CPX findings in selected clinical populations and the implication of these observations to the clinical evaluation of patients with heart and/or lung diseases. Rationale and TerminologyTo contract, skeletal muscle uses energy in the form of adenosine triphosphate, generated from oxidative metabolism of substrate, involving the consumption of O 2 and production of CO 2 . Exchange of these gases in the muscle requires equivalent rates of exchange with the environment. Transport of gases between muscle and environment is mediated by the integrated function of multiple organ systems, any of which could become limiting to exercise if sufficiently impaired. The dependence of gas transport on large excursions in output of the heart and lungs makes disease of these organs particularly common causes of exercise intolerance.The standard expression of capacity for endurance, or aerobic, exercise is the maximumVO 2 , reflecting the highest attainable rate of transport and use of oxygen. Pe...

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“…The respiratory compensation point typically occurs at 90% of the peak HR. 35 The lower HR in the water exercise group could be explained by the improvement in cardiac function, attenuation of the neurohormonal system and vasodilatation promoted by the warm water. 22 Achievement of age-predicted values for maximal HR during exercise is often used as a reflection of maximal or near maximal effort (220 − age).…”

Section: Discussionmentioning

confidence: 95%

The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy

Carvalho

Bocchi

Guimarães

2009

Circ J

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Background:The Borg Scale may be a useful tool for heart failure patients to self-monitor and self-regulate exercise on land or in water (hydrotherapy) by maintaining the heart rate (HR) between the anaerobic threshold and respiratory compensation point. Methods and Results: Patients performed a cardiopulmonary exercise test to determine their anaerobic threshold/respiratory compensation points. The percentage of the mean HR during the exercise session in relation to the anaerobic threshold HR (%EHR-AT), in relation to the respiratory compensation point (%EHR-RCP), in relation to the peak HR by the exercise test (%EHR-Peak) and in relation to the maximum predicted HR (%EHR-Predicted) was calculated. Next, patients were randomized into the land or water exercise group. One blinded investigator instructed the patients in each group to exercise at a level between "relatively easy and slightly tiring". The mean HR throughout the 30-min exercise session was recorded. The %EHR-AT and %EHR-Predicted did not differ between the land and water exercisegroups, but they differed in the %EHR-RCP (95±7 to 86±7, P<0.001) and in the %EHR-Peak (85±8 to 78±9, P=0.007). Conclusions: Exercise guided by the Borg scale maintains the patient's HR between the anaerobic threshold and respiratory compensation point (ie, in the exercise training zone). (Circ J 2009; 73: 1871 -1876

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Principles of exercise prescription for patients with chronic heart failure

Cited by 85 publications

References 39 publications

Proteostasis in cardiac health and disease

Proteostasis in cardiac health and disease

Cardiopulmonary Exercise Testing in the Clinical Evaluation of Patients With Heart and Lung Disease

The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy

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