The effect of physical training on workload, upper leg muscle function and muscle areas in patients with chronic heart failure
Introduction
Not too long ago physical exercise was discouraged in patients with decreased left ventricular function, cardiac enlargement and heart failure [1]. It was feared that the additional workload placed on the left ventricle would lead to accelerated disease progression. In 1988, a non-randomised study by Sullivan et al. demonstrated that physical training induced several important peripheral adaptations that contributed to improved exercise performance [2]. The paradigm shift continued when Coats et al. documented that training increased exercise duration and peak oxygen consumption in a randomised controlled cross-over trial [3]. Several randomised studies followed that corroborated the finding that physical training in heart failure patients improves exercise performance expressed either as maximal power, exercise time or peak oxygen consumption and showed training to be safe. Nowadays, training has been fully accepted as adjunct therapy for CHF patients. In addition to significant reduction in symptoms[4], [5], [6], skeletal muscle strength and muscle endurance have been reported to improve in CHF patients after a period of training [7], [8], [9], [10], [11].
In a previous study we reported that almost 60% of the variance of maximum workload (as measure of exercise performance) in CHF could be ascribed to quadriceps muscle area, as measured by CT scan, and upper leg muscle function (a composite variable of isokinetic strength and endurance) [12].
The relationship between these muscle parameters and improvement in exercise performance after physical training in CHF patients has not yet been elucidated.
The aim of this study was to investigate the effect of physical training on upper leg muscle area, muscle strength and muscle endurance in relation to exercise performance in CHF.
Section snippets
Patient selection
Seventy-seven patients (59 men and 18 women) with CHF (NYHA class II/III, age 59.8±9.3 years) participated. They had been clinically stable for at least 3 months, received optimal medical therapy (see Table 1), and were physically able to visit the outpatient clinic. The present study is part of the study project “Training, insulin sensitivity and anabolic/catabolic balance in chronic heart failure”.
Additional inclusion criteria were: a history of CHF longer than 6 months classified as NYHA
Results
At baseline the study population consisted of 77 patients, including 10 cross-over patients. LVEF and left ventricular end diastolic diameter of 65.1 (9.5) mm were characteristic for systolic dysfunction. Sixteen patients were lost to follow up because of the following reasons: six died (not related to intervention), seven stopped for personal reasons and three could not be reassessed for medical reasons (progressive heart failure, aneurysm of the aorta and muscle injury in the leg) not related
Discussion
In the present study several important findings emerged:
- 1.
A 26 week outpatient exercise program was effective in preventing disease associated reduction of muscle mass as indicated by stable upper leg muscle cross-sectional areas; and
- 2.
The training intervention improved objective parameters of peripheral muscle function such as upper leg muscle function (i.e. muscle strength and muscle endurance).
Conclusion
A training program of simple strength and endurance exercises partly supervised and partly executed at home is feasible, safe and effective with a high compliance and low drop-out rate.
Physical training prevented ongoing muscle wasting and improved muscle strength and endurance. The relation between muscle parameters (muscle strength, muscle endurance and muscle area) and exercise performance did not change after training, indicating that improvement of muscle strength and endurance is
Acknowledgements
This study was funded by the Netherlands Heart Foundation (grant 98.125), Sorbo Heart Foundation, Foundation: Wetenschappelijk Onderzoek Hart-en Vaatziekten Amersfoort and Stichting Bijstand Algemeen Christelijk Ziekenhuis Eemland (Amersfoort, The Netherlands).
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