Editorial
Physical training as a therapeutic measure in chronic heart failure: time for recommendations
| The first 150 words of the full text of this article appear below. |
Over the past decade, traditional medical teaching and advice regarding physical activity in patients with chronic cardiac disease have changed. It is now believed that bed rest and exercise restriction may lead to deconditioning and increased morbidity. Recent studies dealing with both asymptomatic patients with left ventricular dysfunction and patients with symptomatic heart failure support this concept. This has been incorporated in medical knowledge, but so far only marginally applied in clinical practice.
The rationaleLet us briefly review the rationale of this concept. In normal
conditions,1 when dynamic exercise starts, signals
generated by subthalamic neurons, the so-called central command,
determine vagal withdrawal with an immediate increase in heart rate and cardiac output. Sympathetic nerve activity begins to increase later on,
when the heart rate approaches 100 beats/min and vagal withdrawal is
already almost complete. Central command has little direct influence on
the sympathetic nervous system, which mostly responds to chemoreflex,
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Booth, F. W., Chakravarthy, M. V., Gordon, S. E., Spangenburg, E. E.
(2002). Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy. J. Appl. Physiol.
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