The Role of Exercise Training in Heart Failure

Abstract

Exercise training in patients with systolic heart failure (HF) is an accepted adjunct to an evidence-based management program. This review describes the pathophysiologic features that are thought to be responsible for the exercise intolerance experienced in the HF patient. Significant research has expanded our appreciation of the interplay of hemodynamic, ventilatory, and skeletal myopathic processes in this common, chronic condition. Randomized, controlled exercise trials designed to measure endothelial function, inflammatory markers, sympathetic neural activation, and skeletal muscle metabolism and structure have further defined the pathophysiology, documented the impact of exercise training on these processes, and confirmed the benefit of this therapy. Consistent with prior clinical research and patient experience are the recently published results of the HF-ACTION (Heart Failure-A Controlled Trial Investigating Outcomes of exercise TraiNing), which demonstrated a modest improvement in exercise capacity, reduction of symptoms, and improved self-reported measures of quality of life without adverse events. Consideration is given in this review to the benefits of variable intensity programs and the addition of resistance exercise to a standard aerobic prescription. Despite increasing validation of the role exercise training plays in the modification of exercise intolerance, challenges remain in its routine therapeutic application, including acceptance and use as an adjunctive intervention in the management of the patient with HF, limited insurance coverage for HF patients in cardiac rehabilitation, tailoring of exercise programs to best address the needs of subgroups of patients, and improved short- and long-term adherence to exercise training and a physically active lifestyle.

Impacto da pesquisa básica nos avanços da cardiologia

“…The combination of these two interventions resulted in functional improvement and attenuation of cardiac remodeling 10 . We should consider that the fact that the issue of exercise is extensively discussed in the journal is in agreement with what occurs in other publications, while emphasizing the importance of the theme 11,12 .…”

Exercise Training in Group 2 Pulmonary Hypertension: Which Intensity and What Modality

“…5 There is a wealth of literature demonstrating the value of ET in patients with LSHD; the body of evidence is particularly robust in patients with HFrEF and quickly growing in patients with HFpEF. [6][7][8][9][10] The research conducted in this area allows us to understand a number of facets associated with ET in HF, including: 1) a host of expected positive physiologic adaptations; 2) expected clinical improvements; and 3) improvements in prognosis.…”

“…8,16,17 These detrimental changes to the peripheral vasculature, skeletal muscle and respiratory muscle systems combine with cardiopulmonary pathophysiology to meaningfully impact functional capacity in patients with LSHD, often to profound levels.…”

“…Moderate intensity aerobic ET significantly increases vagal tone and reduces systemic inflammation in patients with HF. 8,19 These favorable adaptations induced by ET have clear…”

Exercício físico e microRNAs: novas fronteiras na insuficiência cardíaca

“…In spite of recent evidence questioning the impact of exercise on survival 2 , physical training improves quality of life 3 , functional capacity 4 , inflammation 5 , and autonomic 4 and endothelial function 4 . The mechanisms involved in this phenomenon are not yet fully understood.…”