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Heart failure
Exercise training in heart failure: practical guidance
  1. Viviane M Conraads,
  2. Paul J Beckers
  1. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
  1. Correspondence to Professor Viviane Conraads, Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; viviane.conraads{at}uza.be

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Regular physical exercise modulates cardiovascular (CV) risk and improves endothelial function. As such, exercise training (ET) prevents the development and progression of atherosclerotic lesions. In patients with established coronary artery disease, ET has consistently shown a 15–31% reduction in all cause and cardiac mortality.1

Prevention is not a chief therapeutic target in the management of chronic diseases. In the case of chronic heart failure (CHF), treatment mainly concentrates on reducing hard end points. It should be stressed, however, that maximal aerobic capacity is a powerful, yet underestimated, predictor of outcome.2

Exercise intolerance, with pronounced fatigue and dyspnoea even at low exercise load, impairs autonomy and quality of life in CHF patients. Exercise training is by far the most efficacious way to improve physical performance. A 15–30% increase in aerobic capacity in stable CHF patients has been repeatedly demonstrated following endurance training.

Controversy remains as to whether ET favourably affects outcome and which training modality suits these patients best. A critical issue, which is also applicable to the community at large, is the problem of non-adherence to prescribed exercise regimens.

This article provides general information on the clinical application of ET and includes practical guidance on how to prescribe exercise for CHF patients.

Multifactorial origin of exercise intolerance defines targets of exercise training

To understand the relation between cardiac performance and exercise capacity in healthy subjects, it is useful to recall the Fick equation:

VO2=Q (CaO2 − CvO2) where VO2 is oxygen consumption, Q is the cardiac output, CaO2 is the arterial oxygen content, and CvO2 is the venous oxygen content

Intuitively, disturbed cardiac function and haemodynamics are often considered the sole determinants of exercise intolerance in CHF patients. The demonstration of a poor relationship between peak oxygen …

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